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Describe the internal and external criticism used to assess middle-range hypotheses

Describe the internal and external criticism used to assess middle-range hypotheses

Describe the internal and external criticism used to assess middle-range hypotheses
QUESTION
It is critical to determine whether a theory can be adapted for use in research. Describe the internal and external criticism used to assess middle-range hypotheses.
Describe the internal and external criticism used to assess middle-range hypotheses

ANSWER
Nursing theories have traditionally taken the form of rules, beliefs, and customs (Chinn and Kramer, 2004), with no questioning of everyday practice. As a result, the experienced nurse was evaluated based on a combination of a caring attitude and some technical skills gained via hospital-based practice (Lasiuk and Ferguson, 2005). Furthermore, the nursing discipline relied on a few theories acquired from other disciplines [ibid]. Nonetheless, a dramatic transformation in the subject happened in 1965, when the American Nurses Association openly identified theory development as the profession’s purpose (Meleis, 1997). A few years after this pronouncement, major theories and conceptual models were published, which served as the theoretical basis of nursing curricula.

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Meleis’ (1997: 128) impassioned advocacy for a “reVisioning” of nursing research goals led in current trends toward the development and testing of middle range and practice theories. To attain professional accountability in nursing, theory, practice, and research must be integrated (Gortner, 1973). This is because both are necessary and mutually beneficial. Theory provides a framework for directing practice and research and can lead to theory formation (McEwen, 2007). (Chinn and Kramer, 2004).

I am a general nurse who worked at the Komfo Anokye Teaching Hospital recently. It is Ghana’s second largest hospital and the principal referral center for the Ashanti Region as well as parts of the Eastern, Central, Northern, and Western Regions (Buabeng, Matowe and Plange-Rhule, 2004). I was working on a general surgical ward, where I dealt with both preoperative and postoperative patients. In my practice, I discovered that, despite advances in pain management, postoperative pain was a common concern among surgical patients (Carr and Goudas, 1999, Donovan, 1990 and Long, 2000). Kolcaba’s middle range theory of comfort has proven to be very valuable in my search for a nursing theory that can be applied in my clinical context (surgery) because it addresses patients’ comfort demands.

The purpose of this essay is to apply a nursing theory to a situation that has piqued my curiosity in my clinical practice. It will begin with a case study from my practice and will be followed by a critical reflection on Carper’s epistemic patterns in nursing. The essay will then proceed with a brief assessment of the literature on the primary topics mentioned in the reflection. Kolcaba’s Comfort Theory will next be defined, analyzed, and applied to my practice area (surgical setting). Finally, the essay will conclude with my thoughts on this nursing theory.

STUDY OF A CASE (Refer to Appendix 1 for an extended description).

Baba Musah, a 34-year-old man, was taken to the ward following an emergency appendicectomy. He was evaluated and handled in accordance with the hospital’s postoperative patient management procedure. He did, however, continue to complain of pain, which was accompanied by unstable vital signs. When I approached him and discussed some of his problems, he seemed at ease. As a result, his vital signs stabilized and he expressed relief from his agony.

CARPER’S KNOWING PATTERNS FOR CRITICAL REFLECTION
According to Carper (1978, 1992), knowledge can be obtained in four ways: artistically, personally, empirically, and ethically.

According to Carper (1978), aesthetics is the perception derived from seeing an event at a specific time. At its most developed, aesthetics is the ability to understand a situation and behave without much thought (Slevin, 2003). I sought Baba Musah because I could tell there was something more to it than postoperative discomfort. This is what Polanyi (1966) refers to as tacit knowledge, or what Benner (1984) refers to as intuitive expert practitioner; it is the knowing that cannot be described. I then introduced myself and assured him that everything was private. I went on to ask him about his troubles. As he began to speak, he began to cry, but I supported and soothed him. Following that, he relaxed and resumed his narration. I questioned about his issues because he appeared distressed and powerless. I had no idea that this could make someone cry. Regardless, it prompted me to sit by his bedside and investigate his health more.

The incident taught me that people react differently in different situations. I felt awful at first because I thought my efforts had exacerbated his problem. Furthermore, I was unsure how I would interact with Baba in order to provide him with the support and comfort he need. For Baba Musah, I hoped he felt I was of assistance and that he could put his trust in me. The nurses I worked with were clearly pleased with the outcome of the intervention, as seen by their facial and verbal emotions. It’s tough for me to explain how Baba felt in the situation, but he afterwards conveyed his gratitude to me. I could see he was agitated at first, but after the chat, he appeared relaxed and comfortable in bed.

Personal knowledge is the awareness of oneself and others during a conversation (Carper, 1978, 1992). I was astonished and uneasy at first when dealing with his crying. This is because men in Ghanaian society do not typically cry in public. As a result, I was perplexed and had no idea what was going on. This viewpoint is supported by Zborowski (1952), who claimed that people hold specific pain beliefs based on their socialization culture. Regardless, I demonstrated empathy and concern for Baba because of my own personal experiences with pain during a trauma. This is also consistent with the findings of a survey that found that care-providers’ previous pain experiences influence their attitudes toward those in pain (Brunier, Carson, and Harrison 1995; O’ Brien, S., Dalton, J., Konsler, G., and Carlson, 1996). Experienced oncology nurses’ knowledge and attitude toward the care of cancer-related pain. 515-521 in Oncology Nursing Forum 23. O’Brien, Dalton, Konsler, and others, 1996). Baba was embarrassed to be crying in public after the incident, but I promised him that he would be fine.

