Conceptual models
Please Reply to the following 2 Discussion posts:
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DISCUSSION POST # 1 Trang
According to Utley (2018), “conceptual models represent relationships between abstract concepts and are more general or broad in scope than grand, middle range, and practice theories” (p. 7). In other words, conceptual models are too broad and abstract to be applied to specific nursing practice situations. However, conceptual models are used to develop theories by providing useful frameworks (Utley, 2018). In order to apply conceptual models into practice, the general framework needs to be broken down to mid-range theories and supported by measurement of outcome (Utley, 2018). The Conceptual-Theoretical-Empirical (CTE) model can help narrow down these components to demonstrate how the conceptual model can be used in real-life practice.
The personal theory I have developed in week 2 is that aromatherapy (concept A) reduces (proposition) chemotherapy-induced nausea and vomiting (CINV) (concept B). CINV is among the most feared side effects of cancer treatments that affect up to 40% of cancer patients (Gupta et al., 2021). Nausea and vomiting in cancer patients lead to detrimental problems such as dehydration, malnourishment, and electrolyte imbalances (Dilek & Necmiye, 2020). Aromatherapy is a non-pharmacological method that utilizes essential oils to “stimulate the central nervous system through inhalation and help the formation of positive emotions or elimination of negative emotions” (Dilek & Necmiye, 2020, p. 1). A systemic review by Dilek and Necmiye (2020) suggested that inhalation of aromatherapy reduced the severity of CINV, and it is a cost-effective and applicable intervention for cancer patients.
By utilizing Jean Watson’s conceptual framework of the Theory of Human Caring and some of the middle-range theories, the CTE model will help demonstrate how this theory can apply to practice and measure outcomes to examine the effectiveness of the intervention. The middle-range theories that apply to this situation are Caritas Processes four and eight (Watson, 2021). Caritas four involves “developing and sustaining loving, trusting-caring relationships” (Watson, 2021, p. 1). Trying to help the patients eliminate the feelings of nausea and vomiting, shows that the nurse is in touch with the patient’s condition and needs. The nurse’s action may lead to the patient’s development of trust and rapport. According to Leslie & Lonneman (2016), to establish a trusting relationship between the nurse and patient, the nurse must meet the needs of the patient, respects the patient, and be a reliable person to the patient. Caritas eight involves “creating a healing environment at all levels; subtle environment for energetic authentic caring presence” (Watson, 2021, p. 1). The act of utilizing scent by the nurse directly creates a new healing environment for the patients. This physical change of the environment stimulates the central nervous system, creates positive emotions, and eliminates negative emotions (Dilek & Necmiye, 2020).
To measure the effectiveness of aromatherapy, there are two things to measure. The first measure is the utilization of aromatherapy and the positive acceptance of the smells in patients experiencing nausea and vomiting. The nurse needs to have a list of patients with nausea and vomiting symptoms and ask them if they use aromatherapy in their room, what kinds of aromatherapy they are using, and if there are reactions to the smells. The second measure is to measure the effectiveness of aromatherapy in reducing the symptom of nausea and vomiting. This can be measured by using the Rhodes Index of nausea, vomiting, and retching (INVR) before and after the use of aromatherapy to measure the incidence and severity of nausea and vomiting (Ahmad et al., 2016).
DISCUSSION POST # 2 Nozomi
I have worked in the Medical-Surgical/Telemetry unit for a few years now, and one of the most common cardiac diseases that I have seen in patients is Congestive Heart Failure (CHF). In fact, CHF affects about 26 million people worldwide, and 800,000 new cases are diagnosed every year (Wang & Li, 2021). Furthermore, the incidence rate is expected to increase every year due to the rising number of people with risk factors for CHF, such as hypertension and diabetes (Wang & Li, 2021). CHF is very debilitating; not only can the disease lower the quality of life for patients, but it can be very costly to public health due to the poor outcomes and high cost of treatment (Wang & Li, 2021). Therefore, prevention of CHF and better management of the disease are beneficial to individual patients and for society as a whole.
One way to develop a practice theory is by utilizing the Conceptual-Theoretical-Empirical model, or the CTE. According to Utley et al. (2018), conceptual models illustrate relationships between abstract concepts and they are broader in scope than grand, middle, and practice theories. Although they may not be clearly useful in practice settings, conceptual models are very important in setting the framework for practice (Utley et al., 2018). After identifying the conceptual model, one can move on to propose a theory. Lastly, the empirical stage will describe how the theory will be measured and evaluated.
I would like to propose a theory that the provision of self-care education (concept A) will lead to (proposition) increased quality of life for CHF patients (concept B). For this theory, I will be applying Orem’s Self-Care Deficit Theory. Self-care is defined as “a human regulatory function that individuals have to perform to achieve health and well-being” (Attaallah et al., 2018). Orem’s theory maintains that the ability of individuals to care for themselves is affected by various internal and external factors, such as age, prior health history, family system, socioeconomic status, culture, and educational level (Attaallah et al., 2018). Thus, in order to help patients improve their self-care abilities, it is crucial for nurses to understand the individual factors. Additionally, self-care education methods need to address those factors and tailor them to the needs of CHF patients.
For example, in their study, Wang & Li (2021) used a CHF education tool in which patients were given a two-day classroom education from experienced nurses after discharge, in addition to the routine discharge education using pamphlets. The classroom education consisted of PowerPoint slides that covered topics such as cardiac anatomy, CHF risk factors, diet management, exercise, monitoring BP, and exacerbation symptoms (Wang & Li, 2021). As a result, patients who received additional classroom education had decreased re-admissions due to CHF compared to the control group who only received routine educational methods. In another study that focused on geriatric patients with CHF, regular verbal and written education from nurses about CHF, in combination with video educational materials, improved patient knowledge about the disease, compared to those patients who only received routine primary care visits (Attaallah et al., 2018). For their study, Attaallah et al. (2018) also conducted cognitive assessment tests prior to conducting education in order to make sure that patients are able to comprehend the educational materials. As a result, Attaallah et al. (2018) found that patients who received frequent follow-up appointments reported increased knowledge about the disease, were better able to manage CHF, and experienced fewer hospitalizations due to CHF.
In order to test my theory, the outcome, which is “improved quality of life for CHF patients,” needs to be measured. One way this can be measured is the 30-day CHF readmission rate, which is also a tool used by CMS to evaluate hospitals on how well CHF patients are managed (Attaallah et al., 2018). Another useful tool is the Minnesota Living with Heart Failure Questionnaire (MLHFQ), which is a 21-item questionnaire that uses a six-point Likert scale, from 0, which is none, to 5, which represents “very much” (Bilbao et al., 2018). The MLHFQ is one of the most commonly used tools to evaluate the quality of life for patients with CHF. Furthermore, the six-minute walking distance (6MWD) tool is another important indicator to measure heart function (Bilbao et al., 2018). Instead of relying on just one tool, several different methods can be used to measure the quality of life for CHF patients in relation to patient
