Assignment: Concept Analysis Essay

Assignment: Concept Analysis Essay

Assignment: Concept Analysis Essay

Concepts are an important part of theory development in nursing, as they are framework’s building blocks (Bergdahl & Berterö, 2016). Concept analysis has therefore become an important part of theory development and examination of evidence-based practices in nursing. According to Alghamdi (2016), concept analysis focuses mainly on dissecting the concept into its elements as a way of promoting clarity and understanding of its use in nursing. It is an important practice in nursing which helps in identifying whether our professional experiences are similar through categorization of similar aspects of a concept (Hasanpour-Dehkordi, 2016). Self-care is one of the concepts that are largely utilized in the development of nursing theories. It mainly encompasses individual’s ability to meet their diverse needs with minimal assistance from others. The concept was put forward by Dorothea Orem in her theory of Self-Care. Therefore, this research paper explores in detail the concept of self-care, its attributes, antecedent and consequence, empirical referents, and construction of cases.

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Dorothea Orem developed the concept of self-care in her theory of Self-Care Deficit Nursing Theory in 1980. According to Orem, self-care is the performance of the various activities that one initiates personally as a way of maintaining their lives and feeling of well-being. The meaning was later revised to encompass the care that one performs independently when h/she has reached maturity state that is characterized by control, consistence, and deliberate initiation of purposeful action (Smith & Liehr, 2018). The World Health Organization defines self-care as the ability of individuals, families, or communities to engage in activities that promote their health, prevent disease occurrence, maintenance of health, and coping with a disease or disability without depending on a self-care agent such as a health care provider (WHO, n.d.). The activities include lifestyle modification, healthcare seeking habits, rehabilitation, and hygiene. Factors such as depression, illness, inefficiency, feelings of futility, and worthlessness affect one’s self-care practices (Hasanpour-Dehkordi, 2016). Therefore, it is important that nurses work actively with their patients in ensuring that they meet their self-care needs independently.

Literature Review

Several studies have been conducted to explore the concept of self-care in nursing according to Dorothea Orem’s theory. One of them is the study by Mills, Wand and Fraser (2018) that explored self-care meaning among palliative patients. Self-care was found to be a self-initiated behavior that is targeted at promoting the general wellbeing and good health. The meaning of self-care differs based on individual’s context.  For instance, palliative care patients perceived self-care as the ability to manage the barriers as well as enablers to the practice of self-care, ability to maintain different individualized self-care strategies, and proactively engage in activities that promote personal health and wellbeing. The themes on practices of self-care also emerged in the research by Mills et al., (2018). It emerged that self-care practices that healthcare providers and patients utilized include meditation, spiritual practice, having adequate sleep, healthy diet, relaxation at home, and ensuring team cohesion in workplace settings.

According to Abreu et al. (2015), self-care is one of the regulatory functions of the human beings that need to be carried out by individuals themselves to preserve their health, self-esteem and life. The activities are deliberate and encompass measures used to prevent illnesses and maintain a healthy living (Abreu et al., 2015). Crane and Ward (2016) conducted a study to explore the nurses’ understanding and management of self-care. The results showed that nurses could promote their self-healing and self-care by being aware of the stressors and the available physical techniques they can use to facilitate their self-care and self-healing. The awareness stimulates the adoption of self-care practices since it alerts their mental, physical, and emotional responses to different stressful situations. Nurses can also engage in physical activities such as meditation, deep breathing exercises, mindfulness, visualization, and hypnosis among others (Crane & Ward, 2016). These activities promote self-care, as they are powerful in facilitating physical healing and reducing emotional and physical stress.

Barriers to self-care have also been analyzed extensively in research to understand them as a way of coming up with interventions of

their occurrence and adverse effects on individual’s health. Jahan et al., (2018) and Tony et al., (2018), found that negative attitude, low level of knowledge, motivation, and poor relationship between patients and their healthcare providers affect adversely one’s ability to engage in self-care abilities. According to Cecilio et al., (2018), doubts about the medical management of a disease, and family issues hinder the ability of patients to engage in self-care abilities. Therefore, enabling factors such as strong family and social support, and assisting clients develop realistic expectations should be made available for them to be able to address the above barriers (Adu et al., 2019).

