Evaluating Two Middle Range Theories Nursing Essay

Evaluating Two Middle Range Theories Nursing Essay The purpose of this paper is to evaluate two middle range theories abilities to test the concept of comfort for the practice question Do neonatal nurses who care for dying infants who attend an end of life care educational training program compared to neonatal nurses who do not attend the program experience a difference in comfort levels (Comfort Level for Caring for Dying Infants (CLCDI)) when caring for a dying infant? A summary of two middle range theories the Comfort Theory (Kolcaba, 1994) and the Theory of Self-Efficacy (Resnick, xxxx) will be summarized and then critiqued using Smith and Liehrs (xxxx) Framework for Evaluating Middle Range Theory. The discussion will conclude with a summary of strengths and weakness of the theories and a research hypothesis to reflect that reflects the most appropriate theories conceptual definitions and propositions. Introduction Background Despite nurses as frontline caregivers for dying patients and their families many nurses have identified that they struggle with the responding adequately to the emotional devastation to parents and siblings when caring for a neonate with an unresolved terminal condition (Frommet, 1991). With the advances in neonatal care and life sustaining treatments, sick and very preterm infants do not often die in utero, at birth, or shortly after birth, but instead they often live much longer in a healthcare paradigm of comfort care and dignified death. This relatively new emersion of the end of life model integrates a more holistic approach which considers a more comprehensive view of the patients needs (emotional, spiritual, and medical) (Mallory, 2002; Mallory, 2003; WHO, 2002). With this paradigm shift, health care professionals are obligated to assess the adequacy of their own knowledge, attitudes, and beliefs about death and dying. Multiple studies regarding nurses preparation for dealing with death and dying have consistently found that nurses that nurses do not feel educationally prepared to care for dying patients and insist that healthcare professionals should receive additional education on end of life care to bridge the deficit gap (Frommet, 1991; Robinson, 2004; White, Coyne, Patel, 2001; Beckstrand, Callister, Kirchhoff, 2006). These findings have led to a further observation that nurses caring for these complex patients regularly experience moral distress from competing principles of their personal, collegial, organizational, and religious/spiritual ethics (Frommet, 1991). Practice Problem To help ease this moral distress an evidence based end-of -life educational training program for NICU nurses has been successfully implemented in several neonatal intensive care units (NICUs) to increase the nurses comfort level of caring for neonates and their families at the end of life (Bagbi, Rogers, Gomez, McMahon, 2008). To determine if an evidence based end of life educational program impacts nurses comfort levels in caring for dying infants and their families a question was developed using the population (P) intervention (I) compared to (C) outcome (O) format (Newhouse, Dearhold, 1997). The following discussion will focus on this PICO question Do neonatal nurses who care for dying infants who attend an end of life care educational training program compared to neonatal nurses who do not attend the program experience a difference in comfort levels (Comfort Level for Caring for Dying Infants (CLCDI)) when caring for a dying infant? During the intervention a monthly 1 hour, neo natal end of life education program will be conducted over a 6 month period of time based on research about what nurses would like to know about caring for a dying infant (Robinson, 2004). For the purpose of this problem, comfort is defined as the ability of the NICU nurse(s) to show adequate knowledge and skills in providing neonatal end of life care for dying babies and their families. For this problem comfort will be measured as a score on the ordinal scale of Comfort Level Caring for Dying Infants (CLCDI). The instrument consisting of 15 items, measured on a 5 point Likert type scale equates scores of 1=never; 2=rarely; 3=sometimes; 4=often, 5=always measures the level of comfort a NICU nurse has caring for dying infants as opposed to their perception toward pediatric or neonatal end of life care (Bagbi, Rogers, Gomez, and McMahon, 2008). In evaluating the score, the higher the reported score the greater level of comfort NICU nurses have in caring for dying babies. Testing the Concept of Comfort A portion of Kolbacas (1991) Theory of Comfort and Resnicks (2008) Theory of Self-Efficacy, two middle range theories, will be used to test the concept of comfort for providing an organizing structure. Based on previous studies about nurses comfort when caring for patients, propositions five and six of Kolbacas Theory of Comfort seem to be a promising fit for this problem (Kolbaca, 1991, Kolbaca, XXX). These propositions collectively propose that patients, nurses, and other members of the healthcare team agree upon desirable and realistic health seeking behaviors (HSBs) and if enhanced comfort is achieved, patients, family members, and/or nurses are strengthened to engage in HSBs, comfort is further enhanced (Kolbaca, 1991). However, comfort as defined conceptually in this case as knowledge and skill can alternatively be equated with a sense of competence or self-efficacy of the NICU nurse to care for a dying infant and their family. There are many examples in the nursing literature linking self-efficacy to knowledge and skill (xxxx, xxxxx).) Self-efficacy, knowledge, and skills are also central to Banduras theory, which is the basis for Resnicks (xxxx) Self-Efficacy theory. Self-efficacy as described in Resnicks (xxxx) Theory of Self-Efficacy for this context is described as the judgment about the nurses ability to organize and execute a course of action required to attain designated types of performances. The theory states that perceived self-efficacy, defined as the individuals judgment of his or her capabilities to organize and execute courses of action, is a determinant of performance (Resnick, xxxx). Self-efficacy beliefs provide the foundation for human motivation, well-being, and personal accomplishment (Resnick, xxxx). According to Resnick (XXXX) theory individuals with higher levels of self-efficacy for a specific behavior (caring for a dying infant) are more likely to attempt that behavior. There are many examples in the literature using the Theory o f Self-Efficacy to