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Applying Theory to a Practice Problem in Nursing

Introduction

Resilience is a popular concept in nursing. The origins of the concept can be traced to the early psychiatric studies that explored the reasons why certain children were unable to withstand and overcome adverse life situations (Earvolino-Ramirez, 2007). Today, resilience is usually conceptualized as one’s ability to cope with situations despite adversity (Earvolino-Ramirez, 2007). Resilience is sometimes believed to be one of the fundamental concepts in nursing, since practicing nurses are expected to be able to overcome the pressures and adverse situations facing them and their patients. The purpose of this paper is to reconsider the relevance of Laura Polk’s Theory of Resilience in the context of nurse and physician stress. The problem of nurse and physician stress remains one of the most prevalent in nursing environments. According to Jensen, Trollope-Kumar, Waters and Everson (2008), 55% of physicians and nurses claim their personal lives have suffered because of work. Changes in organizational structure, the lack of decision-making autonomy, long hours and work overloads – all these factors lead to stress in nurses and physicians (Jensen et al., 2008). Many nurses are bound to operate in stressful environments: for instance, Dermody and Bennett (2008) found nurses working in hemodialysis units to be particularly susceptible to stress, due to the complexity of care provided to patients with kidney disease. Cohen-Katz, Wiley, Capuano, Baker and Shapiro (2005) also suggest that stress and the nursing profession cannot be fully separated: nursing shortages, traumatic illness events, patients’ suffering and inability to make independent decisions in physician-controlled environments greatly contribute to the development of stress and burnout in nurses. Given the seriousness of the problem, complex strategies need to be developed, in order to facilitate the development of resilience in nurses.

Laura Polk and Theory of Resilience

Biographic note

Unfortunately, biographical information about Laura Polk is quite scarce. She currently occupies the position of Assistant Professor at the College of Southern Maryland, Department of Nursing and Health Technology (CSM, 2012). Laura Polk teaches three different courses, all being focused on the principles and practices of nursing (CSM, 2012). Still, the contribution made by Polk to the development of the nursing theory of resilience is difficult to underestimate. Polk (1997) also attempted to produce a comprehensive nursing model of resilience.

Resilience: Concept and theory

Polk (1997) was, probably, the first nursing theorist who attempted to expand the concept of resilience into a theory and nursing conceptual model. It should be noted, that Polk’s theory of resilience is a middle-range nursing theory which, according to McEwen and Willis (2010), provides answers about a particular nursing phenomenon but does not cover the entire discipline. McEwen and Willis (2010) suggest that Polk’s theory of resilience is a middle middle-range theory, which does not deal with an exclusive phenomenon but, at the same time, provides the basis for delineating the main aspects of complex nursing situations.

Polk (1997) describes resilience as “the ability to transform disaster into a growth experience and move forward” (p.5). In other words, resilience for Polk (1997) is the potential source of positive experiences that have to teach nurses to be less stressful and more powerful when dealing with problems and adverse situations. In Polk’s theory, four main patterns of resilience are specified: dispositional, relational, situational, and philosophical (Polk, 1997). The dispositional pattern incorporates the physical and psychosocial elements of resilience (Polk, 1997). These include the sense of self, temperament and intelligence, as well as physical health. The relational pattern is essentially about relationships (Polk, 1997). The situational pattern reconsiders resilience through the prism of the situation and individual capacity to deal with it (Polk, 1997). The fourth, philosophical pattern demonstrates personal beliefs and their impacts on resilience (Polk, 1997).

Unfortunately, at present, the body of literature describing and applying Polk’s theory of resilience is rather scarce, mostly due to the fact that the theory is new by itself. Peterson and Bredow (2009) claim that earlier researchers and nurses have used a variety of creative approaches to understanding the concept of resilience in its entirety. Still, some researchers used Polk’s theory to propose more specific theories and conceptual models for nursing care. Mandleco and Peery (2000) mentioned Polk’s theory of resilience while developing an organizational framework for resilience in children. Hengudomsub (2007) used Polk’s model to review the meaning of resilience in elderly people. McGee (2006) tried to analyze the meaning of resilience from the nursing perspective. The Polk Resilience Patterns Scale was used in a number of studies to measure changes and patterns of resilience (e.g. Shelton, 2009).

Applying Theory to the Problem of Nurse and Physician Stress

Polk’s theory relies on the premise that resilience is what enables individuals to transform negative experiences into the source of growth and development opportunities (Polk, 1997). As a result, the theory can be used to help nurses reconsider negative experiences and become stronger in the face of adverse situations and events. The patterns of resilience proposed by Polk (1997) allow for a more detailed examination of various resilience levels and responses in nurses. These patterns also provide extensive opportunities to detect the most problematic aspects of resilience in nurses and address them more effectively. Applying the theory of resilience to reduce the scope of stress in nurses should start with the use of Polk’s resilience scale that includes 20 different items and measures the patterns of resilience mentioned above (Polk, 1997). Then comes the analysis of each of the resilience patterns without separating them from the individual: in Polk’s theory, resilience is conceptualized as a complex synergistic relationship between all four patterns in a nonlinear manner.

Unfortunately, Polk’s theory of resilience is still too new to have a well-developed practical component. In its present, its contribution is limited mainly to detecting and analyzing the most problematic aspects of resilience in nursing. The results of such analysis should provide information and guidance to develop practical approaches to resilience. These approaches can also be taken from the existing literature, but Polk’s middle-range theory of resilience will provide the necessary criteria to make this process more effective.

Conclusion

Stress is one of the most serious problems affecting today’s nursing profession. A broad range of factors is responsible for nurse and physician stress, including nursing shortages and workloads, changes in organizational structure and requirements, long working hours, as well as the lack of decision-making power. Laura Polk’s theory of resilience provides sufficient opportunities to enhance resilience in physicians and nurses. Polk’s Resilience Scale and the patterns of resilience incorporated in the theory can help nurses assess their preparedness to deal with adverse life situations and address the most problematic aspects of resilience.

References

Cohen-Katz, J., Wiley, S.D., Capuano, T., Baker, D.M. & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II. Holistic Nursing Practice, 19(1), 26-35.

CSM. (2012). Laura V. Polk, DNSc, RN. College of Southern Maryland. Web.

Dermody, K. & Bennett, P.N. (2008). Nurse stress in hospital and satellite hemodialysis units. Journal of Renal Care, 34(1), 28-32.

Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73-82.

Jensen, P.M., Trollope-Kumar, K., Waters, H. & Everson, J. (2008). Building physician resilience. Canadian Family Physician, 54(5), 722-729.

Hengudomsub, P. (2007). Resilience later in life. Thai Pharmaceutical and Health Science Journal, 2(1), 115-123.

Mandleco, B.L. (2000). An organizational framework for conceptualizing resilience in children. JCAPN, 13, 99-111.

McEwen, M. & Wills, E.M. (2010). The theoretical basis for nursing, 3rd ed. Philadelphia: Lippincott Williams & Wilkins.

McGee, E.M. (2006). The healing circle: Resiliency in nurses. Issues in Mental Health Nursing, 27, 43-57.

Peterson, S.J. & Bredow, T.S. (2009). Middle range theories: Application to nursing research. Philadelphia: Lippincott Williams & Wilkins.

Polk, L.V. (1997). Toward a middle-range theory of resilience. Advanced Nursing Science, 19(3), 1-13.

Shelton, D. (2009). Leadership, education, achievement, and development: A nursing intervention for prevention of youthful offending behavior. Journal of American Psychiatric Nurses Association, 14(6), 429-441.

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