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Defining Attributes of Self-Care Concept

Self-care concept has several attributes. One of them is that it is affected by interaction. Interaction is perceived as the basis of self-care. The healthcare providers and seekers of healthcare interact to explore the health needs that should be met. The interaction is important, as it allows for patient’s involvement in the planning of care, its implementation and evaluation (Hasanpour-Dehkordi, 2016). Consequently, studies have shown that positive or effective interactions enhance patient’s self-care since the compliance and rate of satisfaction are enhanced.

The other characteristic of self-care is that it is affected by education. Education determines one’s ability to engage in activities that promote self-care. As a result, it is important that health care providers offer adequate health education to the patients for them to achieve their self-care objectives. The education could be in the form of face-to-face training or group training. Clinical evidence has shown that effective self-care education results in increased patient participation and enhanced self-care (Hasanpour-Dehkordi, 2016). Therefore, health care providers should strive towards ensuring that patients are well informed about their healthcare needs and ways of meeting them in a collaborative way.

The other feature of self-care is that it is affected by self-monitoring and self-reliance. Self-monitoring entails, that the activities that an individual engages in on a daily basis promotes healthy living. Self-monitoring enhances the adoption of health promotion practices among the vulnerable populations. It also addresses the cultural needs of the patients by ensuring that holistic approaches to disease management are used. Self-reliance on the other hand focuses on ensuring that the self-care interventions are ethical in nature. It includes incorporating the aspects of respect, justice, honesty, and non-maleficence among others in the provision of care. As shown by Hasanpour-Dehkordi (2016), self-reliance and self-monitoring empower patients to embrace and explore additional ways in which their diverse self-care needs can be met.

Antecedent and Consequence of Self-Care Concept

Antecedents refer to the events that happen before self-care. One of them is self-esteem. A direct correlation exists between one’s self-esteem and self-care. Individuals that have a high sense of self-esteem are likely to engage in self-care with minimum support when compared to those with low self-esteem. The difference arises from the fact that these individuals are ready to embrace change and can explore the different ways in which barriers to self-care can be addressed using independent efforts (Hasanpour-Dehkordi, 2016). Consequence refers to the outcomes that occur after an event. An example of a consequence that relate to self-care concept is reduced hospital stay. Patients who actively engage in self-care are likely to have few hospital stays when compared to those who do not engage in self-care. This effect can be seen in diabetic patients where admitted patients who adhere strictly to dietary and exercise requirements are likely to be discharged earlier due to controlled blood sugars when compared to non-compliant diabetic patients.

Empirical Referents

Several tools have been developed measure the objective presence of self-care concepts. One of them is the use of Therapeutic Self-Care (TSC), which focuses on self-care abilities of patients in acute care settings. It consists of 13 items that measure different self-care aspects such as taking medications, recognizing as well as managing symptoms, undertaking the activities of the daily living, managing symptoms of a disease, and adjusting one’s activities of the daily living due to a condition. This tool aids in evaluating the self-care needs of a patient and the ways in which they can be met (Sidani & Doran, 2014). The other way of measuring self-care concept in an objective way is by using the Adherence and Self-Management Monitoring tool. This tool allows for the determination of whether a patient is adhering to a given treatment regime or not. Through it, the expected consequences of care are predicted (Lu et al., 2016).

Construct Cases

Model Case

An example of a model case is a patient who has been diagnosed with type 2 diabetes. The patient is able to initiate his activities of the daily living independently. He also adheres to the prescribed medications and exercise. He has also learned to live with the fact that he might have to take diabetic medications for the rest of his life. The patient’s self-care ability is attributed to his high level of self-esteem, education on diabetes management, positive interactions with the healthcare providers, and strong social support. The consequences of his self-care abilities include his reduced rates of hospital admissions, increased sense of health and wellbeing, and regulated blood glucose levels.

