Table of Contents
Introduction
There are numerous theories in nursing and these theories serve as guidelines for the clinical practice. The three theories and theorists selected for this paper are: prescriptive theory (Ernestine Wiedenbach), energy fields theory (Martha Rogers), and the middle range theories (Jean Watson). The overall purpose of this paper is to study these theorists and theories, noting the patient population of surgical and cancer patients experiencing pain and anxiety, and considering their environmental, emotional, and nursing care needs. The philosophy behind each of these selected theories will also be presented. It will also describe how nurses can apply all three theories in order to ensure that comprehensive care is achieved. This paper shall also discuss how theories are similar and how they are different; it will describe the relationships between the theories and the population’s needs. Examples of how the theories can be applied in my care environment would also form part of this study.
Body
Philosophies of the Theorists
The prescriptive theory by Wiedenbach seeks to secure action in the fulfillment of an expressed specific objective (Doss, 2014). Its factors include central purpose, prescription and realities, with nurses establishing a prescription in relation to a central purpose and implementing it based on the realities of the case (Doss, 2014). Wiedenbach highlights that the practice of nursing includes the identification of a patient’s need for assistance, providing the assistance, validating that the requirement for assistance was given, and coordinating the assistance (Doss, 2014).
Through Wiedenbach’s theory, the nurse is also able to identify which actions would be able to assist the patient in coping with his disease (Richards, Johnson, Sparks, & Emerson, 2007). The help provided is a deliberate act which allows parties to manage the barriers to their action or functions (Richards, Johnson, Sparks, & Emerson, 2007). Mutual decisions also make up this theory especially as the patients and other health professionals and support care can also benefit from related therapies (Richards, Johnson, Sparks, & Emerson, 2007).
Watson’s middle range theories highlight on the importance of focusing on human-to-human caring processes including caring transactions (Lukas, 2004). These theories have a narrow focus and apply relational concepts which express or predict phenomenon (Lukas, 2004). Watson supports alternative therapies in pain management, including the use of auditory modes in healing and self-care (Lukas, 2004), and the use of aromatherapy to relieve stress (Norred, 2000).
In the energy fields theories, Martha Rogers suggests the presence of energy fields as a basic unit of the living and non-living. The energy field of a person is irreducible and multidimensional and Rogers highlights that “characteristics of energy fields include openness, mutual process, dynamic unity and the capacity to establish patterns that are fundamental to human-environmental processes” (Ramnarine-Singh, 1999, 360). Such energy fields are associated with therapeutic touch and the patient in relation to his environment (Baumann, 2009; Ramnarine-Singh, 1999). With therapeutic touch and therapy, there are also different techniques which can be used by the nurse and other health professionals to reduce stress and anxiety as well as promote healing in the patient (Ramnarine-Singh, 1999).
Application of Theories to Practice
The different theories are used to provide care within the clinical setting. Wiedenbach’s theory for instance can be applied in the nursing setting when first, the nurse would observe the symptoms and behavior of the patient (Doss, 2014). This is followed by an exploration of the meaning of the symptoms/behavior and a discussion of these symptoms with the patient. The cause of the discomfort or the symptom is also discussed (Richards, et al., 2007). Finally, the patient’s ability to manage the discomfort is established, including a determination of the patient’s possible need for help from the nurse or other health professionals.
In the clinical setting, a symptom of nausea may be observed in the cancer patient undergoing chemotherapy. The nurse can proceeds to explore the meaning of such symptom, including its connection with the patient’s primary condition or recent procedure. The symptom is discussed with the patient in order to gain insight on other symptoms he may be feeling aside from the nausea as well as the possible trigger for his nausea. The possible cause of the nausea is established based on all factors and circumstances evaluated. A determination is then made on how the nausea can be relieved including possible referral to his attending physician for treatment of his symptoms.
In the nursing context, Watson’s middle range theory highlights the nurse’s focus on caring processes which ultimately help promote holistic management of the patient (Lukas, 2004). Watson’s theory supports the use of alternative therapies in patient management, from aromatherapy to music therapy, as well as other non-pharmacologic therapies (Norred, 2000). The holistic care involves the nurse providing care for the body, mind, and spiritual needs of the patient. A cancer patient who is in pain for instance can receive holistic care in the form of chemotherapy (body), psychotherapy to cope with pain (mind), and spiritual counseling from his pastor (spirit). When this cancer patient is experiencing pain, he may also receive pain relievers (body), music therapy (mind), and family support and encouragement to alleviate his pain experience (spirit).
