Part II. Theory reflection in research

1. Part II. Theory reflection in research • Research purpose • Examine relationship of stress, severity, uncertainty, coping, and adaptation in families of children undergoing liver transplantation • Research question • Three main questions looking at variables over the pre and post-transplantation time periods • Research methods • Descriptive, longitudinal study of 15 mothers whose children were at least 5 years post-transplantation • Instruments used: FILE, POMS, CHIP, FAD, PPUS (Lobiondo-Wood, 2003; Lobiondo-Wood, Williams, & McGhee, 2004)

2. Theoretical framework • Nursing theories offer a framework for nurses to apply to their practice. The framework is the knowledge that guides nursing actions when caring for patients (Cody, 2013). • Lobiondo-Woods theory • Based on Double ABCX Model by McCubbin • Used in 2000 by Van Riper to study family stress in families with a sibling with Downs syndrome (Smith & Liehr, 2003)

3. Theoretical framework cont’d • Relevant today with transplant patients • Essential to teach, assess early intercessions, and provide support to families during all phases of the transplant course • Without the framework, it would be difficult to assess family stress during transplantation

4. Theory in practice • Nurses often care for patients and families who are faced with a stressful situation such as: • Sickness • Death • Financial hardships • Strained Relationships • Surgery • Nurses can alter patient’s and families perception of the stressor • Education is the key to avoid crisis and to help families cope when dealing with a crisis • Nurses can introduce new resources and facilitate coping and adaptation

5. Theory in practice cont’d • Practice example: Patient is preparing for a complex surgery • Complex surgery is the stressor • The nurse alters the family’s perception of the surgery through education and open conversation • The education that continues through the post-operative period and prior to discharge facilitates coping and adaptation • The nurse introduces new resources such as home care and physical therapy to aide in the adaptation process

6. Tie between theory and practice • Theory provides framework for how nurses can help families through an extended period of the liver transplantation process (Lobiondo-Wood et al., 2004) • Acknowledge stress and uncertainty • Early information dispersal and teaching • Allow mother time to recognize issues in order to build rapport • Importance of nursing knowledge (Lobiondo-Wood, et al., 2004) • Nurses are involved for an extended period • Rapport is essential to identify needs and provide interventions • Holistic approach to help patient and family • Help families with long term aspects of care during times of uncertainty

7. Contributions to nursing • Contributions (Lobiondo-Wood et al., 2004) • Maternal stress, coping, and uncertainty had significant changes over time • Family stress did not have significant changes • Supports the need for testing nursing interventions focused on education and support • Early and long term support as needs change • First step towards investigation of short and long term family implications of having a child that received a transplant • Set the state for further development of research based nursing interventions for children and their families

8. Conclusion • This presentation was designed to provide a better understanding of a middle range nursing theory, and it’s implications for nursing practice. We hope these findings can be a benefit to your own personal practice as you assist patients and families during stressful situations

9. References • Cody, W. (2013). Philosophical and theoretical perspectives for advanced nursing practice (5th ed.). Burlington, MA: Jones & Bartlett Learning. • Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation nursing models and theories (2nd ed.). Philadelphia, PA: F. A. Davis. • Lobiondo-Wood, G. (2003). Theory of family stress and adaptation. In Goosby, B. J., Caldwell, C. H., Bellatorre, A., & Jackson, J. S. (2011). Ethnic differences in family stress processes among African-American and black caribbeans. Journal of African American Studies 16(3), 406-422. • Lobiondo-Wood, G., Williams, L., & McGhee, C. (2004). Liver transplantation in children: Maternal and family stress, coping, and adaptation. Journal for Specialists in Pediatric Nursing 9(2), 59-66.

10. References cont’d • LoBiondo-Wood, G. (2008). Theory of family stress and adaptation. In  P. R. Liehr & M. J. Smith (Eds.), Middle Range Theory for Nursing (2nd ed.).(pp. 225-240). New York, NY: Springer Publishing Company. • Peterson, S., & Bredow, T. (2009). Middle range theories: Application to nursing research. (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins. • Smith, M., & Liehr, P. (2003). Middle range theory for nursing. New York, NY: Springer Publishing Company.