The factual and impersonal information derived from principles, rules, theories, and science is referred to as empirical knowledge. Carpenter (1978, 1992) Baba Musah was evaluated and handled in accordance with hospital practice for postoperative patients. As a result, his vital signs were monitored on a regular basis until stabilisation was achieved. Pain medication (intravenous pethidine) was administered as needed based on the pain score. I focused on the relevance of communication as a therapeutic technique in the absence of considerable improvement in his health. This motivated me to approach him and find out what was causing his sorrow. We talked about how to cope with his current worries once we explored them. Baba was taught about the disease’s progression, treatment, and results. Following the encounter, following examinations revealed that the discomfort had improved and the vital signs had remained steady.

Ethical knowledge entails making rational and moral judgments about what is right and wrong (Carper, 1978, 1992). Baba Musah was handled with decency and respect by using his title, attending to his requirements, and giving him the privacy he asked. Regardless, some of the ethical difficulties that arise include nurses’ right or wrongfulness in turning away from a patient in agony in order to attend to other patients who also require treatment. Another ethical quandary raised by this case study is the providing of proper information prior to an urgent operation to decrease the anxiety of unknown results. However, after analyzing the patient, this conundrum can be satisfactorily resolved.

CONCEPTS
Pain management, communication, and comfort are some of the key principles that emerge from this reflection. Morris (1991) defines pain management as the reduction of an individual’s pain to an acceptable level. Communication is a two-way process of delivering information through both verbal and nonverbal ways (Arnold and Boggs, 1995; Balzer-Riley, 1996). According to Slater (1985), comfort is a pleasurable condition of physiological, psychological, and physical harmony between a person and their surroundings.

The therapeutic nurse-patient interaction is essential for effective pain treatment (Briggs, 1995). This means that effective pain management requires effective communication. Patients grow more comfortable as their pain is adequately handled. From the notions listed above, I will select comfort as the key concept because it is a broader construct that includes pain management. Furthermore, through dialogue, nurses become aware of the patient’s comfort.

For many years, numerous authors have defined comfort from various points of view. Some regard it as an essential aspect for patients (Nightingale, 1859), while others regard it as the primary issue of nursing (Harmer, 1926). Although the term “comfort” is suggested in these statements, it is clear that it is the primary focus of nursing. Thus, Harmer (1926) emphasizes the importance of delivering care in a comfortable atmosphere.

Comfort is seen as an important nursing action and obligation (Morse, 1983). (Van Blarcom, 1953). As a result, nurses are evaluated based on their ability to make their patients feel at ease (Goodnow, 1935). As a result, the American Nurses Association (1987) emphasized the importance of sustaining a patient’s dignity and comfort until death. Without a question, nurses are the most effective people in providing comfort to patients (Funk and Tornquist, 1989). However, comfort is a subjective condition that is best defined by the patient (Richards, 1980; Paterson and Zderad, 1988). Furthermore, the goal of comfort aids individuals in achieving a sense of well-being (Gropper, 1992).

Comfort can be used as a noun, verb, adjective, or gerund in reference to a process or an outcome. However, in nursing practice, the phrase is defined as a sense of satisfaction following difficult health care settings (Kolcaba, 1994). The difficulties surrounding this contentious term have revealed that the concept of “comfort is multi-dimensional, signifying various things to different people” (Hamilton, 1985: 32). Personally, I describe comfort as the fulfillment of needs, expectations, or wants that, when received, inspires an individual to feel good.

THE COMFORT THEORY IS DESCRIBED.
Theoretical Background
Katharine Kolcaba began developing her theory during her master’s program in nursing (MSN) and finished it over a ten-year span while obtaining her doctoral degree. She received her PhD from Case Western University in 1997 and authored a book on Comfort Theory in 2003. Induction, concept analysis, deduction, and retroduction were used to develop the theory of comfort (Kolcaba, 2003).

Kolcaba incorporated comfort into her dementia care paradigm at the inductive stage. She spent two years analyzing comfort and came up with three types of comfort (relief, ease and renewal). This was eventually refined to provide the current taxonomic structure of comfort, which defines comfort as the state of meeting requirements for relief, ease, and transcendence in physical, psychospiritual, environmental, and social situations (Kolcaba 1991).

Comfort was linked to other nursing concepts throughout the deductive stage to build a theory. Murray’s (1938) work offered a framework for incorporating Kolcaba’s nursing notions, whilst the three categories of comfort were acquired from other nursing theorists’ work. Orlando (1961) named relief, Henderson (1966) found ease, while Paterson and Zderad identified transcendence (1976). Schlotfeldt’s idea of health seeking behaviors (HSBs) was also accepted (1975). Kolcaba incorporated the concept of institutional integrity into her middle range theory of comfort at the retroductive stage (Kolcaba, 2003). Comfort theory describes customised patient care and predicts the benefits of continuous comfort measures, comfort, and participation in health seeking behaviors (Kolcaba, 2003).

Ideas and Propositions
The theory of comfort describes major ideas such as comfort needs, comfort measures, intervening variables, comfort, health seeking behaviors, and institutional integrity. Comfort requirements occur as a result of stressful health-care settings that cannot be met by a patient’s support system. Nursing measures are designed to address these demands while taking into account patient aspects such as past experience, age, attitude, emotional state, support system, and income (Kolcaba 1994).

Comfort is a multifaceted sensation that can be offered in physical, psychospiritual, environmental, and societal situations (Kolcaba, 1994; Kolcaba and Fox,1999). Kolcaba (2001) defines three sorts of comfort as follows: alleviation as meeting a specific health care requirement, ease as a state of steadiness or happiness, and transcendence as rising above life’s obstacles.

Describe the internal and external criticism used to assess middle-range hypotheses

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