Application of Non-Nursing Theories to Clinical Practice
Made by:
Malgorzata Sklodowska
David White
Christina Holderfield
Kristin Ferraiolo
Introduction
Patient admitted to a hospital is under a lot of stress. Sense of hopelessness, giving up freedom and control, and allowing others to make decisions and direct care is stressful. Nurses and other medical staff must be understanding of patient vulnerability and create a trustful relationship that will guide the patient to reach the most favorable outcomes.
Richard Lazarus created Stress Theory that is helpful in understanding patient response to stress from psychological point of view. It focuses on emotions, beliefs, and life events. On the other hand, Aaron Beck is an author of Cognitive Theory that presents patient who has distorted perception that causes him too have a false image of himself that needs to be corrected to return to status quo.
Aaron Beck: Cognitive Theory
According to Beck depression is a result of negative thoughts about self, world, and future. The more bad thoughts the worse the depression. Patient has a very low self-esteem and thinks he is worthless. He is afraid that everyone is against him and that the future does not hold anything positive and there is no hope. People tend to select things from the environment that support and confirm their negative thoughts and attitude, and ignore everything positive (Allen, 2003). Negative thoughts fall into 3 categories:
- polar reasoning: lack of perfection equals failure
- selective abstraction: ignoring success and focusing on failures
- over generalization: believe that being bad one thing means being bad at everything else related to it
“Psychological stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus and Folkman, 1984, p. 19).
When a person approaches a situation the first step is to appraise and determine if there is a potential loss, threat or benefit resulting from it. Based on that the person decides if she has the coping mechanisms necessary to solve the situation. Resources used can be psychological, social, physical, or material, and they aim to reduce or tolerate the inconvenience. If coping mechanisms are suitable stress turns into a positive situation, if they are not it becomes negative (Berjot & Gillet, 2011).
Comparison of Two Theories
Diagram
Lazarus Stress Theory diagram
Diagram
Aaron Beck: cognitive theory triad
4 meta paradigms of nursing are:
human, environment, nursing and health.
Beck's Cognitive Theory:
- human: patient's thought process determines the level of depression
- environment: patient looks at the environment purposefully focuses on negative aspects
- health: physiological and psychological states are intertwined. Poor mental state leads to poor physiological health.
- nursing: in order to make patient better nurse must focus on changing patient's thinking patterns.
Nursing Meta paradigm in Each
Theory
Lazarus Stress Theory:
- human: how a person deals with stressful situation and if he has coping mechanisms to convert negative stress to positive.
- environment: everything in daily life can be a source of stressful situation. It is up to a patient if he perceives it as a loss, threat, or opportunity.
- health: stress and health are inseparable. One affects the other greatly.
- nursing: nurses have to be aware that some situations can be stressful and try to eliminate them to avoid escalation of negativity.
Application of Theory to Practice
key concepts from each theory as they apply to your
practice
Applying Beck's concepts into practice
By using a cognitive-behavioral approach, the nurse can alter a patient's emotions or behavior by changing his or her negative thoughts or irrational beliefs. This can be done for example by shedding a positive light on a situation or acknowledging positive qualities about the patient. As the patient's emotions, beliefs, or attitudes change, they start to feel better. this approach can also be helpful in identifying mal-adaptive defense mechanisms
(McEwen & Wills, 2018, pp. 310-311)
Applying Lazarus' concepts into practice
The nurse must be able to identify stress and the effect it is having on their patient's physical and psychological well being. It's important to assess patient's coping mechanisms and the resources/support he or she has. Having insight on patients' stress and coping processes can help the nurse to understand behavioral changes. The nurse can aid in problem solving and cognitive restructuring to facilitate coping and adaptation.
(McEwen & Wills, 2018, pp. 316-317)
Situation-Specific Example
client situation where the two theories may be applied
Let's say you are taking care of a patient who is tearful, yelling, throws the call bell, and is angry with you for things you have no control over. Identifying underlying stress will help the nurse to understand the patient's behavior. Further assessment reveals the patient recently lost their spouse unexpectedly, and is now being hospitalized. The patient states she is lost without her husband. She tells you she has no family locally and doesn't know if she can afford the unforeseen expenses.
Two appropriate nursing diagnoses for this patient are:
Ineffective Coping related to situational crises as evidenced by patient yelling, displacing anger onto nurse, and throwing call bell.
theory-specific nursing diagnosis for each client
situation.
Grieving related to loss of a loved one as evidenced by patient is tearful and angry, verbalizes recent loss of spouse, states she is "lost without him" .
how each theory can be used to design nursing
interventions.
Using Beck's theory the nurse will recognize that the patient is displacing her anger onto the nurse. Identification of this mal-adaptive coping mechanism will help the nurse to understand the patient's behavior towards them. The nurse can then present positive reinforcement, and encourage healthy emotions and thoughts, thus changing the patient's belief system and outlook.
Interventions Using Beck's Theory
(McEwen & Wills, 2018, pp.310-311)
Using Lazarus' theory, the nurse will identify the physical, psychological, and financial stress. The nurse must also address the patient's support system and resources to ensure effective coping. This will help the nurse to support the patient appropriately and aid in the patient's problem solving and adaptation.
Interventions Using Lazarus' Theory
(McEwen & Wills, 2018, pp. 316-317)
Research pertaining to the relation between stress and a person's physical health, and if stress during hospitalization has a negative effect on patient outcomes, would exemplify the importance of implementing Lazarus' theory into nursing practice.
components of each theory that need more research
before it can be applied to your types of clinical practice.
