In this week’s assignment, you’re expected to complete a working draft of your concept analysis paper that’s due in Week 5. As a “check-in” opportunity, selected components of Steps 1-5 must be provided in your initial post to this week’s discussion board. Additionally, if you have had insights that have developed since beginning your paper, include them in your initial post. If you are unsure about how to do something, ask in your initial post. In short, this is your space to use to your advantage in order to revise and refine your work thus far and progress towards a final product. Please note, though, that this is a graded discussion and is not optional.

You should include the following in this discussion:

• Why are you doing a concept analysis (besides earning course credit)? Why are concepts significant to the discipline? How do concept analyses contribute to the development of nursing knowledge and nursing science? These questions should be answered in your introduction paragraph (Step 2) where you describe your aim/purpose.
• Of the 4 concepts (trust, hope, suffering, uncertainty), which one did you select? Refer to Step 1 in your draft paper.
• What are the defining attributes of the concept you’ve identified (Step 4)?
• Of the 4 cases (model, contrary, borderline, invented), using the critical attributes, select and describe 1 case in your initial post (Step 5).
• Include your reference list thus far (Step 3 in your draft paper).
• Include any questions and/or insights you have for your peers to consider in their reply posts.

Fisrt Reply: 

The reason why I am doing a concept analysis is to further explore a topic and discover the many ways one single topic has a significant impact on nursing. Concept analyses are crucial for the development of nursing as they provide vital information that nurses are able to learn from and implement into further practice. These analyses educate nurses in topics they might have not explored or present further information on topics they might be familiar with. These analyses spark interest within nurses and prompt the creation of new ideas that might be beneficial in further patient care. The purpose of this analysis is to initiate curiosity within one another and spark conversation in where one can present new ideas to a topic. Out of the four topics, I chose to trust as it is a vital part of nursing. Without trust, the communication between nurse and patient is little or non-existent in where no information will be discussed and might influence the plan of care.

The attributes that best relate to trust are communication, confidence, and competency. Trust allows the patient to feel comfortable with the nursing staff and will ease the discussion of personal information and details which will greatly facilitate the type of care the patient receives. Knowing additional information might help explain certain symptoms a patient might be experiencing and allow them to receive the correct nursing regimen. Trust is very important for the nurse to establish with their patients and is interwoven with building a strong rapport. Being able to effectively interact and communicate with the patient demonstrates proficient competency and allows the nurse to provide the best care possible.

Model Case: A 45-year-old female is admitted to the hospital for a fractured tibia that resulted from a work injury. Throughout the admission, she is extremely reserved and only answers in “yes and no” answers. The nurse notices that she is guarded and allows little to no physical contact. The patient is visibly anxious in where she observes her surroundings very digitally. The nurse sits down next to the patient and is talking to her in a way that she is very warming and kind in where she genuinely is interested in the patient’s backstory. The patient is taken aback by how much dedication the nurse is inputting into her health and decides to share additional information on how the injury was sustained and information on her previous health history. Here, the patient gained trust in the nurse in where she felt comfortable to confide personal information.

second reply:

The concept analysis that I choose for this paper is suffering. As an ICU nurse for years, I seen a lot of unnecessary suffering especially at the end of life that could have been avoided. As nurses we took an oath to do no harm and have an ethical responsibility to relieve suffering when we are able to. Especially when it comes to end of life we should try to decrease the suffering and anxiety that is associated with it when it comes to the patient.

Merriam Webster states the definition of suffering is the state or experience of one that suffers, forced to endure. The free dictionary describes suffering as pain, misery, or loss experienced by a person who endures pain. Bible study tools describes suffering at the experience of physical pain and, or mental distress. One thing that all of these definitions have in common are that suffering is pain and distress that is phyical and mental. The thesaurus shows that synonyms for the word suffering are discomfort, torture, anguish, and misery. None of these descriptions is something that we would ever intentionally put one of our patients as a nurse or a loved one through.

Foyle (2005) states not all pain and suffering is extreme, bordering on the unbearable. Pain and suffering range from infinitesimal to the unimaginably excruciating. And both pain and suffering may last seconds or lifetimes. They may be fleeting or chronic. Svenaues (2020) goes on to say that suffering can also be related to no longer being able to be the person one wants to be in the eyes of others, to losing one’s dignity and identity. Pastrana (2008) states the improvement of a person’s wellbeing and contributing to a good end of life. Both the improvement of a person’s quality of life and the relief of suffering are unanimously regarded as central aims of physicians. The next article I found talks about that delaying the withdrawal of treatment when it is clearly indicated may result in unnecessary patient suffering at the end of life, distress for family as well as moral distress for staff.

