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Application of Concept Analysis to Clinical Practice

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The concept is a general idea that is derived from human perception of events in the environment. This is based on the belief that occurrences in a given context are necessary to a wholesome interpretation of a phenomenon ( McEwen, Willis, 2011, pg,. 25). Applications of concept analysis to clinical practice has become accepted among practitioners as paradigms of practice. Paradigms are an intellectual or theoretical view of a discipline based on universal beliefs and values shared by the practitioners.

Paradigms are important in any discipline in that they help to answer questions and concerns of the discipline, shape practice, concept, and aid the formation of guidelines. Other aspects of influence of paradigms include, investigation methods, problems solving, research and arriving at theories and other principles of practice (Barker, 2010, p. 435). Since nursing is an art as well as a science, the discipline is guided by paradigms to improve practice, patient care, guide as well as curriculum. According to Rogers’ Unitary Theory, the human being is an intact entity (whole).

The intertwined physical, psychological, social, and spiritual nature of the human implies that ailments transcend the physical and affect other aspects. The theory states that nursing is both science and art, nurses are concern with people and the environment, which have the natural purpose to promote health positively and the wellbeing of the individual where ever they live. The framework provides an alternative to the traditional view of nursing which is often portrayed as redundant, mechanical, logical, and static.

Due to the integral (unitary) nature of human beings, physical, mental or spiritual aspects of health are impacted by nursing care. As such physical symptoms may affect the psychological, spiritual, environmental, social and cultural aspect of the individual. Hence the need for holistic care is vital. Nurse’s therapeutic touch influences the energy field in patients, and promotes healing emotionally and physically. This theory has been valuable in nursing research, evident in nursing educations and practice settings. Concept analysis also serves as a measure that enables medical personnel become familiar with the jargons of the profession.

This paper examines a peer reviewed article titled: Therapeutic Touch, Pain, and Caring Implications for Nursing Practice. The aim of the descriptive study was to investigate the impact of therapeutic touch (TT) on adult patient with tension headache in a Chiropractic clinic in Southern Ontario, Canada. The study utilized therapeutic touch (TT) as pain reduction and relaxation measures. The goal was to promote comfort in patients with tension headache, using Roger’s framework: that when therapists touch comes from the heart and mind the subjects experience pain relief.

Nursing research has carefully documented that therapeutic touch generates a soothing effect when utilized as nursing non pharmacologic intervention in patients who are anxious. Literature Review The review shows numerous studies, 1970 – 1980 indicating minimal work on the significance of therapeutic touch (TT) in nursing practice. Data in the late 1900’s, suggest that Roger theory has some methodological limitation. Denison (2001) gave a suggestion for more research funding on the methodological disagreement on the efficacy of TT intervention on patients with anxiety and pain.

Other studies indicate that TT promotes comfort in patient with pain. Research Physiological Investigations Krieger (1975) noted a nurse who acknowledged therapeutic touch (TT) an effective nursing intervention in patient with pain, but needed a scientific framework to study this occurrence. She started examining the physiological outcome of a healer named Oscar Estebany. The health of patient treated by this healer with therapeutic touch irrespective of their physiologic conditions improved.

In 1971, a pilot study was carried out on two groups. The study group had TT and the control group had none. Both groups’ hemoglobin was tested before and after the study, the result showed an increase in hemoglobin level in the group that had TT and no change in hemoglobin with the control group. Another study conducted in 1979 where TT was applied on patient who had electroencephalogram, electromyography and electrooculography, results showed patients were fully relaxed with improvement in symptoms during follow up appointments.

Further research done by Quinn 1982 through 1992, using qualitative and quantitative methods indicated that therapeutic touch increases hemoglobin level, induces physiologic relaxation, reduces pain and anxiety as well as accelerated wound healing process, improved affection , reduces inflammatory process and alteration in immunological set limits. Quinn (1993) study shows positive effect on psychoimmunological response on the lymphocyte configuration. Heidt (1981) found TT of benefit to cardiovascular patient.

