Story Theory in Nursing Situations
Story Theory in Nursing Situations
Introduction
Middle range theories are widely applicable in solving some of the challenges that are experienced in the nursing practice. This paper gives a reflection of how I applied the Story Theory, a middle range theory, in a situation involving self-care maintenance. Self-care maintenance in the nursing practice refers to activities performed by a patient to preserve health, improve well being, or to maintain emotional and physical stability (Kus, 2011). In some cases, self-care maintenance behaviors and activities focus on self-improvement but in other cases, they mirror recommendations by nurses and other healthcare providers. Taking medication as prescribed is one of the behaviors that mirror recommendations by healthcare providers. As Kus (2011) explains, adherence to self-care maintenance is very essential as it is associated with the best outcomes. I work as a community health nurse in New York and in the past, I have encountered situations where patients fail to adhere to the recommendation for taking medications as prescribed by healthcare providers. Three months ago, I made a home visit to an elderly patient who was home bound. He had a number of medication bottles but I realized that he had not been taking his prescribed medications. I decided to ask him why he was not adhering to the recommendations. He replied that he experienced trouble while opening the bottles, he was not able to read labels and he was not sure about time to take the medications. While trying to solve the situation, I decided to apply the Story Theory.
Story Theory
Story Theory is a middle range theory that was developed by Mary Jane Smith and Patricia Liehr in 1999. Smith and Liehr described “story” as a narrative happening that enables a person to connect with self through a dialogue with another persons ( HYPERLINK “http://shu.summon.serialssolutions.com/search?s.dym=false&s.q=Author%3A%22Dolly+Garcia-Willix%22” Garcia-Willix & HYPERLINK “http://shu.summon.serialssolutions.com/search?s.dym=false&s.q=Author%3A%22Patricia+Sferrazza%22” P Sferrazza, 2010). Ease emerges especially when a person accepts the story as his/her own and embraces the complexity of a particular situation. According to Smith and Liehr (2008), most nursing encounters occur in the context of story. Within a community, stories may be given to a patient by nurses, family members and other healthcare providers. Whenever a nurse engages a patient to discus about a health challenge or health matters, Story Theory is applicable.
Usually, a patient perceives the healthcare provider who is giving a story as an expert and keeps on querying vague story directions. Usually, after listening to a story from a nurse, a patient abandons preexisting assumptions and starts believing in the information presented in the story. According to Smith and Liehr (2008), this enables the patient to connect with self and to create ease. The Story Theory is based on three main assumptions. The first assumption is that human beings change as changes occur in their world. The changes usually take place in various connected dimensions. The second assumption is that human beings live in a world where past and future events are transformed at the present moment. The third assumption is that people change their perceptions of experiences as their awareness increases (Liehr & Smith, 2008).
There are three concepts of story theory, namely, connecting with self-in-relation, intentional dialogue and creating ease. The related method dimensions are developing story plot, complicating health challenge and movement towards resolving. The nurse engages a patient through intentional dialogue about a particular health challenge. As story sharing proceeds, the patient connects with self-in-relation. As the message presented in the story becomes clear to the patient, the patient starts experiencing easiness. This makes it easy for both the nurse and the patient to solve the health challenge.
In response to the issue raised by the elderly patient, I decided to come up with a story that would provide solutions to the issue. I started by explaining to the patient that self-care is usually a challenging process to both patients and clinicians. However, I explained that it is a necessary process for the every patient. I was not sure whether the patient gave a genuine reason for not taking the prescribed medications. So, I decided to explain to him about the factors that influence a patient not to take the prescribed medications. I explained how to overcome the barriers. I also mentioned some facilitators of self-care. I explained to him that inability to read labels and prescriptions given by healthcare providers is one of the major challenges experienced by elderly people. I informed the patient that it is always important to ask for assistance from family members or other people who are available in reading the labels and prescriptions and in opening the bottles.
Secondly, I talked about the importance of motivation. I explained to the patent about the benefits of taking the medications as prescribed, such as preserving health, improving health, improving, improving overall wellbeing and maintaining physical and emotional stability. I explained to the patient that desire for such benefits should act as a source of motivation for self-care. Also, I mentioned about how cultural beliefs can act as barrier to self-care. I explained about how culture may affect an individual’s self image and drive for self-care. As well, I talked about how confidence can affect drive for self-care. I explained to the patient that he had to have confident that he would get better after taking medications as prescribed. Also, I mentioned about the importance of making it a habit to take the prescribed medications. Finally, I emphasized that self-care is usually not effective when a patient does it alone. I mentioned on the importance of always seeking assistance from significant others.
Use of story theory in Nursing Situations
The Story Theory is useful to healthcare professionals and researchers. To healthcare professionals, the theory helps in assessing where a patient is struggling in self care practice. As HYPERLINK “http://shu.summon.serialssolutions.com/search?s.dym=false&s.q=Author%3A%22Riegel%2C+Barbara%22” Riegel, Jaarsma & Strömberg (2012) explains, a patient who is poor in self care maintenance needs a very different intervention from a patient who is unable to recognize symptoms. For instance, adoption of a given self maintenance behavior may require motivation whereas recognition of symptoms may require skills (Riegel et al (2012).
Further, assessment of where a patient is facing difficulties may help health professionals to come up with a tailored intervention that may be more cost-effective and advantageous than a general intervention that focuses on areas of self care that the patient could have already mastered. The theory can also be applied when dealing with patients with emotional stress, chronic diseases and psychiatric illnesses and patients who have difficulties in making decisions (Kus, 2011). The usefulness of the theory to researchers is that it provides a structure that helps them to focus their research efforts. This helps to speed up the attainment of the expected results that can then be translated into clinical practice (Kim & Rodney, 2009).
Conclusion
In conclusion, the Story Theory is one of middle range theories that are applicable in solving certain challenges that are encountered in the nursing practice. I applied the theory in a situation where an elderly person had not been adhering the recommendations by healthcare providers to take the prescribed medications. I gave him a story that helped to change his perception towards self-care. The theory is also applicable in situations where healthcare providers deal with patients with emotional stress, chronic diseases and psychiatric illnesses and patients who have difficulties in making decisions. As well, the theory is useful to researchers.
.
References
Garcia-Willix, D. & Sferrazza, P. (2010). A middle range theory of caregiver stress. Home
Healthcare Nurse, 28(5), 268
Kim, S. K. & Strump, R. L. (2009). Driving forces of coordination costs in
distributor-supplier relationships: toward a middle-range theory. Journal of the Academy of Marketing Science, 37(4), 384 – 399
Kus, K. (2011). Matters of Belief: Middle-Range Theory, Religion, and the “State”.
Archeological papers of the American Anthropological Association, 21(1), 11
Liehr, P. R. & Smith, M. J. N. (2008). Middle Range Theory for Nursing, Second Edition:
Second Edition. New York: Springer Publishing Company
Riegel, B., Jaarsma, T. & Strömberg, A. (2012). A middle-range theory of self-care of chronic
illness. Advances in nursing science, 35(3), 19