A real-life scenario that uses the concept of suffering at the end of life is of a middle-aged woman I took care of in the ICU. She had a massive CVA a few years back that had left her with not much cognitive impairment, paralyzed on her left side of her body, and unable to eat or drink by mouth. She was bedridden and was placed in a nursing home where she would get the care she needed. The patient was brought into the emergency department by ambulance because her heart rate was extremely tachy, her blood pressure was low despite efforts to raise it, and she was running a fever. During assessment they found a large decubitus ulcer on her coccyx. They ran regular chemistry and also got blood cultures. Vitals, assessment, and labs showed the patient was septic from this ulcer on her coccyx. The intensivist, the general surgeon and myself spoke to the family explaining that there was a couple options for this lady. One option was to take her to surgery where she would be intubated and probably not come back off the vent. The ucler would be debrided and with location and size probably would never heal, and the risks of her being so sick and going under the stress there was a good possibility of the patient passing during surgery. The second option would be to make the patient a DNR and make her as comfortable as possible and family could enjoy the time, they have left with her and the patient would not suffer. Despite all the efforts the family choose surgery, this patient would go on to have several surgeries. She was left on the vent, she was in pain daily, was fed meds and nutrition through a peg tube in her belly, a foley and rectal tube, and several lines that were giving her medication to sustain her life. She would endure this torture and suffering for 9 days, in this time she coded twice and was brought back. Finally on the 10th day the family decided to make her a DNR and let her be terminally weaned so she could die. Nine days this lady suffered and endured pain even though it was unneccessary.

Third Reply

Introduction

The purpose of a concept analysis is to identify the goals of a concept and explain its notable characteristics, attributes, antecedents, and consequences. Concepts are said to be the central point of all knowledge, they join facts that would otherwise stand alone and are essential in learning because they facilitate the incorporation of new knowledge that is always arising (Rodgers, 2017). Being in a concept-based course facilitates learning by allowing students to interrelate topics and think more critically rather than just focusing on memorization of facts. The concept of hope is one that is crucial to nursing because it allows positivity to enter the hearts of those who are feeling their lowest. Hope maintains spirits high and offers those who are going through tough times a second chance at life. Nurses must incorporate hope into their care in order to provide patients a sense of direction, whether that be when a cure is not on option or when they just need some comfort. (Benner, 2017).

Defining Hope

There are many ways to define hope, one of the definitions being, to hold a desire with the anticipation that something will happen or will be true (Merriam-Webster, 2021). According to the Cambridge Dictionary it is to want something to occur and to have enough reason and confidence to believe that it will come true (Cambridge English Dictionary). Hope can also be defined as an intent to do something if possible and the want of something to happen and believing it is possible (Oxford, 2021). Synonyms of hope include, but are not limited to, expect, trust, anticipate, confidence, longing, faith, desire, and assumption. (Collins, 2016). In the International Medical Journal, Ghavi pointed out that hope and life meaning were interrelated with each other, therefore making hope a factor of the meaning of life (Ghavi, 2021), and an essential part of nursing care.

Attributes of Hope

A variety of attributes come to mind when speaking about hope. A few that stood out in this concept are, a positive outlook on what’s to come, a means of enjoying what is currently happening in life, and optimism for a better reality that is coming soon. Some common themes that Daneault observed were, hope as an irrational phenomenon, hope for a miracle, hope for a prolonged life, and hope for a better quality of life, (Daneault, 2016).

Model Case

A patient, Elizabeth, was diagnosed with breast cancer and was completely frightened by the news. After having several tests ran the doctors found that she would be able to participate in chemo and radiation therapy in order to shrink her tumor. The odds of it being completely removed were very high. Along with the good news and the support and motivation of her family, Elizabeth was able to keep high hopes that she would soon be healthy. Elizabeth kept up with her medications and continued to focus on her physical and mental health in order to ensure that she was doing her part in becoming the healthiest version of herself. Seeing the doctors and her family so hopeful kept Elizabeth fighting until she was completely cancer free.