Situation-specific Theory Research Articles

Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure

AimsTo explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies...

“He’s Not the Person I Married:” A Situation-Specific Theory for Negotiating Personhood in Residential Dementia Care

This article introduces a situation-specific theory describing how staff work to negotiate the personhood of people with dementia who are living in residential aged care facilities. In providing person-centered care to individuals living with dementia, residential care staff are often challenged to care for a person whose preferences and decision-making depart significantly from those expressed before disease progression. They encounter the person as they are now, but they also encounter traces of the person as they were then. This theory considers how staff reckon with residents’ personhood in flux and, ultimately, how they affirm and bestow personhood through person-centered care.

Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department: A Situation-Specific Theory.

In many countries, parents experiencing miscarriage seek treatment in the emergency department (ED). Parents frequently report dissatisfaction with ED care, while nurses report not knowing how to provide optimal care. This article describes the development of a situation-specific theory, Compassionate care for parents experiencing miscarriage in the ED , based on 4 concepts (change trigger, transition properties, conditions of change, and interventions). This theory evolved from a comprehensive review of the literature, 2 empirical studies, Transitions Theory, and collaborative efforts of an experienced team. The detailed theory development process facilitates its integration in practice and supports new theory development.

Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department: A Situation-specific Theory.

Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department: A Situation-specific Theory.

Development of a Situation-Specific Theory for the Transition of Survivors of Stroke With Dysphagia.

The process by which stroke survivors move toward health while facing various difficulties can be construed as a "transition." Importantly, nurses need to understand and support this state of transition effectively. This study developed a situation-specific theory to explain post-stroke transition by integrating the findings of a qualitative study that explored the rehabilitation experiences of stroke survivors with dysphagia with a scoping review of qualitative studies using the theoretical framework of transition theory. This theory will help understand the transitions that stroke survivors with dysphagia undergo during recovery and provide a framework for exploring nursing care to support healthy transitions.

Factors Predicting Caregiver Contributions to Self-care in Patients with Heart Failure

Introduction Caregivers play an important role in contributing to self-care in patients with heart failure (HF). To date, knowledge regarding factors associated with caregiver contributions to self-care remains limited, particularly in Thai patients with HF. Objective This study aimed to 1) describe caregiver contributions to self-care, and 2) examine factors predicting caregiver contributions (self-care maintenance, symptom perception, self-care management) of patients with HF. Design This correlational predictive study was guided by a situation-specific theory of caregiver contributions to heart failure self-care. Methodology The study included 128 caregivers of patients with heart failure, who were purposively selected based on the following inclusion criteria: aged at least 18 years, unpaid for their caregiving tasks, and living with the patients who attended the heart failure clinic and general internal medicine clinic at an outpatient department of a super-tertiary hospital from April to August 2023. Data collection was conducted using questionnaires and record forms, and the data were analyzed using descriptive statistics, simple linear regression, and multiple linear regression. Results The majority of the participants were female (75.78%), with an average age of 46.10 years (SD = 13.74). Caregiver contributions (CC) to symptom perception and self-care maintenance were found to be adequate, with means of 73.38 (SD = 14.83) and 72.72 (SD = 13.75), respectively. In contrast, self-care management was deemed inadequate, with a mean of 68.83 (SD = 16.56). Multiple linear regression analysis revealed that health perception and self-efficacy together predicted CC for symptom perception, explaining 35.20% of the variance. Health perception, self-efficacy, and positive aspects of caregiving together predicted CC to self-care maintenance, explaining 31.50% of variance. Self-efficacy and comorbidities in patients together predicted CC to self-care management, explaining 21.20% of variance. While the status of caregivers to patients was not a statistically significant predictor of all three dimensions of CC to self-care in the patients with HF in this study. Recommendation The results of this study can be utilized to develop specific programs aimed at enhancing caregiver contributions to the self-care of patients with HF, particularly in promoting self-efficacy, positive aspects of caregiving, caregivers’ health perception, and managing the comorbidities of the patients.

"Perinatal loss, a devastating cyclone": A situation-specific nursing theory.