support nursing education interventions (xxxxx, xxxxx). For these reasons, Resnicks Theory of Self-Efficacy (xxx) will be used to test the concept of nurses comfort or knowledge and skill (self-efficacy) in caring for dying infants and their families. The purpose of the following discussion is to summarize, describe, analyze, and evaluate these theories using the Framework for the Evaluation of Middle Range Theories (Smith, 2008) and conclude with a synthesis and research hypothesis to reflect conceptual definitions and propositions of the theory with the best fit. Theory Summaries: Comfort and Self-Efficacy Kolcabas Comfort Theory The Comfort Theory is a humanistic, holistic, patient need based nursing derived middle range theory (Kolbaca, xxxx). The concept of comfort has had a historic and consistent presence in nursing. In the early 1900s , comfort was considered to be a goal for both nursing and medicine, as it was believed that comfort led to recovery (McIlveen Morse, 1995). Over time comfort has become an increasingly minor focus, at times reserved only for those patients for whom no further medical treatment options are available (McIlveen Morse, 1995). The term comfort is used as a noun (comforter), adjective (comforting), verb (to comfort), or adverb (comfort the patient) (xxx). It is also used as a negative (absence of discomfort), neutral (ease), or positive (hope inspiring). Webster (1990) defines comfort as relief from distress; to soothe in sorrow or distress; a person or thing that comforts; a state of ease and quiet enjoyment free from worry; anything that makes life easy; and the lessening of misery or grief by calming or inspiring with hope. The origin of comfort is confortrare which means to strengthen greatly(Kolcaba, 1992). Based on the diversity of these terms comfort is a complex term. Kolcabas (1991) concept analysis of comfort helped to clarify the role of comfort as a holistic concept for nursing. This review confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients (David, 2002). Over a period of years and revisions Kolcaba (1994) developed the comfort the ory which continues to evolve and change with changes as recent as 2007 (Figure 2). Kolcaba (1994, 2001, 2003) has defined comfort as the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience (physical, psychospiritual, sociocultural, and environmental). The terms relief, ease, and transcendence are types of comfort that occur physically and mentally (Figure 2). The terms are defined based on definitions from medicine, theology, ergonomics, psychology, and nursing (Kolcaba Kolcaba, 1991). Relief is the state of having a discomfort mitigated or alleviated. Ease is the absence of specific discomforts. Transcendence is the ability to rise above discomforts when they cannot be eradicated or avoided (e.g., the child feels confident about ambulation although (s)he knows it will exacerbate pain). Transcendence, as a type of comfort, accounts for its strengthening property and reminds nurses to never give up helping their children and family members feel comforted. Interventions for increasing transcendence can be targeted to improving the environment, increasing social support, or providing reassurance. The three types of comfort occur in four contexts of experience: physical, psychospiritual, sociocultural, and environmental. These contexts were derived from an extensive review of the nursing literature on holism (Kolcaba, 1992). When the three types of comfort are juxtaposed with the four contexts of experience, a 12-cell grid is created, which is called a taxonomic structure (TS) (Figure 1) . Taken together, these cells represent all relevant aspects (defining attributes) of comfort for nursing and demonstrate the holistic nature of comfort as an important goal of care. All comfort needs can be placed somewhere on the taxonomic structure, and the cells are not mutually exclusive. A sample pediatric case study using the TS as a guide for a holistic comfort assessment is demonstrated below (see Figure 1). The concepts for the middle range for Comfort Theory include comfort needs, comfort interventions, intervening variables, enhanced comfort, health-seeking behaviors, and institutional integrity (Kolcaba, 1994). All of these concepts are relative to patients, families, and nurses (Kolcaba, 2003; Kolcaba, Tilton, Drouin, 2006). There are eight propositions which link the above concepts together. All or parts of the Comfort Theory can be tested for research (Peterson Bredow, 2010). In the comfort theory, Kolcaba asserts that when healthcare needs of a patient are appropriately assessed and proper nursing interventions carried out to address those needs, taking into account variables intervening in the situation, the outcome is enhanced patient comfort over time (Kolcaba, 2007). Once comfort is enhanced, the patient is likely to increase health-seeking behaviors. These behaviors may be internal to the patient (eg, wound healing or improved oxygenation), external to the patient (eg, active participation in rehabilitation exercises), or a peaceful death. Furthermore, Kolcaba asserted that when a patient experiences health-seeking behaviors, the integrity of the institution is subsequently increased because the increase in health-seeking behaviors will result in improved outcomes. Increased institutional integrity lends itself to the development and implementation of best practices and best policies secondary to the positive outcomes experienced by patients (Kolcab a, 2007). To translate the concepts to practice the effectiveness of a holistic intervention can be targeted to the taxonomic structure for enhancing comfort in a specific patient, family, or nurse population over time. Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental).The comfort theory has been operationalized in many research settings with a variety of patient and target populations ranging from end of life care to the comfort of nurses (xxxx). Resnick Theory of Self-Efficacy Self efficacy is described as a way to organize an individuals judgment of his or her capability to execute a course of action. The Theory of Self-efficacy states that self-efficacy expectations and outcome expectations are not only influenced by behavior, but also verbal encouragement, reflective thinking, physiological sensations and role or self-modeling (Bandura, 1995).. Through self evaluation an individual judges their capability to perform and established self expectations which is visually depicted in the conceptual model (Appendix 2) (Resnick, 2008). Resnicks Theory of Self Efficacy is based on Banduras social cognitive theory and conceptualizes person-behavior-environment as triadic reciprocity the foundation for reciprocal determinism (Bandura, 1977, 1986). Most of the research into self-efficacy beliefs among older adults has been quantitative and has consistently supported the influence of those beliefs on behavior. However, it has not been established how efficacy beliefs actually influence motivation in older adults, or what sources of efficacy-enhancing information help strengthen those beliefs. Kolcabas Comfort Theory: Description, Analysis, and Evaluation Theory Description Historical context. The Comfort Theory is a humanistic, holistic, patient need based nursing derived middle range theory (Kolbaca, xxxx). The concept of comfort has had a historic and consistent presence in nursing. In the early 1900s , comfort was considered to be a goal for both nursing and medicine, as it was believed that comfort led to recovery (McIlveen Morse, 1995). Over time comfort has become an increasingly minor focus, at times reserved only for those patients for whom no further medical treatment options are available (McIlveen Morse, 1995). The term comfort is used as a noun (comforter), adjective (comforting), verb (to comfort), or adverb (comfort the patient) (xxx). It is also used as a negative (absence of discomfort), neutral (ease), or positive (hope inspiring). Webster (1990) defines comfort as relief from distress; to soothe in sorrow or distress; a person or thing that comforts; a state of ease and quiet enjoyment free from worry; anything that makes life easy; and the lessening of misery or grief by calming or inspiring with hope. The origin of comfort is confortrare which means to strengthen greatly(Kolcaba, 1992). Based on the diversity of these terms comfort is a complex term. Kolcabas (1991) concept analysis of comfort helped to clarify the role of comfort as a holistic concept for nursing. This review confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients (David, 2002). Over a period of years and revisions Kolcaba (1994) developed the comfort the ory which continues to evolve and change with changes as recent as 2007 (Figure 2). Structural Components. Assumptions. Kolcabas Theory of Comfort (1994) makes four basic assumptions about reality. She assumes that humans beings have holistic responses to complex stimuli; comfort is a desirable holistic state that is germane to the discipline of nursing; human beings actively strive to meet, or to have met, their basic comfort needs, and that comfort is more than the absence of pain, anxiety, and other physical discomforts (Kolcaba , 2009). Concepts. Kolcaba defines six concepts of comfort which are relative to patients, families, and nurses (Table 1) . The term family, as defined by Kolcaba (2003) encompasses significant others as determined by the patient (Kolcaba, 2003; Kolcaba, Tilton Drouin, 2006). The first concept is of comfort needs which is the relief/ease/transcendence in physical, psychospiritual, sociocultural and environmental contexts of human experience. Comfort interventions in the model are defined as interventions of the health care team specifically targeting comfort of the patient, family and nurses. Intervening variables are positive or negative factors over which the health care team has little control, including physical limitations of the hospital or patients home, cultural influences, socioeconomic factors, prognosis, concurrent medical or psychological conditions. Health-seeking behaviors are those behaviors of patient, family or nurses (conscious or unconscious) which promote well-being; may b e internal, external or towards promoting a peaceful death. The final concept, institutional integrity, added in most recently, are values, financial stability and wholeness of health care facilities at the local state or national levels. Propositions. To help test the concept of nurses comfort caring for dying infants, propositions five and six of Kolcabas comfort theory are examined. These propositions state that patients, nurses, and other members of the healthcare team agree upon desirable and realistic health seeking behaviors (HSBs) (five) and if enhanced comfort is achieved, patients, family members, and/or nurses are strengthened to engage in HSBs, which further enhances comfort (six). These propositions provide rationale for why nurses and other health care professionals should focus on the patient, family, or in this case the nurses comfort beyond altruistic reasons. Because health seeking behaviors include internal and external behaviors almost any health-related outcome important in a healthcare setting can be classified as a health seeking behavior (Peterson Bredow, 2010). The desirable and realistic health seeking behavior (HSB) for this study is nurses comfort (knowledge and skills) to relieve moral di stress in caring for a dying infant and their family. Several studies support that moral and other types of distress are frequently observed in nurses who care for dying infants (Frommet, 1991) and most importantly indicate that nurses are seeking education regarding patient end of life issues (XXXXX). It is believed that reducing this distress and frustration can be affected through an effective end of life educational programs and is likely to improve the knowledge and skills nurses need to help increase their comfort level in caring for dying infants (xxxxx). Functional Components. Visualizing the concepts in the conceptual model, the Theory Analysis and Evaluation To analyze and evaluate Kolcabas Comfort Theory (1994) the substantive foundation, structural integrity, and functional adequacy of the theory using Smith and Liehrs (2008) Framework for the Evaluation of Middle Range Theories is discussed below (Appendix 1). Substantive foundations. Assessing the substantive foundation of a middle range theory is based on four criteria (Smith, 2003). The first criterion evaluates whether the theory is within the focus of the discipline of nursing. Kolcabas comfort theory successfully addresses four concepts comprising the metaparadigm of nursing, defining the concepts as they correspond to the theory (Dowd, 2002; Kolbaca, 2007) as well as presents a diagram of how the Comfort Theory relates theoretically to other nursing concepts (Figure 2) (Kolcaba, 1994) . Nursing is described as the process of assessing the patients comfort needs, developing and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions. Person is described as the recipient of nursing care; the patient may be an individual, family, institution, or community. Environment