N620 Application of Theory to Practice

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Application of Theory to Practice-

Quality of life experienced by Caregivers

Student:

N620 Theoretical Basis for Advanced Practice Nursing

Long Island University

Application of Nursing Theory

Nursing theories have played a pivotal role in the advancement of the nursing practice. It is a guide for the practice of nursing that ultimately deems positive results which impacts patient care in situations that arise in the many facets of the nursing profession. The application of nursing theory to practice in each situation faced in the vast healthcare services can be addressed and dealt with effectively once applied. Application of nursing theories is a framework which models’ interventions that nurses can apply into practice on a case by case basis. All in all, the application of nursing theories into practice serves patients and their families holistically in the advancement in their care either in a hospital setting or transitioning care into the community. Caregivers often underestimate the role they are undertaking when making commitments to care for sick relatives at home. According to the National Alliance for Caregiving and AARP, approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last twelve months in the USA . The Caregiver Stress theory is a middle range nursing theory that predicts stress and its outcomes in caregivers from a variety of different perspectives . The purpose of this paper is to highlight the impact on the quality of life for caregivers with the application of the Caregiver Stress Theory.

The theory of Caregiver Stress was derived from the Roy Adaptation Model to use as a basis in understanding the relationships among caregivers and the stress faced when caring for a chronically ill or recuperating relative . The objective here is to anticipate the stressors of being a caregiver from the burdens, life changes, social and financial roles and implement ways to relieve some of these challenges (Tsai, 2003). This theory has four assumptions of the caregiver; that is, how the caregiver responds to environmental change; the caregivers’ perceptions will determine how they will respond to the environmental stimuli; the caregivers’ adaptation is a function of their environmental stimuli and adaption level; and lastly the caregivers’ effectors are results of chronic caregiving, such examples include marital satisfaction and self esteem .

Application of Caregiver Stress Theory in Research

The following is an analysis of the Caregiver Stress theory model and its application into nursing practice. The area in which this theory is concentrated in this paper is community health nursing practice. The interventions this theory depicts can be used as a counter measure to decrease or minimize the stress that caregivers face when caring for their loved ones. We apply the Caregiver Stress theory Process Model to give familial caregivers of liver transplant candidates. The theory enhances the use of specific nursing interventions. This connection of theory to practice is especially important in the current health care environment, where the nursing shortage demands efficient and effective patient care . The Stress Process Model is a specific and concrete middle-range theory, which makes it simple to apply in clinical practice and research. This model is particularly useful for nurses who support the family caregivers of clients on the liver transplant list. The model identifies characteristics that predispose caregivers to stress that can interfere with completion of caregiving roles and tasks before and after patients’ liver transplantation .

Another study was utilized, the Caregiver Stress theory, tested via a mediational model of risk and protective factors associated with the psychological adjustment of caregivers of head-injury patients. Forty-three caregivers of patients who had suffered a head injury participated in this study . The findings strongly supported hypotheses as caregiver burden was associated with poorer psychological adjustment with the lack of social support and a higher percentage of approach coping strategies ineffectively. The relative to overall coping strategies were associated with better psychological adjustment with the implementation of the Caregiver Stress theory model. As predicted, caregiver burden showed a direct relationship to psychological adjustments, while social support showed an indirect relationship to adjustment mediated by percentage approach coping . The Caregiver Stress theory is a model which anticipates the burdens placed on caregivers and narrows interventions to navigate positive outcomes.

The structure of the Caregiver Stress theory includes the input section. The input section is made up of an objective burden that is focal stimulus of the caregiver’s situation which means that the task and responsibilities that are associated with the caregiving of a person with a chronic condition. These responsibilities may interfere with other aspects of the caregiver’s life and include interpersonal relations and finances in which are defined as contextual stimuli. Contextual stimuli also include social supports, social roles and stressful life events . The input section of the Caregiver Stress theory put these aspects into perspective to incorporate the financial burdens along with the added stressors of adjusting the social roles once played by the caregiver.