The aim of this paper is to develop a preliminary theory that explores in depth into understanding the experiences of women who have suffered a spontaneous perinatal loss during any trimester of their pregnancy regarding their emotional response to this loss. A grounded theory approach was used, and 25 in-depth interviews were conducted with Spanish women who suffered a spontaneous perinatal loss. Theoretical sampling and constant comparative analysis were used to reach theoretical saturation. EQUATOR guidelines were followed, using the COREQ checklist. The "Perinatal loss, a devastating cyclone," a situation-specific nursing theory, explains the process that a woman experiences when she loses her baby at any stage of pregnancy, drawing an analogy with tropical cyclones as natural disasters that destroy everything in their path. This situation-specific theory includes three dimensions, explaining the phases identified in the perinatal loss process (phase prior to impact [before the perinatal loss], impact phase [diagnostic moment], emergency phase [hospital care], relief or honeymoon phase [return home], disillusionment or stock-taking phase [after the first postloss days at home], reconstruction and recovery phase [grief construction process] and consequences [with an eye to the future]). Three intervention areas were described around the perinatal loss process: "rescue area" (partner, grandparents, and siblings of the deceased baby), "relief area" (healthcare professionals), and "base camp" (society). The situation-specific nursing theory "Perinatal loss, a devastating cyclone" is the final product of a grounded theory study that provided an in-depth analysis of women's experiences when they suffer a spontaneous perinatal loss at any point in their pregnancy. The situation-specific theory "Perinatal loss, a devastating cyclone" with the seven identified phases and the three areas of intervention could be used as a framework for healthcare professionals in their clinical practice as a guide to support women in this disfranchised grief.

“Application of Transitions Nursing Theory among Patients with Cardiac Arrests to Assess the Impact of Cardiopulmonary Resuscitation Duration on Functional Outcome—A Conceptual Framework”

Background: Change is the only constant in life, and humans continuously strive to cope and adapt based on the changes in their health (physical and mental) status. Cardiovascular diseases (CVD’s) are the leading cause of cardiac emergencies that cause enormous impact on patients, families, and health systems prompting processes and strategies for coping with their health status changes and their aftermath effect. Aim: A discussion of the conceptual framework of transition theory applicable to the study to assess the impact of the cardiopulmonary resuscitation (CPR) duration on the functional outcome among patients with in-hospital cardiac arrest (IHCA). Methodology: The transition theory, a middle-range and situation specific theory is applied to the prospective study conducted at a tertiary care hospital in South India. The outcomes were measured using the cerebral performance category (CPC). Results: The theory identifies that cardiac arrest is a situational transition affected by the chronicity of the disease as described with unfavorable outcome with CPC score of 3–5. The fear of death, dependency state of the patient in an unfavorable outcome based on CPC, and caregiver burden on family due to the prolonged duration of acuity of the disease or death of the patient are identified as properties in this theory. Based on the study, the personal meaning includes lifestyle modifications, the impact of spiritualism, financial stability, and the educational qualifications of the patient and family identified as personal meanings that play a major role as facilitators and inhibitors. The patterns and responses in this study identified with follow-up appointments, confidence in caring for themselves, and coping for themselves among the survived cardiac arrest patients. The nursing therapeutics identified from the study are risks identified from the comprehensive assessment, readiness to intervene and implement nursing actions, educating the patient and family based on the transition, and enhancing the creation of a healthy environment. Conclusions: The transition theory is holistically applicable for patients with cardiac arrest, identifying the process and changes adapted by the patient and family with the progression of the disease and the roles adapted by the family members in the event of the patient’s death.

Autocuidado de pessoas com Insuficiência Cardíaca: a importância da telenfermagem na pandemia da COVID-19

Abstract Objective: to describe factors of influence of telenursing on naturalistic decision making about self-care of people with heart failure during COVID-19. Method: this is a descriptive study with a qualitative approach, with 16 participants interviewed after hospitalization for decompensated heart failure. The data was collected using audio and video technology and submitted to content analysis, guided by the Situation-Specific Theory of Heart Failure Self-Care. Result: two thematic categories emerged from the analysis: Self-care as a decision-making process and Factors influencing decision-making, which describe tele-nursing as a support resource for people with heart failure, during changes in care in the pandemic period. Conclusion: it was possible to understand the relationship between telenursing and the establishment of a bond, in order to stimulate naturalistic decision-making by people with heart failure in their daily lives in a coherent way, leading to better health outcomes.