is considered to be the external surroundings of the patient and can be manipulated to increase patient comfort. Fi nally, health is viewed as the optimum functioning of the patient as they define it. The ability of the framework to suggest interventions that help guide nursing interventions to increase comfort supports the discipline of nursing, and in doing so meeting the first criteria. The second criterion evaluates whether the assumptions are specified and congruent with the focus. The four assumptions in the Comfort Theory are explicitly stated and so meet the second criteria. Comfort theory (xxxx) assumes that humans beings have holistic responses to complex stimuli; comfort is a desirable holistic state that is germane to the discipline of nursing; human beings actively strive to meet, or to have met, their basic comfort needs, and that comfort is more than the absence of pain, anxiety, and other physical discomforts (Kolcaba , 2009). Because the Comfort Theory (XXXX) substantially describes the concept of comfort at the middle range level of discourse, the third criterion of the substantive foundation is met. Kolcabas (1991) concept analysis of comfort helped to clarify the role of comfort as a holistic concept for nursing. This review confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients (David, 2002). The Comfort Theory provides an excellent description, explanation, and interpretation of the comfort concept in multiple domains and practice settings. Comfort theory is at the middle range level in that is defined in a measurable way and can be operationalized in both research and practice settings. The final criterion for this category evaluates if the origins are rooted in practice and research experience. The Comfort Theory has been used in numerous practice and research settings to provide a framework where patients have comfort needs and enhancing their comfort is valued. It has also been used to enhance working environments, especially for nurses, and most recently as a framework for working toward national institutional recognitions. More specifically parts are all of the theory have been used to test the effectiveness of holistic interventions for increasing comfort (xxxxxxx), to demonstrate the correlation between comfort and subsequent HSBs (xxxxx) and to relate HSBs to desirable institutional outcomes. It has also been used as a framework for helping families make difficult decisions about end of life (xxxxx). International and national healthcare institutions have also used Comfort Theory to enhance the work environment for nurses (xxxx). In these cases, nurses comfo rt is of interest and is theoretically related to the integrity of the institution. Summarize specific studies and tools used here. Structural integrity. There are four criterion for evaluating structural integrity. The first criterion is that the concepts are well defined. The concepts (defined above) of comfort needs, comfort interventions, intervening variables, enhanced comfort, health-seeking behaviors, and institutional integrity are clearly defined and easy to understand. There are numerous examples of applying the concepts in the literature for further clarification (xxxxx). The second criterion of structural integrity is that concepts within the theory are at the middle range level of abstraction. The concepts of the Comfort Theory-comfort needs, comfort interventions, intervening variables, enhanced comfort, health seeking behaviors, and institutional integrity are near the same level on the ladder of abstraction at the middle range level. They are more concrete because they can and have been operationalized and measured (xxxxx). The third criterion of structural integrity is that there are no more concepts than needed to explain the phenomena. Overall, the concepts adequately explain the phenomena of comfort. The theory is synthesized and organized in a simple manner. Lastly, the fourth criterion evaluates whether the concepts and relationships among the concepts are logically presented with a model. In the Comfort Theory (1994) model the ideas are integrated to create an understanding of the whole phenomenon of comfort in a model. The Comfort Theory (1994) model is a great example of presenting the concepts and statements in a linear logical order so the appreciation of the theory can be recognized (Smith, 2003). Functional adequacy. Because the criterion for functional adequacy overlap somewhat the five criterion will be discussed collectively. The five criterion include: theory can be applied to a variety of practice environments and clients; empirical indicators have been identified; published examples exist of research and theory in practice; and that the theory has evolved through scholarly inquiry. The Comfort Theory easily meets all of these criterions. For example, the Comfort Theory has been used widely in a variety of research in practice settings and patient and family populations. Even though the Comfort Theory has been used most widely with patients and families at the end of life and surrounding holistic palliative care nursing interventions, there has been a broad application of the theory in other populations as well including mothers in labor (xxxx), Alzheimer patients (xxxx), pediatric intensive care unit patients and families (xxxx), patients on bedrest (xxxx), those underg oing radiation therapy (xxxx) and for infants comfort and pain (xxxx). Most recently research of using the theory in practice has expanded to support institutional nursing recognition and comfort in the nursing working environment. In each of the populations mentioned above a psychometric comfort instrument has been developed as empirical indicators of concepts in the theory. However, the empirical indicators extend beyond empiricism and some include perceptions, self reports, observable behaviors and biological indicators (Ford-Gibloe, Campbell, Berman, 1995; Reed, 1995). The Comfort Theory (1994) has also been revised with the latest revision in 2007. The empirical adequacy of the Comfort Theory is evidence of the maturity of this theory (Smith, 2003). Summary The Comfort Theory (1994) is a well defined and well tested theory. Its strength lies in the versatility, adaptability, and testability of the concepts. The comfort theory clearly defines the concepts in the theory and the relationship between them. Because the comfort theory meets most of the substantitive foundations, structural integrity, and functional adequacy criteria the Comfort Theory (1994) is a strong middle range theory. An area that could increase