Borderline Case

An example of borderline case is a patient who has been diagnosed with sickle cell disease. The patient has been able to meet her self-care needs. This includes her ability to undertake her activities of the daily living, adhere to the prescribed medications, and attends regular hospital checkups. Her self-care abilities are attributed to her level of education and the active role she plays in planning the care she needs.

Contrary Case

An example of a contrary case is a patient who has been diagnosed with cholera. The patient lives in an environment where there is poor disposal of wastes. The source of water used for domestic purposes is contaminated. The patient does not practice hygiene practices in his household. The patient reports that he does not treat drinking water as it is against their cultural beliefs. From this case, self-care does not play a role since the environment is the source of the problem.

Theoretical Applications of Self-Care Concept

The concept of self-care can be applied in the nursing process. It can be applied in assessment, development of nursing diagnosis, planning, implementation, and evaluation of the care given to the patient. The nurse uses the concept to assess the self-care abilities of the patient. An example is determining whether the patient is able to undertake the activities of the daily living independently or not. The information will be used in formulating nursing diagnosis. An example would be activity intolerance related to the disease process as evidenced by the patient’s inability to regulate bladder emptying. The diagnosis will then aid in the development of a plan that needs to be embraced to meet the self-care deficit (Williams, 2016). Lastly, evaluation is undertaken to determine whether the intervention was effective in meeting the set objective or not and the things that require a revision.

The other application of the concept is in nursing research. Researchers can use the concept in exploring the experiences of patients suffering from different conditions. An example is the increased use of the concept in exploring the self-care abilities of patients who are diagnosed with conditions such as diabetes, cancer, and sickle cell disease. The use of this concept in research aids in the development of evidence-based approaches that can be employed to improve the health and wellbeing of the patients.

The Purpose of Concept Analysis

The analysis of self-care concept is important in many ways. Firstly, it provides an understanding of the meaning of the concept in relation to the nursing practice. It provides insights into the ways in which the concept can be used to meet the healthcare needs of the population. Concept analysis also provides an understanding of its application to various areas of research. It allows the researchers to explore the ways in which the concept can be used to underpin the provision of evidence-based care. Lastly, analysis of the self-care concept allows for the critique of its applicability to the nursing practice (Finkelman, 2017). The healthcare providers understand the strengths associated with the underpinning theory and ways in which it can be used to promote the health and wellbeing of the patients.

How Self-Care Applies to Dorothea Orem’s Theory

The concept of self-care underpins Orem’s theory of self-care and self-care deficits. The theory asserts that patients recover faster if they are given the opportunity to undertake their own self-care. This assertion implies that a strong focus on the promotion of self-care will result in the realization of the goals of care stated by Orem in her theory. Orem also identified that individuals have requisites that include universal and development requisites. The requisites can only be achieved in case of patient’s self-care abilities (Masters, 2014). Therefore, based on the above data, a direct correlation exists between self-care concept and Dorothea Orem’s theory of self-care and self-care deficits.

Conclusion

In summary, concepts are an important foundation for theory development. Self-care concept is an example of a concept that underpins various theories of nursing including Dorothea’s. The concept largely focuses on individual’s ability to engage in activities that promote health and wellbeing independently. The concept is affected by factors such as education, interaction, self-reliance, and self-monitoring. Tools that measure its use objectively have been developed. Therefore, they should largely be utilized to explore the ways in which the concept can be applied in nursing practice and research to enhance the quality of care. Through it, it will be possible to understand the different theories that the concept applies.

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Concept analysis is mainly associated with boundary work which directs A given discipline as well as creates connections between theory, research, and actual practice. The concept of palliative care forms a vital apsect in the nursing profession. The Kolcaba’s Comfort theory perfectly incorporates palliative care given that she employs a holistic approach which is focused majorly in enhancing patients well being. Palliative care is basically the concept of healthcare professionals working as a team to provide comfort and alleviate patient suffering as a result of a number of illnesses and medical conditions (Lafond et al., 2019). This paper provides literature review in addition to themes and ideas of the selected concept. It also elaborates the characteristics and different aspects of palliative care. The empirical referents elaborate the ways that can be utilized in measuring the magnitude of the concept. Several patients cases have also been reviewed for inclusion of the attributes of palliative care.