Nurse-infant bonding: A theory synthesis

This theory synthesis of Hill & Flanagan's concept of bonding and Swanson's Theory of Caring yields a situation-specific theory of Nurse-Infant Bonding to describe and explain this phenomenon. The outcomes for the nurse, infant, and mother (or parental figure) are identified to support the importance of nurse-infant bonding and important developmental outcomes. Implementation of these cognitive processes and observable actions must be implemented by the nurse in settings in which an infant is at risk for poor physical, social, and emotional development.

Situation-Specific Theory from Autonomic Dysreflexia Nursing Diagnosis Based on Roy’s Adaptation Model

Introduction: Autonomic dysreflexia (AD) is a condition developed secondary to a spinal cord injury, which manifests with the loss of coordinated autonomic responses and cardiovascular control. For the care of the person, the nurse has the nursing diagnosis of AD, which allows the precise interpretation of the human responses of each individual. However, it is necessary to strengthen and update the diagnosis to the new disciplinary knowledge that evolved with nursing practice. For this, proposing a situation-specific theory is essential to explain the phenomenon of interest and guide practice. Objective: To construct a situation-specific theory for the nursing diagnosis of AD derived from the adaptation model of Sor Callista Roy. Materials and methods: Theoretical study developed in five stages: defining the approach to construct the theory, defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. Results: The situation-specific theory included defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. We described the concepts and their relationships through seven propositions and identified 19 ineffective behaviors and 43 environmental stimuli. Of them, 39 are focal, and four are contextual stimuli. Conclusions: This situation-specific theory offers a substantiated and comprehensive explanation of the human response to AD for supporting nursing care.

Abstract 15239: Patient Self-Care Mediates the Relationship Between Caregiver Contributions and Symptom Burden in Heart Failure

Introduction: Patients with heart failure (HF) experience high symptom burden that can be mitigated with adequate self-care. The situation-specific theory of caregiver contribution to HF self-care suggests that caregivers have a key role in improving patient symptom burden. Hypothesis: a) caregiver contribution to self-care influences patient self-care; b) patient self-care influences symptom burden; c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden. Methods: Secondary analysis of baseline and three-months data from the MOTIVATE-HF trial, which enrolled 510 HF patient-caregiver dyads in Italy. Data were collected using the Self-Care of HF Index v.6.2, the Caregiver Contribution to Self-Care of HF Index, and the HF Somatic Perception Scale. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test study hypotheses. Results: On average, caregivers were 54 ± 15.46 years and mainly female (74.5%), while patients were 72.4 ± 12.28 years and mainly male (68%). Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β=0.280, p<0.001), which, in turn, was associated with lower symptom burden (β=-0.280, p<0.001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β=-0.079, 95% BC bootstrapped CI: -0.130, -0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β=0.238, p=0.006). The model accounted for 37% of the variance in symptom burden (p<0.001). Conclusions: Targeting caregivers to increase their contribution to self-care can increase patient self-care and, consequently, lower patients’ HF symptom burden.

Transition to the Role of Family Caregiver of Older Adults After a Stroke: A Specific Theory