Significant research on caregiver roles and related/corelated concepts utilizing the Caregiver Stress theory (Tsai, 2003) performed, yielded many results. Friedman and Buckwater (2014), research pertaining to gender and family relationship on caregiver role perception as an important factor . The focal point of the research is on workload, burden, and help among family receiving benefits from home health care agencies. They determined that roles, responsibilities, and responses varied considerably based on gender and ethnicity and urged community health nurses to recognize vulnerabilities of care providers. Similarly, Hansen and colleagues (2012) explored the concepts of role strain and satisfaction with family caregivers making life-sustaining treatment decisions within the context of ongoing care for elderly ill relatives in a variety of settings . Another example in which Caregiver Stress theory is used came from Frye (2016), which studied issues experienced by fathers in their role of caregivers of children with autism spectrum disorder, noting that their need for support as they reported significant concerns related to responsibilities finances, as well as their experiences of grief and loss .

Description of the problem

The role of a caregiver regardless of the gender, economic status, or age is very stressful. Ms. CC is a forty-one-year-old single African-American female who is the primary caregiver for her two elderly parents, she also has a ten-year-old daughter, works full time as a Registered Nurse, a per diem job, school part-time and is also a home-owner. Ms. CC’s mother is an 84-year old who suffers early onset dementia, history of CVA with left-sided deficit and her father has a history of Kidney cancer, hypertension, Afib, multiple abdominal surgeries, also recent CT scan showed a mass in his abdomen which he refuses treatment or further studies. Ms. CC’s busy life has cost her time away from daughter, two marriages and increasing financial burdens. She is constantly stressed, depressed and frustrated. Ms. CC perseveres and carries the weight of all her responsibilities alone without assistance from her other six siblings. Ms. CC maintains her role as mother, professional worker, friend in time of need, and caregiver. Her caregiving role involves taking her mother to doctor appointments, such as, the neurologist, psychiatrist, and medical doctor. Also, her father has regular doctor’s appointments. She makes sure her home has adequate food, personal supplies, meal prep, bills are paid, clean and tidy and her parents’ medications are obtained and administered. With her mother’s state of dementia, she must make sure she is safe as many attempts is made by mother to leave home if left unattended. Ms. CC has overwhelming responsibilities that she often reflects and wonders how she has been coping for the past nine years. Ms. CC has encountered divorce, sibling rivalry, and many detours and many adjustments had to be made to keep pushing through .

Application of Caregiver Stress Theory to Practice

In assessment of the problem of caregiver strain experienced by Ms. CC it is obvious that she needs assistance. She is susceptible to illness due to physical stress; depression and the lack of social support which can create an unsafe situation for her parents. The purpose of the Caregiver Stress theory (Tsai, 2003) predicts caregiver stress and its outcomes from the demographic characteristics, caregiving burdens, stressful life events, social support and social roles . The major concepts applied to the problem of caregiver strains is caregiver adaptation, input (objective burden, stressful life events, social support, social roles, demographic information), control process (perceived caregiver stress and depression), output (physical function, self-esteem, role enjoyment, marital satisfaction). The main goal of this theory was to provide insight into experiences of caregivers which can hinder not only the patient being cared for, but the person who undertook the role as a caregiver. . Possible solutions involve social support, such as home health aide for parents, emotional and physical support for Ms. CC and transportation assignment to get parents to and from medical appointments with aide services. The home health aide can prepare meals, cleanliness of the home, and food shopping. These responsibilities lifted from the shoulders for Ms. CC can give her new hopes and opportunities of a clear future with better quality of life.

The Caregiver Stress theory model was designed to assess the informal caregiving processes affecting caregiver health and quality of life. When this model theory is applied to caregivers of older adults with dementia who were independent and now dependent on others, the experience and stress associated with caregiving reflects a process that changes over time. The potential proliferation effects of the stress involved in the caregiving role highlight the existence of a complex stress process . The caregiver stress model gives the community health nurses the knowledge to be impactful in this situation, this include, social supports and concepts of self-efficacy, which determine how the individual handles stress which may sustain Ms. CC and decreases the effects of the stressors .

