This research paper analyzes the concept of health behavior change in the field of nursing. The structure of the paper, including theory development bases on the concept analysis framework of Smith and Liehr (2008).
Working as a nurse in the ICU comes gives one different experiences basing on the various one is exposed to. I work in the ICU, where I am responsible for taking care of the critically ill patients. Specifically, I am charged with those who need artificial ventilation or breath. In order to perform my duty perfectly, I am supposed to ensure that the patients get better by preventing any other side effects, which may result in the course of their admission in the ICU. One of the most dangerous risks that ICU patients on artificial air are exposed to is the Ventilator-associated Pneumonia (VAP). The prevention of VAP by nurses involves a is a 5-steps process, called the VAP bundle. Of the five steps, interruption of the sedation to introduce extubation to the patient is one most critical step. This is also commonly referred to as weaning from the mechanical ventilation. It has to be practiced every day, in addition to the assessment for the readiness of extubation. Previously, the physicians attending to patients in critical situations attempted to reduce the length of time of mechanical ventilation. They did this by manipulating ventilator modes and gradually decreasing the ventilator support. Nonetheless, reseatch today has shown that sedation can have a bigger impact on the length of time of mechanical ventilation, and other patient outcomes than can manipulating ventilator modes (Eber, Laximinarayan, Perencevich, Malani, 2010).
Different patients respond differently to the process of sedation, depending on their health status and ability to cope. One major incidence that comes to my mind when sedation is mentioned is one I experienced with a one day post renal transplant patient. This patient had been admitted to the ICU for 12 hours observation. She was in quite stable condition as she was alert and conscious, and waited to be transferred to the surgical ward. However, the patient exhibited high levels of anxiety a she kept questioning about the ICU experience and what her outcome would be. As a professional, I strengthened her hope, while talking to her. Unfortunately, an overdose of “FK” is administered to the patient, who collapses afterwards. After undergoing successful surgery, the patient is put on mechanical ventilation and later sedated so that she does not fight the mechanical ventilation equipment. After she stabilized, the weaning process from mechanical ventilation took effect. This is in accordance with the VAP bundle protocol of preventing the occurrence of VAP. On receiving the physician’s order, I adhered to it by holding the sedation to assess if the patient is ready for extubation. However, after successful extubation, the patient grow agile, bitter, and violent. She asked if I could undertake the same processof extubation on my own mum. She felt this was some kind of a mean act as it dehumanized her. My attempts to explain the importance of the process were not welcome by the patient, as she could not understand.
The Phenomenon of Interest
The phenomenon of interest related to my story and her first action after weaning her from mechanical ventilator, best described as “Waking up to breath”. This phenomenon was termed after a discussion with two of my colleagues while we are doing our assignment for statistics course. We stopped for a while and discussed our concept development. Thus, each one of us presented her story and then we helped each other the come up with a concept.
Theoretical Lens for Viewing the Phenomenon
The theoretical lenses used to view this phenomenon is used to shape the meaning of this phenomenon. The phenomena in this research is ‘waking up to breath.’ This describes the reaction of the involved patient after how she reacted to the fact that she was being weaned from the mechanical ventilator. She reacted rather violently. Various theories can be used to bring this phenomenon into perspective. However, I choose to choose one of the middle range theories. The theory of self-efficacy is one that will bring a deeper meaning and understanding to this phenomenon. This theory is important in determining the activity or situation an individual can perform or avoid.
In this theory, a person’s self-efficacy is determined by behaviors, environment, and personal or cognitive factors. These influence each other; however, cognitive factors play a bigger role. In self-efficacy, objectives are achieved through perseverance and overcoming obstacles and observing others succeed through sustained efforts. In addition, in self-efficacy, it relates to a person’s perception of their ability to reach a goal. According to Bandura (1986), behavior relations and changes are affected by repeated failures, motivation, performance, and frustrations. This theory is applied to this phenomenon since it is widely applied to health behavior change. Cognitive and behavioral psychotherapy for depression are based on theoretical concepts of self-efficacy.
Kasikci (2011) also addressed the self –efficacy theory emphasizing how it dras its roots from the social theory. He asserts that people are responsible for their own motivation and behavior. Thus there is a relationship between self-perception and individual action. On the other hand, Bandura refers to self-efficacy as the level of a person’s confidence in their abilities to successfully execute different tasks (Bandura, 1997). Bandura (1997) asserts that behaviour is a result of outcome expectations and self-efficacy expectation. Kasikci describes outcome expectations as hope that specific behavior will result to positive outcome. He describes efficacy expectations as a person’s assessment of their ability to behave in a particular way (Kasikci, 2011). Bandura named four mechanisms that influence self –efficacy; these are, mastery experience, modelling, social persuasion and judgement bodily states (Bandura, 1986).
Self-efficacy helps in the development and implemention of health promotion programs in advanced practice. The role of advanced practice nurses emphasizes health maintenance, healthy life style promotions, consultations, case management counselling about risk status and risk reduction (Lev, 1997).
A reconstructed a story from a person who has experienced the phenomenon
The patient I dealt with in my case was a woman aged fourty-two, a single mother with an adult daughter and son. She underwent a renal surgery successfully, but admitted for few more days because of her poor coping. When asked about her experience in the ICU, these were her words;
I had never been to the ICU before, and so I was really afraid. All my life, I believed ICU is for people who had slim chances of living, so when I entered the ICU doors, I did not know what to expect afterwards. I was anxious, as I pestered the attending nurse if I was going to live or die. The whole mechanical ventilation thing was awful. I felt I was not going to get any better. Extubation was irritating, and this compelled me to yell at the nurse and at some point turned violent. Nonetheless, I got better but since I did not cope well, it took me a little longer to totally heal.
A Mini-saga that captures the reconstructed story
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