the generalizability especially for nursing institutions is a change in the term in the model of nursing interventions to comfort interventions (xxxxx). Resnicks Self-Efficacy Theory: Description, Analysis, and Evaluation Theory Description Historical context. Resnicks Theory of Self Efficacy is based on Banduras social cognitive theory and conceptualizes person-behavior-environment as triadic reciprocity the foundation for reciprocal determinism (Bandura, 1977, 1986). The cognitive appraisal of these factors results in a perception of a level of confidence in the individuals ability to perform a certain behavior. The positive performance of this behavior reinforces self-efficacy expectations (Bandura, 1995). Structural Components. Although it is not explicitly stated, the core of this theory assumes that people can consciously change and develop or control their behavior. This is important to the proposition that self-efficacy also can be changed or enhanced through reflective thought, general knowledge, skills to perform a specific behavior, and self influence. This perspective is rooted in the model of triadic reciprocality (foundation for reciprocal determinism) in which personal determinants (self-efficacy), environmental conditions (treatment conditions) and action (practice) are mutually interactive influences. Therefore, improving performance depends on changing some of these influences (Bandura, 1977). In order to determine self-efficacy an individual must have the opportunity for self evaluation to evaluate how likely it is he or she can achieve a given level of performance. Concepts. The two major components of self efficacy include self-efficacy expectations and outcome expectations (Table 2). Self-efficacy expectations are judgments about the personal ability to accomplish a given task. Outcome expectations are judgments about what will happen if a given task is accomplished. These two components are differentiated because individuals can believe a certain behavior will result in a specific outcome, however, they may not believe they are capable of performing the behavior required for the outcome to occur (Bandura 1977, 1986). For example, a NICU nurse may believe attending an end of life education series will increase his/her knowledge and skill and ease moral distress, but may not believe that they could provide sensitive care for some ethical, religious, or moral reason. It is generally anticipated, but not always realistic that self-efficacy will have a positive impact on behavior. There are times when self-efficacy will have no or a negative impa ct on performance (Vancouver, Thomspon, Williams, 2001). Bandura (1977, 1986, 1997) suggests that outcome expectations are based largely on the individuals self-efficacy expectations, which generally depend on their judgment about how well they can perform the behavior; can be disassociated with self-efficacy expectations; and are partially separable from self-efficacy judgments when extrinsic outcomes are fixed. Because the outcomes an individual expects are the results of the judgments about what he or she can accomplish, they are unlikely to contribute to predictions of behavior (Bandura, 1977). Judgments about ones self-efficacy is based on four informational sources including enactive attainment, vicarious experience, verbal persuasion and physiological state. The first source, enactive attainment, or the actual performance of a behavior has been described as the most influential source of self-efficacy information (Bandura, 1986,; Bandura Adams, 1977). There has been repeated empirical evidence that actually performing an activity strengthens self-efficacy beliefs due to informational sources (Bandura, 1995). The second source, vicarious experience or visualizing other similar people perform a behavior, also influence self-efficacy (Bandura, Adams, Hardy, Howells, 1980). Conditions that impact vicarious experience include amount of exposure or experience to the behavior (least experience causes greater impact) and amount of instruction given (influence of others is greater with unclear guidelines) (Resnick Galik, 2006). Another source verbal persuasion or exhortation i nvolves telling an individual he or she has the capabilities to master the given behavior. Verbal encouragement from a trusted, credible source in counseling or education form has been used alone to strengthen efficacy expectations (Castro, King, Brassington, 2001; Hitunen et al. 2005; Moore et al., 2006; Resnick, Simpson, et al., 2006). The final information source physiological feedback or state during a behavior can be important in relation to coping with stressors, health functioning, and physical accomplishments. Interventions can be used to alter the interpretation of physiological feedback and help individuals cope with physical sensations, enhancing self efficacy and resulting in improved performance (Bandura Adams, 1977). Propositions. To help test the concept of nurses comfort caring for dying infants,

Venezuela Culture

In all cultures, there are different dimensions that can be categorized into a continuum. Kluckhohn and Strodtbeck have functions of cultural patterns such as common human problems, preferred solutions and most importantly, a continuum. A continuum is how things are rated by percentages. For example, happiness. It could be either more or less in certain situations. In Hofstede’s dimensions of culture, there are two topics and only one can be higher in certain cultures than others. The country I chose to do is the culture of Venezuela.Venezuela is very similar to the rest of the Latin American countries but has exceptional characteristics when it comes to the dimensions that Hofstede describes. The dimensions of culture that will be discussed fall into the four common ones: collectivism, power distance, masculinity and low uncertainty avoidance. Venezuela is a unique country with many different ideas that relate to their culture. Venezuela falls into the collectivism category. This means that the country unites as one, focusing on the needs of groups rather than the individual themselves. The other side of the dimension is individualism.Individualism, as its name says, focuses on the individual where they have to sand up for themselves. Collectivists tend to have large, extended families which continue protecting them in exchange for unquestioning loyalty (Individualism 2009). Also, they work on becoming very skilled at something they are interested in. Venezuelan people are all about being loyal to each other. They see more good in a group, than good in the