Introduction: Nursing professionals develop situation-specific theories to describe, explain, and provide comprehensive care during a family member’s transition to the caregiver role. Objective: To develop a situation-specific theory about the transition to the role of family caregiver of older adults after a stroke. Methodology: The integrating approach by Meleis and Im was applied, which consists of five stages: 1) Description of the context and target population, 2) Verification of assumptions regarding the philosophical stance, 3) Exploration of multiple sources, 4) Theorization of concepts, and 5) Proposal of empirical indicators for validation and verification. Results: The prescriptive theory was developed in the light of Afaf Meleis’ Theory of Transitions and was supported by an exhaustive literature review, with four underlying concepts: Situational transition to the family caregiver role, Care-related knowledge and skills, Self-confidence and coping in adopting the caregiver role, and Nursing therapeutic education. The following assumption emerges from these concepts: a healthy transition to the family caregiver role is directly dependent on the care-related knowledge and skills provided by Nursing therapeutic education to develop self-confidence and coping in adopting the caregiver role. Conclusions: The proposal provides a conceptual framework that identifies the transition challenges and needs faced by family caregivers to adopt the role of caregivers of older adults after a stroke.

Relationships of person-related, problem-related, and environment-related factors to self-care behaviours and the mediating role of self-confidence among patients with heart failure: Cross-sectional analysis of structural equation modelling

BackgroundPromoting self-care behaviours in heart failure management is an important goal and challenge for healthcare systems worldwide. Using the situation-specific theory of heart failure self-care, this study examined the relationships of person-related, problem-related, and environment-related factors to self-care behaviours and the mediating role of self-care confidence in these relationships. MethodWe analysed the baseline data from a previous randomised controlled trial study involving 213 patients with heart failure. Structural equation modelling was used to test our hypothesised model that included age, income, education, depression, anxiety, number of comorbidities, social support, self-care confidence, and self-care behaviours. Depression and anxiety were measured by the Hospital Anxiety and Depression Scale. Social support was measured by the Short Form of the Social Support Questionnaire satisfaction subscale. The Self-Care of Heart Failure Index (version 6.2) was used to assess self-care confidence and self-care behaviours (i.e., self-care maintenance and self-care management). ResultThe final model included age, depression, social support, and self-care confidence as independent variables. Age had a direct relationship with self-care maintenance (β = 0.235, p < 0.001) but not self-care management (β = 0.067, p = 0.179); better social support was directly associated with higher levels of self-care confidence (β = 0.267, p < 0.001); and higher levels of self-care confidence were associated with better self-care maintenance (β = 0.573, p < 0.001) and self-care management (β = 0.683, p < 0.001). The result showed an indirect relationship between social support and self-care maintenance through the mediator of self-care confidence (β = 0.153, p < 0.001), as well as an indirect relationship between social support and self-care management through self-care confidence (β = 0.182, p < 0.001). ConclusionSatisfactory social support can increase self-care confidence, thereby increasing self-care maintenance and management. The findings of this study also implied that self-care maintenance can increase with increasing age. Future interventions directly targeting assessment and management of self-care confidence, available social support, and the age of patients may help enhance their heart failure self-care behaviours.

The Influence of Caregiver Contribution to Self-care on Symptom Burden in Patients With Heart Failure and the Mediating Role of Patient Self-care: A Longitudinal Mediation Analysis.

Patients with heart failure experience high symptom burden, which can be mitigated with adequate self-care. Caregiver contribution to self-care has been theorized to improve patient symptom burden. The mediating role of patient self-care in this relationship has not been tested yet. The aim of this study was to test whether (a) caregiver contribution to self-care influences patient self-care, (b) patient self-care influences symptom burden, and (c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden. In this study, the authors conducted a secondary analysis of the baseline and 3-month data from the MOTIVATE-HF trial, which enrolled 510 dyads (patient with heart failure and caregiver) in Italy. Multigroup confirmatory factor analysis was used to test measurement invariance. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test our hypotheses. On average, caregivers were 54 years old and mainly female, whereas patients were 72.4 years old and mainly male. Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β = 0.280, P < .001), which, in turn, was associated with lower symptom burden (β = -0.280, P < .001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β = -0.079; 95% bias-corrected bootstrapped confidence interval, -0.130 to -0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β = 0.238, P = .006). The model significantly accounted for 37% of the total variance in symptom burden scores (P < .001). This study expands the situation-specific theory of caregiver contribution to heart failure self-care and provides new evidence on the role of caregiver contribution to self-care and patient self-care on symptom burden in heart failure.

Situation-Specific Theory for Health Management in Heart Failure.