As for the energy fields theories and its application to the nursing context, it is important for the nurse to consider the patient as a basic unit with his/her own energy field with the energy field of each person having numerous dimensions (Ramnarine-Singh, 1999). This may be viewed in terms of the different and unique needs and affectations in one patient or one person; such affectations and needs are different from other patients and other individuals (Baumann, 2009). In the more clinical context, the importance of the therapeutic touch is one of the ways by which Rogers’s theory can be applied. A cancer patient who recently underwent surgery and is experiencing anxiety for instance would benefit from this theory. The therapeutic touch can be applied in the patient’s case (Ramnarine-Singh, 1999). A nurse trained in providing therapeutic touch would have to have the skills and knowledge to pass his/hands over the patient’s body, especially over the areas where anxiety is felt the most. Such therapeutic touch, when done properly has the potential of relieving anxiety and stress, balancing the patient’s energy fields, and providing comfort to the patient’s spirit (Ramnarine-Singh, 1999).
Similarities and Differences
Each theory is unique, but they also have some similarities and differences. The energy fields and the middle range theories for instance are similar in terms of the holistic care they ultimately promote in nursing care. The energy fields and middle range theories both acknowledge the importance of ensuring not just physical care for the patient, but also psychological and social care (Ramnarine-Singh, 1999). These theories point out that the patient requires not just physical care, but also requires treatment for his mental health and spiritual needs.
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Both theories also include non-pharmacological options in treatment, including music therapy, aromatherapy, and the therapeutic touch. Wiedenbach shares some similarities with Rogers and Watson’s theories, especially in terms of the nurse’s role in evaluating the patient’s symptoms and developing management processes based on such symptoms. Wiedenbach’s theory is unique for its approach to the target population where the theory focuses on an orderly and well-intentioned approach to nursing care (Doss, 2014). This theory prompts the nurse to first identify the symptom ailing the patient, in this case, the cancer patient suffering from pain. The pain in this case is identified to be in its moderate to severe level as is often expected among cancer patients (Doss, 2014). The intervention then follows, and in most cases, the mode of implementation would likely be as an experiment. Each patient is unique and the nurse may implement a pain management remedy which she may apply to one patient, but not to other patients even when similarly situated. A cancer patient for instance who is experiencing foot pain may receive a foot massage to relieve his symptoms. After three days of intervention, Wiedenbach suggests a post-test pain assessment in order to validate the intervention (Doss, 2014). The pain may be of lesser scale or may not have been relieved at all. Other interventions may be tried until the pain is relieved. Following relief of symptoms, the process of reporting and coordination is undertaken in order to make the proper endorsements relating to the patient’s pain symptoms.
Wiedenbach’s theory in this case is a continuing learning process for nurses who are prompted to test and try numerous interventions to relieve patient symptoms. This theory therefore very much relates to evidence-based practice which has been the thrust of contemporary nursing care. It is also patient-centered as it seeks to consider what would work best for the patient and what would bring the patient the most comfort especially in instances when conventional and pharmacological interventions have already been exhausted.
Watson’s theory also works well for cancer patients in pain because her theory distances itself from the modern and technological tools of treatment and intervention in nursing (Lukas, 2004). She reverts to the caring aspect of nursing, one which is based on compassionate care and the caring arts. For the cancer patient going through pain and anxiety, Watson’s theory provides a welcome alternative from the usual medical and technological treatments he/she is being subjected to. Its focus on human-to-human caring processes relates to the application of alternative therapies which may also provide relief, but in the less conventional fashion, to the patient (Lukas, 2004). Caring processes represent less traumatic and invasive options in relieving pain and anxiety for cancer patients.
As for Roger’s energy fields theory, her theory is unique as it includes the environment and the energy fields in the environment and the fields surrounding each individual (Ramnarine-Singh, 1999). Rogers notes that there is a link between the environment and the individual and in affecting such environment, wave patterns can be changed and can affect the individual. Rogers’s theory is very much associated with the traditional Chinese medicine systems of healing where the healing is addressed from the astral and the mental body (Ramnarine-Singh, 1999). In relieving cancer pain and anxiety, Rogers’s theory seeks to address the mental and inner self of the patient. It seeks to manage healing from the person’s inside core to his/her outside core (Ramnarine-Singh, 1999). For patients suffering from cancer pain and anxiety, it is a healing process which can also help improve their emotional and mental state, thereby ultimately promoting their physical well-being.
Conclusion
To conclude, it can be noted that pain and anxiety are two of the most primary and present challenges healthcare givers and nurses face with cancer patients. Their pain is often in its severe levels and their anxiety is often debilitating. Numerous theories suggest guidelines for the management of these patients. The theories of Wiedenbach, Watson, and Rogers are three theories which help explain evidence-based options in patient care. Wiedenbach presents a more orderly and experimental as well as patient-centered method to pain management. Watson’s theory evokes the importance of using alternative therapies to treatment. Rogers focuses on providing healing and treatment from inside out, acknowledging the importance of considering the environment and the energy fields surrounding the patient. From these theories, a holistic treatment is made possible, one which is very much important in promoting the welfare of the cancer patient.
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