individual. In Venezuela, the labor force has grown a lot over the past few decades. The unemployment rate has been very low and even woman have been getting jobs.The government has worked together so that almost everyone is employed. Labor relations in Venezuela were consultative rather than confrontational, and the Confederation of Venezuelan Workers had good working relationships with the major bus iness group, the Federation of Chambers and Associations of Commerce and Production (Haggerty, 1993). Compared to other Latin American countries, there wasn’t a bad case of labor relations. The government wanted to make sure everyone in Venezuela was working. It’s good to be a collectivism culture because everyone comes and works together as a group.Power distance is another dimension that can be classified as either high or low. This is determined by how much a culture has respect for authority. High power distance focuses more on higher status of power. Teachers, parents and supervisors are treated with respect and are expected to show authority. Low power distance is a little more laid back. People can talk to whomever they want about anything. For example, an employee is able to talk to their manager about comments for the company or business they work for. Venezuela falls into the high power distance category.People with elite status are more educated and focus ma inly on their business and professions. Venezuela was one of the very few countries in Latin America where a number of elite-supported scholarly and community welfare foundations provided support for an imaginative variety of programs and scholarships (Haggerty 1993). People in middle class respect the elite. Thought it is possible to move up from middle class to elite, this can only happen through successful business deals or by marriage. Either way, Venezuelans know to respect the authority wherever they are. Venezuela has a president and vice president who serve five year terms.The president chooses his cabinet and determines the number of ministries. The president is the main leader in charge whom everyone looks up to. He commands the armed forces, calls special sessions of the Congress, and exercises sole control of foreign policy (Haggerty 1993). Venezuela follows a governmental policy where the president has the highest status, followed by the vice president, then it gets low er from then on. Having high power distance does not necessarily undermine the population, but is accepted by the whole Venezuelan culture as one. Masculinity versus femininity, contrary to it’s name, has more to do than just gender roles.Some masculine characteristics focus on a competitive economy, working hard to get by, and fighting as a result of conflicts. Cultures with this dimension are more aggressive. Femininity on the other hand focuses on more calming features. For example, negotiating to resolve conflicts, women are representing in the government and working to live a good life. Venezuela in this case is more masculine. They are more aggressive than other cultures. Violence and crime increased appreciably in the last decades of the twentieth century and have become major issues of popular concern (Dinneen 2003).Having higher crime rates, though that’s not always a good thing, shows the masculinity in the culture. Men take the majority of the power when it comes to government. Although the Constitution of 1960 declared that men and women were formally equal under the law, women who had been active in the struggle for democracy found themselves devoid of its privileges and marginalized from politics (Wagner 2005). Though it said women were just as equal as men, that didn’t live up to its word. Women were still not allowed to participate in higher politics and businesses.They were expected to stay at home and take care of the house and children. Venezuela is ranked higher in the masculine dimension among all of the other Latin American countries. Venezuela’s uncertainty avoidance is considered lower than the other Latin American countries. Some traits of low uncertainty avoidance include openness to change, tolerance of diversity and hold back emotions. Where as in high uncertainty avoidance, they tend to follow strict rules, express emotions, and have a weak interest in politics. The goal of the culture is to control almo st everything in order to avoid the unexpected.Thanks to their need for security, Venezuelan managers take fewer risks, govern with more written rules and experience lower labor turnover (Workman 2008). There have been processes of social and political changes. Theses processes have attracted more international attention over the years and for more to come. Venezuela was the world’s leading exporter of oil. Venezuelan’s leaders wanted to concentrate on the oil industry as the main source of financing for their reformist economic and social policies (Haggerty 1993). They weren’t afraid to find new non cabinet ministries and form new policies to expand their economy.Even with the economic crises that occurred with the collapse of the financial system in 1994, the government worked to get it back up. When it comes to differences, Venezuelans try to explore the issue. They are curious to what is going on. If they need to make a change, they will do so and take the r isk. For example, during the 1980’s Venezuela had a huge foreign-exchange revenue from oil. Because of this, they developed a voracious demand for imported luxury goods that persisted even as oil prices ebbed in the mid do late 1980’s (Haggerty 1993).This resulted in a weakness in the Venezuelan economy. Even though this happened, the government wasn’t afraid to take the risk. In conclusion, Venezuela has many different characteristics that make them a unique culture. Being a collective culture, they unite as one. They like to focus on everyone as a group to make sure everyone is satisfied. They also fall into the high power distance category. Venezuela has high power authority that is respected by everyone. If they have questions, the people with high status will have all the answers.Venezuela is also a masculine culture. Men dominate over women for occupations and power. Also, this makes the country more aggressive than others. They stand up for themselves and aren’t afraid of anything that comes in contact with them. Finally, Venezuela has low uncertainty avoidance. They will take a risk if they want to and they aren’t afraid to show emotion. This shows they are a strong country that will make changes if it is a concern. Venezuela is a very well-rounded culture with many great qualities about them.