Definitions/Explanation of Nursing Concept

            Palliative care refers to the focus on alleviating the patient’s strains and symptoms especially those suffering from terminal and serious illnesses. The main objective of palliative care is to reduce patients suffering and promote their wellness and general quality of life. Palliative care can also be defined as an approach which is aimed at improving the patients quality of life, both adults and children, together with their families as a result of a terminal illness (Lafond et al., 2019). Pain and suffering alleviation can be best achieved through identifying the illness in its early satges, conducting correct assessment, and coming up with the most appropriate plan to handle the issue. The healthcare care team for the patient is usually made up of nurses, physicians, pharmacists, social workers, chaplains, psychiatrists and nurse aides, among others. the family members of the patients are usually educated by the team on how to cope up with the situation and help in caring for the patient. in as much as palliative care mainly focuses on terminally ill patients, those who are receiving curative care may also pose as candidates. Apart from the hospital, the patient can also receive palliative care from home or even nursing homes. It is also important to assess the financial status of the family when deciding on the type of care plan to implement. Communicating and discussing with the patient the available care plan options makes them feel in control of their care.

Literature Review

            Different pieces of literature have elaborated the different aspects of palliative care for enhanced understanding of this nursing concept. According to Blackhall et al. 2016, palliative care should be made available to every member of the community. The healthcare system must allocate adequate resources to ensure that patients with terminal illness together with there family members receive quality care and adequate support when needed. Healthcare workers should also be adequately trained to intervene appropriately when it comes to taking care of patients with terminal illness. Miller, Lima and Thompson, 2015, reported that most of the deaths recorded in nursing homes are as a result of nurses being unable to alleviate pain and suffering. As such, nurses need to receive adequate education, training, and experience to be able to appropriately take care of patients with terminal illness by alleviating pain and suffering and educate their family members on how to cope up with and take care of their loved ones. Aldridge et al., 2016, assessed the barriers preventing widespread implementation of palliative care in the united states. They found out that shortage of education and training programs, inadequate workforce trained in palliative care and a poor policy domain as a result of fragmented healthcare system were the main barriers to the spread of palliative care in the US. As a result, appropriate policy should be put in place in America to enhance more educational opportunities and resources to promote palliative care.

A study that was conducted by Kunte, Johansen, and Isenberg-Cohen, 2017, revealed that educating nursing staff, especially nursing assistant on end of life care, reduces the duration of hospital stay leading to an enhanced quality of end of life care at patients home and nursing homes. The nursing assistant normally tends to benefit from a combined education session with nurses. Adams, Miller and Grady, 2016, acknowledged the fact that all patients with unknown treatment and effects usually lie in bed waiting for answers as to why they are suffering.  As such, it is important to introduce palliative care to their care plan to offer concomitant treatment. Provision of comfort care has a significant impact on such patient’s wellness. it is also important to acknowledge that fact that emotional fatigue and burnout are common especially among pediatric patients and hence should be addressed appropriately. Lastly, Jonas and Bogetz, based on their study results suggested that it was important to take into consideration the provision of stress reduction workshops in addition to offering counseling for palliative care professional workforce.

