Application of Concepts from Caring Science
Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two.
Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.
Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.
This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.
Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.
If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).
Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.
Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion.
Present your outcome in an APA formatted paper that meets the University’s standards for a written assignment.
• Due: Monday, 11:59 pm PT
• Length: 5 to 7 pages including title and reference pages
• References: 3 to 10. There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring
Abuse Protection Support in Emergency Care Nursing
Physical, sexual, and emotional abuse incidents are common among individuals seeking treatment and care in emergency rooms. However, due to the inherent fear and stigma that the victims face, they may not be forthcoming about the true story of their injuries. Some may even craft compelling stories. Even when it is apparent that they are lying about the origin of their injuries, some nurses lack the competency to detect the problem or support the patient. Consequently, many abuse victims lack the emotional and moral support to overcome abuse’s physical and psychological impacts, resulting in recurring incidents and deplorable mental health status. Therefore, it is necessary to develop a nursing theory to facilitate comprehensive nursing care to abuse victims in the emergency department.
Physical abuse is a rampant problem in the American community. For instance, the CDC (2021) reports that almost 25% of women and 10% of men experience some form of physical or psychological abuse from their intimate partners. However, stigma and lack of competency among caregivers limit the effectiveness of interventions to support the victims. Other common forms of abuse include violence towards children, the elderly, and vulnerable adults and abuse-induced substance abuse.
Emergency care nurses are pivotal to providing a support framework for abuse victims. First, they must conduct a risk assessment. Emergency Room (ER) nurses should know the demographic entities likely to have more abuse cases. Some vulnerable groups include women, ethnic minorities, children, older adults, and members of the LGBTQ community (US Preventive Services Task Force, 2018). The risk assessment should also address stigma and how it impacts the victims’ cooperation. Next, the ER nurses should screen their patients. Ahmad et al. (2017) elaborate on the various tools and techniques they can use, including checklists, face-to-face discussions, and electronic screening.
Finally, ER nurses should have a solution-based attitude and culture towards the abuse topic. A study by Lee & Kim (2018) highlighted that nurses’ attitude towards child abuse was the critical predictor in supporting child abuse victims. Their perception influenced their knowledge and behavioral control competency. Thus, more positive nurses were more knowledgeable and competent to address child abuse and offered better support to their patients.
The literature illuminates the need for comprehensive abuse support structures in emergency care departments. Some of the outcomes requiring improvement include overcoming fear and stigma by the victims, nurses’ knowledge and attitude towards abuse, and nurses’ competency in screening, counseling, and enabling patients to overcome their abuse and abusers.
Theory Statement: Emergency Room (ER) nurses’ attitude towards abuse impacts the patients’ determination to overcome the abuse.
The theory consists of two key concepts. Concept A is ‘nurses’ attitude towards abuse,’ Concept B is ‘patients’ determination to overcome the abuse.’ The theory seeks to provide a framework to observe both entities, measure them, and evaluate their relationship. Nurses’ attitude towards abuse encompasses the caregivers’ knowledge of and experience with different types of abuse. Their attitude can either be positive or negative. Nurses with a positive attitude are more competent and dedicated to supporting their patients to overcome abuse. Thus, they have an exhaustive understanding of specific abuse’s impact on an individual’s physical and emotional health. They also understand each type of abuse’s prevalence in their community, alongside the cultural, ethical, and legal perceptions. Conversely, a negative attitude entails subpar knowledge on various abuse topics, playing into stereotypes and propagating stigma.
Concept B, patients’ determination to overcome abuse, captures the victims’ resolve and dedication to improving their physical and psychological health and confronting their abusers. Abuse victims, especially those with multiple incidences, tend to engage in risky behavior that jeopardizes their physical health. Hence, improving physical health mainly entails refraining from drugs and other mood-altering substances and habits. An adequate nursing support structure should aid the patients in overcoming the urge to indulge in these behaviors, resulting in sobriety, improved immunity, etc.
Meanwhile, since abuse causes significant psychological damage, emotional health improvement is crucial. Nurses should aim to address, among other issues, self-harm tendencies, depression, fear, and shame that often accompany abuse incidences. Patients who overcome these emotional challenges are more resilient and more likely to overcome the abuse.
Finally, overcoming abuse may require confronting the perpetrator. Actions may include reporting abusers to the authorities and avoiding them (especially in intimate partner violence). Successful confrontation eliminates the risk of abuse recurrence while also granting the victim the emotional resolve to prevent such scenarios in the future. Hence, it is a key component to long-term physical and emotional wellness.
Observing and Measuring the Concepts in Research Settings
One can measure nurses’ attitudes by using a cumulative score questionnaire. It should entail various scenarios to which the nurses respond using a binary system, such as yes/no. The initial queries should determine the respondents’ interaction with abuse. For instance, the question, ‘have you or a close friend/relative experienced physical abuse that required emergency care?’ would highlight the nurses’ encounter with abuse outside their work environment. Other questions can assess the nurses’ clinical competency by determining if they have participated in any continuing education efforts and clinical interventions focusing on any form of physical, sexual, or emotional abuse. Finally, there should be a section evaluating the nurses’ current perception of abuse. The queries can be scenario-like, e.g., ‘should nurses help abuse victims report the perpetrators to authorities?’ Affirmative responses would earn a point, while negative answers score nothing. Thus, a high point tally at the end of the questionnaire indicates that the respondent has a positive attitude towards providing support to abuse victims. In contrast, a low score insinuates the opposite. One can then calculate average scores for different institutions and compare them to the success rate of supporting abuse victims.
Meanwhile, researchers can measure the victims’ determination to overcome the abuse by evaluating the prevalence of risky behaviors, long-term emotional health, and rate of confrontation. One may not assess all these outcomes simultaneously, as their relevance varies according to the specific cultural setting and type of abuse. However, measuring all of them would require the use of a prevalence approach. For instance, one can determine how many confirmed or suspected abuse patients receiving emergency care develop risky behavior, self-harm tendencies, or depression. One can also measure what percentage confront their abusers, either through reporting or avoidance. A high rate of negative outcomes indicates that the patients lack the determination to overcome the abuse. Conversely, fewer negative results relate to more resolve to improve physical and emotional health.
Measuring the two concepts facilitates the creation of a comparison study. Concept A’s entities become the independent variables, while concept B’s components are dependent variables. Therefore, the researchers can observe any correlation between the two concepts. For example, if they measure varying attitude positivity scores in several facilities, they can compare how abuser confrontation rates vary. Statistical analysis would then define the correlation.