Nicotine Addictions

Nicotine addiction is a serious mental disease and illness. There are currently 1. 35 billion smokers in the world today and that number is increasing at an alarming rate. Nicotine related diseases are the number one killer in the world. It is responsible for more deaths each year than drug and alcohol abuse, car crashes, AIDS, murder and suicide put together. There are few ways to fight this addiction, like rehab, the nicotine patch, nicotine gum, or the new drug, Chantix. Nicotine addiction is a serious mental disease and illness and it affects all ages. To first understand nicotine addiction you first need to understand why we start smoking in the first place and why we get hooked. Most people start smoking to relieve stress or anxiety, other people want to lose weight, teens succumb to peer pressure or they’re trying to look cool. Have you ever wondered why it’s so hard to go without eating, why we feel anxiety when bored and an â€Å"aahh† sense of relief when we finish a task? This was dopamine. When we feel hunger our dopamine pathways are teasing us with anticipation, wanting for food. If we keep wanting the anticipation may build into urges or even craves. Each bite that we take or drag off a cigarette stimulates the dopamine until we had enough and have become satisfied. While family members and loved ones are screaming at the smoker to stop, their brain dopamine pathways are screaming even louder that continuing to smoke is important as life itself. Nicotine addiction is permanent, just like alcohol there is one rule when you quit, just using once you will have to go back. It does not matter how much will power we have, the years of smoking, the recorded years of nicotine feeding have wired your brain for relapse. If this is true, that no matter how much will power you have you will go relapse. Then why are some social smokers able to continue and stop like its nothing while the rest of the smoking population got hooked. These social smokers are referred to as â€Å"chippers. † These â€Å"chippers† account for less than 10% of all smokers. Being immune to nicotine addiction is thought to be from genetics. Smokers who are hooked tend to feel sorry for themselves atching 10% walk away like its nothing, little do they realize they were once chippers to, at least for their first couple of cigarettes. Nicotine addiction affects all ages, there are many children who smoke around the world, take for example Ardi Rizal. Ardi Rizal is a two year Indonesian baby who smokes about 2 packs a day or 40 cigarettes. Smoking is normal in Indonesia it is the world 3rd largest leading tobacco consuming country in the world. A lot of adults who are around children will smoke; they will carry a baby in one hand and a cigarette on the other. His mother wants Ardi to quit, but her motivation for Ardi to quit was more on the spending 4 dollars a day other than his health. If Ardi does not smoke he throws tantrums, he has a scar on his head from running into a wall during one of his tantrums, and he also vomits when he cannot satisfy his addiction. The government has offered to pay the family with a brand new car and 100 thousand dollars if they help the baby stop smoking. Nicotine addiction affects all ages. The road to recovery from nicotine addictions is very hard. The first few days might feel like an emotional train wreck on the average smoker but as each passing day the challenge begins to grow less intense. In fact there are more ex-smokers in the United States then there are smokers! There are roughly 70% of daily smokers who want to stop. But few realize that they’re dealing with a permanent disorder and disease of the mind. A puff of nicotine is all it takes for relapse to occur. Usually it takes multiple fail attempts for the user to actually find the key to success. Every recovery is different, it be days, weeks, months, maybe even years to successfully quit smoking, to not feel the desire of a cigarette. There many types of treatment but no cure, there is the nicotine patch, rehab, nicotine gum and Chantix, Chantix has a 50% chance to help the smoker. Nicotine addiction is a serious mental disease and illness. Nicotine related disease causes 440,000 thousand deaths per year, 36,666 thousand per month, 8,461 thousand per week, 1,205 thousand per day, 50 per hour, in the United States alone. It is the number one killer around the world. Every cigarette that you smoke cuts 5 minutes off your life, the same time it takes to smoke it. Smoking just doesn’t cut a few months off the end of your life; it reduces the life of the average smoker by 12 years. Most people don’t think when lighting up especially teenagers, they don’t care about the cancer it causes, the things that it does to your body and physical appearance, that’s how addicted they are. They willing to ignore these facts for a death trap called tobacco.