Defining Attributes

            End of life care (palliative care) is crucial. However, just as elaborated in the Kolcaba’s Comfort theory, caring cannot be defined merely by a succinct statement. As such, it encompasses behaviors and attitudes which healthcare practitioners engage in to help patients. In palliative care, professionals are required to possess a number of attributes such as clinical expertise, trust and honesty, collaboration, family orientation, attentiveness, and deliberateness. Nurses are expected to have clinical expertise on the management of symptoms, and comfort strategies for patients in addition to unique responses to different treatment modalities and the dying process (Kunte, Johansen, and Isenberg-Cohen, 2017). Honesty is essential given that it is the foundation of trust and a healthy therapeutic relationship between the patient, and their families and the healthcare practitioner. Healthcare professionals working in palliative care must be family oriented as result of different patients with different context of multiple and dynamic relationships. Consequently, nurses are expected to be collaborative to be able to come up with cohesive treatment plan for health promotion. Lastly palliative care requires healthcare providers who are goal-directed and purposeful to enhance proper preparations so as to provide the best care and alleviate suffering.

Antecedent and Consequence

One antecedent, in this case, will be development of a new diagnosis or intervention for a chronic disease such as cancer. In such a scenario, both the patient and the nurse will have to embrace the change and enhance outcome. For instance, in the case of cancer patients, pain and suffering are normally caused by the associated signs and symptoms, or even chemotherapy and radiations. As such, in palliative care should enhance new diagnostic criteria for early diagnosis so as to prevent the disease in early stages or come up with new interventions which will alleviate the symptoms with no suffering but instead promote the quality of life of the patient. The main consequence of improved interventions is reduced pain and suffering (Kunte, Johansen, and Isenberg-Cohen, 2017). In palliative care, the priority of the healthcare team is directed towards relief of physical symptoms and maintaining individual dignity and autonomy, in addition to supporting their families. The interventions will also help the affected families deal with impending loss and grief.

Empirical Referents

            The main empirical referents in the case of palliative care could be taking measurements of the patient’s pain level and evaluating the respiratory and cardiovascular status. In patients who are conscious, the adult pain scale can be used to assess the level of comfort, as elaborated by the Kolcaba’s Comfort theory. The process is characterized by the patient verbally stating their current pain level based on a scale of 1 to 10, where 1 is the least and 10 the most severe. Patients who are unconscious can utilize the nonverbal scale which entails different facial expressions for different levels of pain (Meier, & Bowman, 2017). pain reduction is key in alleviating suffering and stress and improving patient’s wellness and quality of life. The respiratory and cardiovascular status of the patient can also be utilized in measuring comfort. For instance, tachypnea can be a sign of a patient being in pain. rales and rhonchi also indicate increased secretions, or aspirations or even heart failure. Use of oxygen therapy and pain medications may help in alleviating pain and suffering.

Constructed Cases

Palliative Care Model Case: A female patient, 40 years of age, with an end-stage ovarian cancer decided to terminate all her cancer treatment plan and only use palliative care. She wanted to receive the care from her home. They approached a home nurse who was very empathetic and supportive of their decision while discussing the goals of palliative care. The nurses then coordinate the social work in arranging for how the patient will receive the best care. The nurse calls for the family and discusses with them the support plan that has been put in place for them. The plan was initiated after two days, of which the patient’s comfort was addressed and family supported appropriately with an interdisciplinary team.

Borderline Case: A male patient, 68 years of age presented to the clinic with severe hemorrhagic cerebrovascular accident. Patients symptoms included right hemiplegia, confusion, and global aphasia. The patient was placed in a skilled nursing facility by a social worker. The patient’s needs were addressed by the nurse in charge. The nurse also speaks to the patient’s wife and acknowledges her of her husbands’ condition. After a few weeks, the wife comes back complaining that the needs of the patient were never addressed, and her husband dies afterward. She insists on speaking to a chaplain. She ends up in deep sorrow. The patient’s comfort was appropriately addressed, however, the care plan lacked family support and inclusion of an interdisciplinary healthcare team.

Contrary case: A male inmate, 48 years old is suffering from end-stage coronary heart failure. The patient displayed poor prognosis. The patient claims that he is tired with pharmacotherapy and would prefer palliative care. He will be allocated to stay at the prison infirmary shackled to a bed. The patient lies in bed with lots of pain. The nurse who was on duty ignored him as it was almost time for her to take a break. The patient’s family are notified that the patient is suffering from a terminal illness. However, their concerned and questions past this information are ignored. No family support is offered. The patient dies, and the family is left helpless as the social work and chaplain who were to assist with the post mortem arrangements and the bereavement support were overloaded with cases. The patient comfort, support for the family and assistance by an interdisciplinary team were all avoided.