This situation-specific theory was developed by linking concepts from Orem's Self-Care Deficit Nursing Theory and standardized nursing languages with the purpose of explaining and describing the health management of outpatients with heart failure. This theory suggests that the health management of these patients is influenced by basic conditioning factors, which may affect individuals' health management capability and may interfere with the ability to present health management behaviors. Knowing the ability of these patients to manage their health will allow nurses to plan their interventions, which will reflect directly on a patient's quality of life, and reduce the chances of hospitalization and health costs.

Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults.

Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults. This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults. Im and Meleis' integrative approach was used to develop the situation-specific theory. Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences. African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.

Adaptation to High-Risk Childbearing: Extension of a Preliminary Situation-Specific Theory with Focus on Psychological State and Functional Status

Introduction: Little is known about expectant and new parents’ psychological experiences of high-risk childbearing. Objective: The paper is a report analyses of data from a Roy Adaptation Model-guided pilot study of women’s and their male partners’ adaptation to high-risk childbearing and thereby extends a preliminary situation-specific theory of adaptation to high-risk childbearing. Materials and methods: A previous paper was a comprehensive report of the results of the pilot study except for psychological state, measured by the Multiple Affect Adjective Checklist-Revised. The additional data analyses reported in this paper are for effect sizes of correlations between the Multiple Affect Adjective Checklist-Revised subscales and maternal and paternal functional status inventories. Results: Correlations of small (r = 0.1), medium (r = 0.3), and large (r = 0.5) effect sizes were found for the measures of psychological state and functional status for both women and their male partners except for psychological state positive affect and maternal functional status during the postpartum, and psychological state anxiety and paternal functional status during the postpartum. Conclusions: Overall, no substantial differences were found in psychological state and functional status for women and their male partners during pregnancy and the postpartum. The findings of this secondary data analysis constitute an extension of the preliminary situation-specific theory reported in a previously published paper.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes

High-quality end-of-life communication between healthcare professionals (HCPs), patients and/or their family caregivers (FCs) improves quality of life and reduces non-beneficial care at the end of life. Nursing homes (NHs) are among the contexts at the forefront of these conversations. Having a solid theoretical basis for the role of end-of-life communication in NHs in transitioning to palliative-oriented care can offer indications for research, practice, education, and policy related to geropalliative care. This study aimed to develop a situation-specific theory of end-of-life communication in NHs by refining an existing theory. A four-step integrative approach was employed that included: (1) checking the assumptions for theorization; (2) exploring the phenomenon through multiple sources; (3) theorizing; and (4) reporting. All elements of the existing end-of-life communication theory in NHs were confirmed: end-of-life communication improved the understanding of FCs about their relatives' health conditions, shared decision-making, and reflections on the desired preferences of residents/FCs for care at the end of life. Furthermore, the family environment affected the burden of FCs in the decision-making process. Finally, time and resource constraints, regulations, visitation restrictions due to the COVID-19 pandemic, and social and cultural values influenced the quality and timing of communication. The study findings confirmed the impact of the political, historical, social, and cultural context on end-of-life communication, thus providing the basis for a situation-specific theory.

Geropalliative Caring Model analysis and assessment according to Fawcett's criteria.

To analyze and assess Lee Geropaliative Caring Model according to Fawcett's criteria. A theoretical-reflective study about the Geropaliative Caring Model. The analysis resulted in a detailed review of the scope, context and content of a situation-specific theory, in order to determine aspects related to nursing practice and research, and assessment addressed the concrete concepts developed in theory, their significance, internal consistency, parsimony, testability and empirical and pragmatic adequacy in nursing as a discipline. Based on the analysis, a situation-specific theory was used based on the science of care and aimed at caring for older adults undergoing palliation and their families, structured into four fields, namely: (1) aligning care; (2) keeping safe; (3) comforting body/mind/spirit; and (4) facilitating transitions. The analyzed and assessed theory leads to a structure that includes well-defined, delimited and interrelated concepts, based on the science of care as a grand theory that allowed Geropaliative Care Model derivation.