Nursing theory

What is it that we do as nurses? How do we describe, explain or investigate our practice? What is our phenomenon of concern? In the discipline of nursing, we need to have some way of understanding the knowledge needed on which to base our practice. The development of nursing theory is an effort to answer these questions.

Nursing theory can be grand, at the level of conceptual system, which attempts to explain as much as possible about nursing in general. It can also be more specific, as in investigating the relationship between exercise and body image in breast cancer patients. In 1997, nurse leaders in the US are suggesting we use the word theory to refer to the latter: testable hypotheses.

Nursing theories are based on concepts, which are investigated such as the concept of comfort. Janice Morse, a nurse researcher from Canada and the US, conducted research to better understand the concept of comfort and the discomfort from the perception of the patient. Her work has led to an understanding of what patients need from nurses to prevent discomfort and suffering.

Geraldine Padilla investigated quality of life in cancer patients. Theory then is a statement for some relationship between two variables or factors, which is based on systematic research and tested and is refined.

Some areas of nursing research includes: pain, pre-operative teaching and effects on patient outcome, experience of uncertainty in cancer patients, the use of the arts as a means of self-expression in breast cancer survivors, coping with chronic illness, patient falls / injuries, maternal infant relationships and health, and anxiety reduction.

Pain management: non-pharmacological nursing interventions

Pain management encompasses pharmacological, non-pharmacological and other approaches to prevent, reduce and stop pain. The main benefit of non-pharmacological pain management is that the patient can take an active role against pain. Various methods of non-pharmacological pain management will be discussed below.

Relaxation: Relaxation lessens the distress associated with pain. Relaxation is used with other pain relief methods. It is never a substitute for other appropriate pain relief methods such as analgesics. Effective relaxation uses some form of classical conditioning. For example, a behavior that is already associated with relaxation may be taking a deep breath, yawning, or thinking of a past, peaceful experience.

Example: Tell the patients to make tight fists of their hands, breathe deeply and hold the breath in for a moment. Then, have them let the breath out and relax the hands. Then encourage them to yawn.

Distraction: The patients will focus their attention and concentration on other stimuli so that they are not preoccupied by the pain. This gives the patient an increased level of tolerance for pain that lasts only during the time the distraction is used. After the distraction, fatigue, increased awareness of pain and irritability may occur.

Example: sing and tap rhythm. The patient chooses a song and stares at a spot or closes his eyes and imagines scene or dancing. The patient may say words without making any sound or will whisper words. Encourage the patient to tap out the song's rhythm. This helps to increase concentration. He begins this exercise slowly and increases speed as the pain increases and decreases speed as the pain diminishes. Listening to music or the use of humor may be other forms of distraction.

Coetaneous stimulation: Some forms of stimulation of the skin are massage, pressure, vibration, heat, cold, ice, bathing, lotion, or menthol. Locations that may be stimulated in an effort to relieve pain include directly over or around the painful area. Cold is usually more effective than heat, and works more quickly and for a longer duration. Alternating heat and cold may be more effective than either form alone.

A MASAGE TECHNIQUE • Assess if a massage is contraindicated • Start with the client lying flat or on his or her side • Begin with the forehead and work down the body • Use a gentle but firm touch • Always stroke towards the heart • Rub downward on the chest and back • Stroke upward on the arms • Use a light lotion or oil •

Example: Ice massage. Use a piece of ice 4-6 inches long. Apply directly to the skin. Tell the patient they will feel four stages in this process: cold, burning, aching and numbness. The treatment usually lasts 5-10 minutes. Use firm pressure and rub the area. Stop when the area becomes numb.

Non-pharmacological treatments are playing an increasing role in the treatment of pain. It is essential for nurses to understand and use these methods.