Theoretical Applications of the Concept

            Concept analysis is essential in availing the framework which guides the discipline and creates a connection between theory, research and actual practice as stated earlier. It breaks down the concept of effective integration. This enhances new insight on research findings which greatly impacts the development of a theory. One of the nursing theories that greatly aligns with the concept of palliative care in Katharine Kolcaba’s Theory of Comfort. This theory is mainly based on the patient’s overall security and contentment as the primary focus. Consequently, Katherine elaborates the holistic approach utilized in enhancing sociocultural psychospiritual, environmental and physical well-being. She goes ahead to incorporate ease, transcendence, and relief in comfort of a patient who is suffering. According to Lafond, Bowling, Fortkiewicz, Reggio, & Hinds, 2019, comfort has been defined as a positive concept that is associated with activities which strengthen and supports the patient.

Assignment: Concept Analysis Essay Conclusion

            In general, palliative care is an important aspect of the nursing profession. It represents a comprehensive approach in enhancing patient’s health and well-being by alleviating pain and suffering especially for patients with terminal illness. Consequently, the patient’s preferences and choices are usually taken into consideration during palliative care. As displayed in Kolcaba’s theory of comfort, holistic care is essential in attending to the patients medical, social, spiritual and emotional needs just like in the case of palliative care. For effective outcome, interdisciplinary resources must be utilized. The caregiver’s concerns must also be acknowledged and addressed appropriately. A support system must also be built for both the patient and his or her family. In this paper I have not exhausted the whole concept of palliative care. However, as a nurse practitioner I will conduct adequate research and adopt appropriate skills especially when it comes to referring a patient. I will also educate the healthcare staff on the concept and related nursing theory. Consequently, I will discuss the attributes of palliative care as elaborated in this paper.

 

Assignment: Concept Analysis Essay References

Aldridge, M. D., McKendrick, K., Meier, D. E., Hasselaar, J., Van, D. E. M., Garralda, E., Centeno, C., … Centeno, C. (March 01, 2016). Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine, 30, 3, 224-239.

Kunte, V., Johansen, M. L., & Isenberg-Cohen, S. (December 01, 2017). Improving Long-Term Care Residents’ Outcomes by Educating Nursing Staff on End-of-Life Communication. Journal of Hospice and Palliative Nursing, 19, 6, 550-555.

Adams, L. S., Miller, J. L., & Grady, P. A. (January 01, 2016). The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions. Journal of Palliative Medicine, 19, 7, 698-705.

Blackhall, L. J., Read, P., Stukenborg, G., Dillon, P., Barclay, J., Romano, A., & Harrison, J. (January 01, 2016). CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic. Journal of Palliative Medicine, 19, 1, 57-63.

Jonas, D. F., & Bogetz, J. F. (June 01, 2016). Identifying the Deliberate Prevention and Intervention Strategies of Pediatric Palliative Care Teams Supporting Providers during Times of Staff Distress. Journal of Palliative Medicine, 19, 6, 679-683.

Meier, D. E., & Bowman, B. (March 01, 2017). The changing landscape of palliative care. Generations, 41, 1, 74-80.

Miller, S. C., Lima, J. C., & Thompson, S. A. (January 01, 2015). End-of-life care in nursing homes with greater versus less palliative care knowledge and practice. Journal of Palliative Medicine, 18, 6, 527-534.

Lafond, D. A., Bowling, S., Fortkiewicz, J. M., Reggio, C., & Hinds, P. S. (January 01, 2019). Integrating the Comfort Theory™ Into Pediatric Primary Palliative Care to Improve Access to Care. Journal of Hospice and Palliative Nursing : Jhpn: the Official Journal of the Hospice and Palliative Nurses Association, 21, 5, 382-389.