Alternate Non-Nursing Theory

Lazarus and Folkman’s Psychological Stress and Coping theory is a model theory that is utilized by the discipline of psychology. The cornerstone of this theory research across multiple fields which focuses specifically on the effectiveness of the problem-focused and emotion-focus taxation taxonomy . Extending this theory of stress and coping an individual can undergo changes personally to align themselves with coping mechanisms that can give them the perception of relief or satisfaction to proceed. This does not mean that it would yield positive results. Utilizing this theory in nursing practice gives the practitioner the tools in focusing on the problems at hand that pose a risk of exacerbating stressful responses for caregiver. This can assist in creating interventions and implementing them, so that the caregiver can develop positive coping mechanisms for both the caregiver and the patient. Combining concepts or elements of multiple theories is common in middle range theory development . In some cases, combining theories; example, non-nursing theory (Stress and Coping Theory) with nursing theory (Caregiver Stress Theory), a nurse anticipates and examines the known/unknown stressors while using the Caregiver Stress theory to model a plan to enhance the coping.

More patients opt to be cared for at home after discharge from healthcare facilities because the perception is that they would be safer and more comfortable at home as oppose to a nursing facility. Some might be more inclined to believe that, especially with the rise of cases in terms of neglect and abuse in these skilled nursing facilities, like nursing homes or rehab facilities. Caregivers who are not given adequate education, social support, assistance, guidance or necessary tools at home, poses increasing strain and thereby creates a decline in the care at home which facilitates the breakdown of the quality of life for the caregiver. This topic is especially close to my heart because the case of Ms. CC is very personal and depicts my life story.

In conclusion, the theory of Caregiver Stress is a middle range theory that has been modified from the Roy Adaptation model in order to offer a practical model for caregivers. This theory once applied to the nursing practice is impactful, in securing a healthy environment for caregivers and their sick relatives. Caregivers are relying on some hope of maintaining a decent quality of life while showing love and compassion for that chronically ill or recuperating relative at home. The stressful constraints of being a caregiver sometimes are so burdensome that depression or physical illness ensues rendering them ineffective in caring for themselves much less others. The interventions of social supports, education, constant guidance and moral support, stimulates the caregiver to be effective providing a more comfortable and safer environment for all parties involved.

References:

Biggs, A., Brough, P., & Drummond, S. (2017, February 18). Lazarus and Folkman’s Psychological Stress and Coping theory. doi:10.1002/9781118993811.ch21

Blankfeld, D., & Holahan, C. (2015, August 19). Social support, coping, and psychological adjustment among caregivers of head-injured patients. 609-624.

Bolden, L., & Wicks, M. N. (2008, June). The Clinical Utility of the Stress Process Model in Family Caregivers of Liver Transplant Candidates. Cinahl(18), 74-79.

Collins, W. L., & Hawkins, A. D. (2016). Supporting Caregivers Who Care for African American Elders: A Pastoral Perspective. Social Work and Christianity, 43(4), 85-103.

Gibson, L., Mc Niel, S., Walker, K., & Tsai, P. (2013, November 14). An Explanation of a Very Select Middle Range Nursing Theory. Retrieved from Theory of Caregiver Stress: http://larrysothergirls.wordpress.com

McEwen, M., & Wills, E. M. (2019). THeoretical Basis for Nursing. Philadelphia: Wolters Kluwer.

Raina, P., O’donnell, M., Schwellnus, H., Rosenbaum, P., King, G., Brehaut, J., & al, e. (2004, January 14). Caregiving process and caregiver burden: Conceptual models to guide research and pratice. BMC Pediatrics, 1-19. doi:10.1186/1471-2431-4-1

Schneier, J. (2017, October 10). Cognotion; A Learning Company: How Many Caregivers Are There In America. Retrieved from cognotion.com: http://www.cognotion.com




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