Heidt studied therapeutic touch (TT) using 30 patients as the subjects in three groups. Group A received TT, group B casual TT and group C none. Results showed a significant reduction in anxiety in group A, supporting her hypothesis. She conducted another study in 1992 based on the previous results to see if TT is due to energy exchanged based on Roger’s theory (1970). Findings also showed a decrease in anxiety. Another study on TT and caring method done by Samarel (1992) defined therapeutic touch and steps involved, the test utilized quantitative research method on 20 participants.

The findings revealed facilitated personal growth based on a satisfying multidimensional experience that the patients were happy about. This shows a positive nursing intervention. Thayer (1990) obtained same result on a mother who applied TT on her child who had peritoneal dialysis . In this case; there was significant increase in urine output. Other investigations conducted showed similar results on different patient populations. Nurses were encouraged to add TT to nursing practice since it is an intervention that is of benefit to the patient.

The theory of therapeutic touch was explained as the transfer of healer excess energy to the pain sufferer which brings about comfort. This resulted on pain reduction, increased hemoglobin levels, decreased anxiety state, a sense of joy and fulfillment and increased energy levels as well as improved immunological parameters seen on the subjects used for this study. Results Five of the subjects who believed that TT will produce a positive outcome on headache pain before the application of therapeutic touch, were relieved of headache pain completely , were relaxed , happy and in a good mood.

The other five groups believed TT will help to an extent before the application of TT, also had tension headache relief in a mild form, but one subject still had severe headache and its associated symptoms. ? Discussion The difference in the reduction of headache in the subjects in both groups in the pre-treatment phase demonstrated that personal patient beliefs and attitudes played a role in the effectiveness of TT. Both groups that showed optimism during the interview phase enjoyed better outcomes. The first group exhibited gratefulness, pain – relief, happiness, and faith.

While the second group showed hopefulness, curiosity and were open to future trials of the method. Implication to Nursing Practice The application of therapeutic touch is essential to nursing practice based on the results seen from the analysis of this research article. Nurses can effectively treat tension headache using TT as nursing intervention. A non-pharmacological approach to pain management that is cost effective requires no supervision, no Doctor’s order or equipment. Nursing is the art of caring for individual sick and well in the society.

The assessment of pain is a major nursing function and the ability to relieve pain and promote patient’s comfort cannot be over emphasized. Therapeutic touch (TT) is an effective method of pain reduction. TT should be included in nursing curricula. Nurse educators should be trained to teach nurses at various levels the technique of TT for effective non pharmacological pain management. Concept in Practice Situation In my practice, I have encountered many patients with pain. Non pharmacological approach such as diversion therapy has not been as effective as TT.

On occasion even medication therapy has not been as successful by itself. When I apply TT to patient in pain with assorted diagnosis, sometimes in conjunction with medication, other times without medication, there was significant reduction in pain. Patients are happier and more receptive with TT as a component of their care anytime. This has been my method of nursing intervention before this paper. Being from Africa where medical resources are sometimes scarce, practitioners from this background are adept at using TT.

The vacuum created by lack is often filled with the ingenuity that TT and other practices that are yet to come to light in the West provide. Conclusion Analysis of the peer reviewed article supports Roger’s theory of unitary humans. The theory’s position that nursing is both science and art is justified by the results of the review. Nurses are concerned with people and the environment. Their natural purpose of promoting health and caring for the wellbeing of the individual is only enhanced by the addition of TT to practice.

Nurse’s therapeutic touch influences the energy field in patient and improves emotional and physical wellbeing of both practitioner and patient. Nurses are happier and feel more fulfilled when they see the success of their efforts. TT has been and will remain a revered practice among African traditional healers. African women work very hard. Due to their weaker physiology, their bodies often react to the over burden. To soothe the resultant aches and pains, they resort to traditional TT healers, who give special touch to soothe their aching bodies. The benefits and savings resulting from this practice are invaluable.

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