Essay on Gender and School Violence - 1060 Words

The most recent acts of violence by children have prompted us as a nation to look at the causes and possible solutions to this crisis in our schools. In fact, according to Public Agenda, a national organization that conducts public opinion research on educational issues, school safety was identified as the most important issue affecting schools by those surveyed (Johnson Immerwahr, 1994/1995). Yet school violence does not exist in a vacuum. It is directly related to the violence in our society. And for many children, particularly those who experience family violence early in their lives, school can often be their only safe haven. In 1992, over three million youngsters were reported to child protection advocates as possible abuse†¦show more content†¦We expect girls to be passive and nurturing and boys to be aggressive and competitive. Since the beginning of their lives, children in our society learn to behave in ways that meet their parents expectations in order to gain their approval. As parents, we buy radically different toys for girls than for boys. Female children learn to be moms, housekeepers, and makeup artists. Males, on the other hand, are expected to fantasize being GI Joes, play with guns, and combat fear. The media also help shape the minds of our children and set societys expectations of them. Cartoons, video games, and movies are full of examples of strong, brave, aggressive and often violent male characters. Female characters, with few exceptions, continue to be passive and fit the ideal of beauty in our society, i.e., blond, thin, and fragile-looking. Advertisers also help reinforce these images of girls and boys in our society through the printed media targeted to them as consumers. In schools, boys and girls begin to practice in larger social settings what they have learned in their home environments. Bullying is a form of aggression that begins to show in the early stages of childrens development; it can lead to more violent forms of behavior if it is not resolved. Yet schools for the most part either ignore bullying or squelch the behavior without dealing with its causes. We continue to hear the expression, Boys will be boys, in reference to their aggressiveShow MoreRelatedViolence And Masculinity Of South Africa1578 Words   |  7 PagesViolence against women is prominent in South Africa. Many women have been murdered by the hands of their partners or the average men you see on the way to work (Merten, 2017). This essay will discuss the relationship between violence, masculinity and femicide in South Africa. It will further use the key theoretical contributions of Feminist and Hegemonic Masculinity Theories in assisting us to understand violence against wom en in South Africa. Gender is a critical social issue as it is associatedRead MorePersuasive Essay On Gender Roles789 Words   |  4 PagesEssay 1 I think gender roles are changing and will continue to change in the future. I do not think gender roles will go away but I do think they will be modified. Gender stereotypes will always be around because of females and males physical appearances, athletics, academics, moral-ethical, and self- satisfactions. The social role theory makes the differences seem larger because they have been exaggerated through our culture. If people follow the â€Å"roles† females and males are supposed to play thenRead MoreMy Understanding Of Education Level Peace Building Efforts Essay1225 Words   |  5 Pagescontexts has broadened and, at the same time, challenged my understanding of gender dynamics in conflict context. This reflection essay aims to discuss how these presentations deepened and complicated my understanding of gender. It will mainly focus on Kurshid’s presentations of violent extremism in Pakistan. However, I will also use part of Fatma’s presentation on Western Sahara for the first part of the discussion below. II. Gender Issues and Perspectives During the presentations, I came across with numerousRead MoreEssay on The Citadel1279 Words   |  6 Pagesunmanly emotion. As a whole, the public does not realize that society has a tremendous impact on the actions of men. Because of these expectations held, men are forced to become the image that the world views as proper. Using James C. Scotts essay, Domination and the Arts of Resistance, and Susan Faludis, The Naked Citadel, the connection between the image that men are expected to maintain by the general public and the behavior of the cadets at the Citadel is revealed. In an attempt to ameliorateRead MoreWhy Women Should Be Treated By The Workplace, And The Psychology Of It All1743 Words   |  7 Pageshalf of the world seems to at least know what is really happening behind the curtain. Ambiguous people have manipulated the very much realness with what is exactly taking place in our society. In this essay, I will be talking about the following things; Inequity in the wor kplace, â€Å"Asking for it†, Violence against women globally, Education, and The psychology of it all. These five topics need to be demanded attention. Our younger generation needs to be cognizant of what has been going on for many millenniumsRead More`` Despues De Lucia ( 2012 ) Is The Second Feature Film Written And Directed By Mexico City1372 Words   |  6 PagesMendoza) as they move from Puerto Vallarta to Mexico City to start a new life (IMDb). The purpose of this essay is to examine how physical, sexual, psychological violence are directed toward women and the effects it has when not confronted. I will also analyze the value of having a woman’s narrative when focusing on women’s issue in the film Despuà ©s de Lucà ­a (2012). Defining Violence Violence is defined as â€Å"the intentional use of physical force or power, threatened or actual, against oneself, anotherRead MoreEssay about The Unfair Treatment of Women1572 Words   |  7 Pagesawfully expensive education for a girl? My mother was involved in her education throughout high school. The number of opportunities presented to her while growing up and in her education, however, did not even come close to the number of opportunities presented to her male counterparts. In her yearbook, she is pictured among the Future Teachers of America, the only organization offered in her high school that relates to furthering the education of its young female students. The male students were alsoRead MoreGender Inequality And Gender Equality1673 Words   |  7 Pages Gender inequality Women are one-half of the world population they deserve equal opportunity as men because at the end gender equality is part of humanity progress. Many women around the world are treated less favoured than men not only in countries that have traditional gender role but even in societies that believe in equal right for both male and female. Gender inequality means unequal treatment or perceptions of individuals based on their gender. It results from differences in socially constructedRead MoreSchool Bullying and Violence1356 Words   |  5 PagesPart 1 Cover Letter - The purpose of this essay was to both call attention to and inform an audience about the issue of school bullying and violence. Research shows that the issue is far more prevalent than expected, and is gender neutral. What is surprising in these findings point to the fact that the statistics regarding bullying are not, as one might expect, focused predominantly on boys. While boys and girls mature and socially interact d ifferently, 30-40% of the bullying reported above occursRead MoreViolent Media Is Good for Kids964 Words   |  4 PagesViolence in media is healthy and beneficial for children—or so claims Gerard Jones, author of â€Å"Violent Media is Good for Kids†. It is undeniable that the title of Jones’s essay is straightforward and aptly named, if not confidently bold. But while his claim may boast confidence, it lacks credibility. Jones does do a great job introducing his controversial claim by using passion, persuasion, and personal experience. However, his insufficient evidence and fallacious reasoning fail to support