Research pertaining to less incidences of things like postpartum depression after discharge, or suicides/attempts in psychiatric patients after discharge, etc. in hospitals utilizing a cognitive-behavioral approach in patient care, would help to delineate whether the patient's thought process was positively affected by Beck's theory during hospitalization, and also long term once they rely on solely their own thoughts and emotions.
Concept Review:
Richard Lazarus
Aaron Beck
Model Diagram -1
Refinement of concepts for use in Nursing
Model Diagram - 2
BECK: COGNITIVE THEORY
BECK
For effective nursing treatment, a further explanation of care would be needed for the concept of Cognitive Distortions. According to McEwen and Wills (2018), the details of cognitive distortions are arbitrary inference, over-generalization, selective abstraction, magnification and minimization, underlying assumptions, entitlement, perfection, and automatic thoughts. In addition to a further explanation of this concept, for effective use in the nursing profession, patient education needs to be included so that when the patient overcomes the distortions, they are taught how to cope with them and know the triggers.
Assessments would need to be explained to focus the treatment of the patient for the right care plan. In order to achieve his concept of Cognitive Restructuring, the appropriate problem needs to be identified in order to treat the patient with the specialized care plan.
LAZARUS: STRESS, COPING, AND ADAPTATION THEORY
LAZARUS
The Stress, Coping, and Adaptation theory precisely explains how to apply the concepts in the nursing profession by providing a "framework for nurses to assess the effects of stress, both physical and psychological on the individual, and the coping processes the individual uses" (McEwen & Wills 2018, p. 317)
Synthesis of Theory & Application
Application in Nursing Practice
Application
of Theory
“Life is 10% what happens to you and 90% how you react to it.”
― Charles R. Swindoll
This mantra applies with the theories studied as well as in everyday practice. Studying nursing theories has presented information to allow improvement in nursing practice by taking the information and advice from history and learning from it to provide the best care possible. Nurses should be committed to a holistic view of the patient, understanding the impact a positive environment has on the patient and the healing process. Paying attention to the emotional need of the patient as well as the medical needs of the patient. This will improve the future of nursing and the positive outcomes of the patient population. Applying nursing theories positively affects nursing at the bedside by encouraging utilization of theories related to caring for the whole person as well as paying close attention to the patient environment and possible outcomes.
Cognitive Theory: Beck
Theory #1
Beck's Theory states that in dealing with assumptions of one's self in a stressful situation one may judge themselves too harshly based on a past experience. He referred to these as "cognitive distortions" (McEwen & Wills 2018, p 310). It is thought that by introducing positive perspective on the patient he/she will redirect self blame and the person will gradually begin to feel better about themselves (McEwen & Wills 2018, p 311). For example, a patient admitted with a stroke now has deficit with right side hemiplegia. The patient is right handed, therefore, this is quite an affect on the patient's eating, writing, playing of an instrument etc. Patient feels depressed related to the situation. The nurse can assist the patient with seeing the positive and shedding light on the patient's abilities, rather than the disabilities.
Stress, Coping, and Adaptation Theory: Lazarus
Theory #2
Lazarus's theory is useful in managing patient's in stressful situations by laying out the process of stress, coping, and adaptation. Patients are in stressful situations and they must be guided through the process of managing their emotions through acceptance of an illness and the changes that may come with said illness. Most of the time patients are not expecting a medical event that takes place whether it be a car accident, a cancer diagnosis, a cardiovascular event, or just a general illness which presents challenges in their every day life. Education of illness, possible outcomes, and encouragement should all be part of assisting patient with adapting to a new way of life.
Summary:
In summary, Lazarus and Beck's theories aid nurses at the bedside in evaluating and treating their patients as they go through the changes associated with various illness. It is important to recognize the impact that perception, stress, and coping have on the healing process. If a patient is not well mentally and is unable to cope with the physical changes associated with their situation they may not flourish. "To treat the illness, the cognitive distortions must be changed" (Beck, 1976) (McEwen & Wills, 2018, p 310).
Summary
References
References
- Allen, J.P., (2003). An Overview of Beck's Cognitive Theory of Depression in Contemporary Literature. Retrieved from: http://www.personalityresearch.org/papers/allen.html
- Berjot, S., & Gillet, N. (2011). Stress and coping with discrimination and stigmatization. Frontiers in psychology, 2, 33. https://doi.org/10.3389/fpsyg.2011.00033
- Charles Swindoll Quotes. (2020). Retrieved from https://www.goodreads.com/author/ quotes/5139.Charles_R_Swindoll
- Lazarus R. S., Folkman S. (1984). Stress, Appraisal and Coping. New York: Springer
- McEwen, M., & Wills, E. M. (2018). Theoretical Basis for Nursing (5th ed.). Philadelphia: Wolters Kluwer
- Untitled photograph of Beck's cognitive triad retrieved from https://www.tutor2u.net/psychology/reference/explaining-depression-becks-cognitive-triad
- Untitled photograph of Lazarus's Stress Theory retrieved from http://increasingintelligence.blogspot.com/2017/03/how-to-get-rid-of-stress-and-burnout.html
- Untitled photograph retrieved from https://lehighacres.abwa.org/6-tips-for-managing-holiday-stress/
- Untitled image of Richard Lazarus retrieved from: https://www.berkeley.edu/news/media/releases/2002/12/04_lazarus.html
- Untitled image of Aaron Beck retrieved from: https://en.wikipedia.org/wiki/Aaron_T._Beck
- Untitled image of Richard Lazarus retrieved from: https://senate.universityofcalifornia.edu/_files/inmemoriam/html/richardlazarus.html
- Untitled image of Aaron Beck retrieved from: https://www.psychotherapy.net/videos/all