Essay Example on Nursing Theory: Foundations of Discipline & Practice

For many years, administrators, practitioners, and nursing scholars have pushed for nursing theories that lay a foundation of discipline and nursing practice (Brown). These theories are meant to evaluate and make the necessary decisions concerning patient care. This also includes providing insights that help in the understanding of emerging phenomena in nursing and also helping in decision making. The urge resulted in the emergence of various theories that have evolved because of the inability to meet all these needs. Despite that, the theories have some common drawbacks, even though some have untested formulation and inaccurate propositions that are usually assumed. Studies also imply that the validation of nursing theories had been excluded from mainstream nursing after an observation by Silva (1986), who studied five major nursing journals.

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The essence of the middle-range theory of caregivers was made to address issues of the nurses concerning the services they gave to different patients concerning their illness. They wanted to accomplish four principal aims in theory such as: to predict caregivers' stress and its outcome from demographic characteristics, social support and roles, stressful life events, and the objective burden they go through in caregiving (Riegel, Jaarsma & Stromberg, 2012). This theory was also meant to specify the relationship between contextual stimuli, focal stimuli, and the control measures taken in the RAM by testing the relationship between the possible sources of stress. To clarify the theoretical relationship of depression and caregiver and whether or not caregiver stress can be a source of depression. The ultimate aim was to supplement and revise the theory of caregiver stress concerning statistical evidence.

The caregiver stress was first derived from the Roy Adaptation Model. There are four known assumptions in this theory. Tsai (2003) suggest that the first two theories are assertions made in the RAM while the other two reflect the premises in the RAM (Tsai, 2003). The first assumption is that caregivers can react to environmental changes. The second assumption is that the perception of caregivers decides how they respond to the ecological changes occurring around them-therefore concluding that the intactness of their understanding influences how they adapt to a particular environment. The next assumption is caregiver's ability to adapt is functional following their environmental stimuli and their adaptations level. The last assumption relates to the factors that affect a caregiver, such as marital satisfaction, enjoyment, and self-esteem are a result of long-term caregiving.

The middle-range theory of caregiver stress is divided into different levels, which are differentiated by the level of abstraction. The first level is most abstract and is represented by concepts of the RAM. The next level includes the idea of the middle-range theory of caregivers. A relationship between the idea of RAM and the concept of the theory of caregiver stress provides the concepts required for testing.

According to the RAM concept, the ability of a caregiver to cope is based on stimuli levels and the strength to adapt to the environment. In the caregiver stress theory, the caregiver's burden is identified as a focal stimulus. Contextual stimuli, in this context, refer to social support, social roles, and stressful life events. Extra incentives include age, relationships, gender, and race (Tsai, 2003). Despite that, no effort is made to identify the caregiver's adaptation levels because their adaptation levels depend on the combination of the effects of the significant relevant environmental stimuli mentioned above.

The objective burden received from caregiving represents the focal stimuli experienced by the caregiver. Actual weights include the duties they perform primarily with dreadful disease caregiving. This may interfere with a caregiver's life in terms of interpersonal relationships, finances, and other roles. In the middle-range theory of caregiver stress, the burden of caregiving is the focal stimuli that activate the coping process. As a result, this causes the caregivers to seek the available psychological and physical resources to cope with caregiving. According to Riegel, Jaarsma and Stromberg (2012) Although contextual and residual stimuli also affect the caregiver and even influence the seen stress, the burden of the caregiver to perform their roles is the most critical stimulus leading to caregiver stress (Riegel, Jaarsma & Stromberg, 2012).

Contextual stimuli contributes to how focal incentives affect the adaption process, or how they can moderate the relationship between focal stimuli and the coping procedure of the caregiver. In the middle-range caregiver stress theory, the contextual stimuli either add to the effect of focal stimuli of moderate the relationship between objective burden as a caregiver or the coping mechanism. Extra incentives such as a caregiver's race, age, gender, and contact with the patient also contribute to the effects of focal stimuli. However, the impact of extra incentives is not defined yet.

The control process is defined as the casual path between environmental stimuli and adaptive modes. The theory proposes that a caregiver's response is the function of the focal, contextual and residual stimuli and his/her adaptation level and therefore the conclusion that the behavior resulting from that is called the control process. This means that the controlling procedure is the linking variable between environmental stimuli and the adaptive modes invented by the caregiver.

Visible caregiver stress results in responses like low levels of marital satisfaction, low self-esteem, limited physical functionality, and reduced role enjoyment. Perceived stress is the perceptual component of the copying process, which includes activities with which contain both regulator and related subsystems (Tsai, 2003). The method of perception is part of cognition activities. Through information processing, someone can carry out selective coding, memory, and attention. Understanding also helps in linking the regulator subsystems to the cognate subsystem. A conclusion is drawn from this because the input to the regulator subsystems also produces perception. In theory, perceived caregiver stress is also described as the caregiver's cognitive evaluation of importance concerning caring for a chronically ill close person.

The effects of contextual and residual stimuli on the control procedure have not been clarified yet. However, they are still treated as the mediators between focal stimuli and the coping process. They also indirectly influence the coping mechanism through focal incentives. In addition to that, they are perceived as additive factors that affect focal stimuli, and they are also moderators between the observed caregiver burden and the coping process.

References

Riegel, B., Jaarsma, T., & Stromberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204.

Tsai, P. F. (2003). A middle-range theory of caregiver stress. Nursing Science Quarterly, 16(2), 137-145.

Tsai, P. F. (1998). Development of a middle-range theory of caregiver stress from the Roy adaptation model.