Part II. Theory reflection in research Research purpose Examine relationship of stress, severity, uncertainty, coping, and adaptation in families of children undergoing liver transplantation Research question Three main questions looking at variables over the pre and post- transplantation time periods Research methods Descriptive, longitudinal study of 15 mothers whose children were at least 5 years post-transplantation Instruments used: FILE, POMS, CHIP, FAD, PPUS (Lobiondo-Wood, 2003; Lobiondo-Wood, Williams, & McGhee, 2004)

Theoretical framework Nursing theories offer a framework for nurses to apply to their practice. The framework is the knowledge that guides nursing actions when caring for patients (Cody, 2013). Lobiondo-Woods theory Based on Double ABCX Model by McCubbin Used in 2000 by Van Riper to study family stress in families with a sibling with Downs syndrome (Smith & Liehr, 2003)

Theoretical framework cont’d Relevant today with transplant patients Essential to teach, assess early intercessions, and provide support to families during all phases of the transplant course Without the framework, it would be difficult to assess family stress during transplantation

Theory in practice Nurses often care for patients and families who are faced with a stressful situation such as: Sickness Death Financial hardships Strained Relationships Surgery Nurses can alter patient’s and families perception of the stressor Education is the key to avoid crisis and to help families cope when dealing with a crisis Nurses can introduce new resources and facilitate coping and adaptation

Theory in practice cont’d Practice example: Patient is preparing for a complex surgery Complex surgery is the stressor The nurse alters the family’s perception of the surgery through education and open conversation The education that continues through the post-operative period and prior to discharge facilitates coping and adaptation The nurse introduces new resources such as home care and physical therapy to aide in the adaptation process

Tie between theory and practice Theory provides framework for how nurses can help families through an extended period of the liver transplantation process (Lobiondo-Wood et al., 2004) Acknowledge stress and uncertainty Early information dispersal and teaching Allow mother time to recognize issues in order to build rapport Importance of nursing knowledge (Lobiondo-Wood, et al., 2004) Nurses are involved for an extended period Rapport is essential to identify needs and provide interventions Holistic approach to help patient and family Help families with long term aspects of care during times of uncertainty

Contributions to nursing Contributions (Lobiondo-Wood et al., 2004) Maternal stress, coping, and uncertainty had significant changes over time Family stress did not have significant changes Supports the need for testing nursing interventions focused on education and support Early and long term support as needs change First step towards investigation of short and long term family implications of having a child that received a transplant Set the state for further development of research based nursing interventions for children and their families

Conclusion This presentation was designed to provide a better understanding of a middle range nursing theory, and it’s implications for nursing practice. We hope these findings can be a benefit to your own personal practice as you assist patients and families during stressful situations

References Cody, W. (2013). Philosophical and theoretical perspectives for advanced nursing practice (5th ed.). Burlington, MA: Jones & Bartlett Learning. Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation nursing models and theories (2nd ed.). Philadelphia, PA: F. A. Davis. Lobiondo-Wood, G. (2003). Theory of family stress and adaptation. In Goosby, B. J., Caldwell, C. H., Bellatorre, A., & Jackson, J. S. (2011). Ethnic differences in family stress processes among African-American and black caribbeans. Journal of African American Studies 16(3), 406-422. Lobiondo-Wood, G., Williams, L., & McGhee, C. (2004). Liver transplantation in children: Maternal and family stress, coping, and adaptation. Journal for Specialists in Pediatric Nursing 9(2), 59-66.

References cont’d LoBiondo-Wood, G. (2008). Theory of family stress and adaptation. In  P. R. Liehr & M. J. Smith (Eds.), Middle Range Theory for Nursing (2nd ed.).(pp. 225-240). New York, NY: Springer Publishing Company. Peterson, S., & Bredow, T. (2009). Middle range theories: Application to nursing research. (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins. Smith, M., & Liehr, P. (2003). Middle range theory for nursing. New York, NY: Springer Publishing Company.