Impacts of Nursing Care on Adjustment, Self-efficacy, and Infertility Levels among Women

Date:  2021-09-02 01:10:56
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Article Citation (APA): Arslan-Ozkan, I., Okumus, H., & Buldukoglu, K. (2013). A randomized controlled trial of the effects of nursing care based on Watsons theory of human caring on distress, self-efficacy, and adjustment in infertile women. Journal of Advanced Nursing, 70(8), 1801-1812

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PICOT Question

Problem/Patient/Population: Infertility treatment in women.

Intervention: Nursing care based on the Theory of Human Caring.

Comparison: Controlled group of women receiving routine care.

Outcome: Increased self-efficacy, reduced infertility distress levels, and positive adjustment levels.

Type of Study/Time Element: A quantitative randomized research study conducted between May 2010 and February 2011.

General Description and Overview of Study

The study was conducted among a selected number of Turkish women with fertility problems to determine whether nursing care helps reduce distress in such women brought about by adjustment levels, depression, anxiety, and perceived self-efficacy.

Study Aims/Rationale /Purpose

The researchers sought to investigate the impacts that nursing care has on adjustment, self-efficacy, and infertility levels among women based using Watsons theory of human caring.

Study Design

The researchers employed a randomized control trial in their study. According to them, the study was a prospective, randomized controlled trial using a pretest-posttest design (Arslan-Ozkan, Okumus, & Buldukoglu, 2013, p. 1804).

Research Question (s) or Hypotheses

Arslan-Ozkan, Okumus, and Buldukoglu (2013) formulated three main hypotheses for their study. One of the hypotheses was that there would be less adjustment to infertility among the control group than in the intervention group. The other hypothesis was that in the intervention group, there would be higher perceived self-efficacy than in the control group. Their last hypothesis was that there would be higher infertility levels in the control group as compared to the intervention group.

Quality of Study

The researchers in their study made use of quality sources to validate their claims, propositions, and findings thus the quality of the study may be described as high. However, the researchers failed to carry out a comprehensive analysis of their findings and implications of the study.


Sampling Technique/Method, Sample Size, and Characteristics

The researchers conducted the clinical trial at one of the university hospital infertility centers in Antalya, Turkey. They initially included 120 participants in the study but after exclusion exercise, the number was reduced to 108 53 participants in the control group and 52 in the intervention experiment group as the actual sample size. For the women to qualify as a participant in the experiment, they had to meet certain criteria: being a foreign national with less sufficiency in the Turkish language, being below the age of majority (18 years) or above 45 years of age, having been diagnosed with a chronic disease, and suffering from secondary infertility.

The sample size was found to be strong after standard deviations and mean scale scores. The randomization of the sample was done through the use of SAS version 8.2. The researchers also blinded the participants to treatment allocation and used a sealed envelope method in randomly selecting those who qualified to participate in the study.

In terms of intervention, the control group of women was given routine nursing care, the intervention experimental group of infertile women received both routine nursing care and nursing care based on Watsons theory of human caring. The intervention group thus received nursing care that emphasized values such as openness, human needs assistance, the creation of a healing environment, teaching and learning, and compassion. The care was also based on problem-solving, acceptance and promotion of feelings, caring, trusting, and helping relationships, sensitivity to others and self, honor, hope, and faith, love, and kindness (Arslan-Ozkan, Okumus, & Buldukoglu, 2013).

Further, using transpersonal interviews which lasted for three-quarters of an hour, the researchers conducted a nursing care program alongside IVF treatment. During the interviews, some of the attributes exhibited by the caring nurses included positive thinking, motivation, empowerment, social support provision, touching, empathy, encouragement, and active listening. The control group, on the other hand, received no booklets, music, or relaxation techniques. Socio-demographic data forms, infertility distress scales, and infertility self-efficacy scale were used in collecting data.

Major Variables Studied

Independent Variables

The independent value used in the experiment was nursing care since it remained constant.

Dependent (Outcome) Variables

The dependent variables were distress, self-efficacy, and adjustment levels because they varied from one group to the other based on the quality and nature of care given to the infertile women.

Declaration of Conflict of Interest

The authors declared that there was no conflict of interest in the study outcomes.


Statistical Analysis

In the analysis of the data collected, the authors used the SPSS Statistical Package tool or software. They also determined the Cronbachs alpha coefficients to assess the reliability of the scales used. The groups were then compared after randomization based on infertility treatment, marriage duration, occupation, education status, and age.

Main Results of the Study

On the infertility distress, the major finding was that there a significant decrease in the post-test and pretest scores based infertility distress scale (IDS) for both groups. The main finding on perceived infertility self-efficacy was that there was a statistically significant difference in the infertility self-efficacy scores following nursing care intervention. There was also a significant increase in the perceived self-efficacy among infertile women in the intervention group.

The adjustment levels also differed between the group's post interventions. A similar case study by Ozan, Okumus, and Lash (2015) found that Watsons theory of human care is effective in that it helps women to cope with the effects of in vitro fertilization treatments. Moreover, another study by Ozan and Okumus (2017) found that the nursing care that is based on the theory of human care assists in reducing and relieving distress and anxiety among women who have undergone unsuccessful infertility treatments.

Clinical Significance

The significance of these results is that they confirm the researchers hypothesis that the application of Watsons theory of human care in the clinical setting reduces the distress levels, increases perceived self-efficacy and leads to positive adjustment levels among infertile women.

Safety Concerns Described

The researchers did not address any safety concerns that could have arisen in the course of the study.


Implications for Practice and Further Research/Evaluation

The major implication of the findings of this study is that it calls on nurses to use Watsons theory of human care in caring or women with infertility problems and in the nursing or clinical care generally to improve the healing process among patients. The study also implies that infertility nurses or nurses, in general, should have a proper knowledge and understanding of Watsons theory of human care to improve patient care and recovery.

As Norman, Rossillo, and Skelton (2016) indicate in their study, a theory of caring such as Watsons theory of human care may be successfully used to create a healing environment in hospitals through emphasis on the Caritas processes, such as belief in miracles, spirituality, kindness, love, compassion, and healing. Therefore, as Bloomberg, Griffiths, Wengstrom, May, and Bridges (2016) succinctly note, there is a need for future research to explore the experiences undergone by women who receive nursing care based on this theory. According to these authors, even though compassion is considered an important aspect of nursing care, currently there exists no rigorous critical research and overview on the effectiveness of varous intervention techniques that promote compassionate care for patients.


Arslan-Ozkan, I., Okumus, H., & Buldukoglu, K. (2013). A randomized controlled trial of the effects of nursing care based on Watsons theory of human caring on distress, self-efficacy, and adjustment in infertile women. Journal of Advanced Nursing, 70(8), 1801-1812

Blomberg, K., Griffiths, P., Wengstrom, Y., May, C., & Bridges, J. (2016). Interventions for compassionate nursing care: A systematic review. International Journal of Nursing Studies, 62, 137-156

Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal, 104, 401-409

Ozan, Y.D., & Okumus, H. (2017). Effects of nursing care based on Watsons theory of human caring on anxiety, distress, and coping, when infertility treatment fails: A randomized controlled trial. Journal of Caring Sciences, 6(2), 95-109

Ozan, Y.D., Okumus, H., & Lash, A.A. (2015). Implementation of Watsons theory of human caring: A case study. International Journal of Caring Sciences, 8(1), 25-35

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