Part II. Theory reflection in research
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Research purpose

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Research question
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
Examine relationship of stress, severity, uncertainty, coping, and
adaptation in families of children undergoing liver
transplantation
Three main questions looking at variables over the pre and posttransplantation 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
 Based
theory
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:




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

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
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
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
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

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.