Frameworks for Research
Patricia Liehr and Mary Jane Smith
From Practice to Research
To be introduced to frameworks for research, put yourself in the shoes of Kate and thoughtfully listen to her story by attending to the message it brings for the practicing nurse wishing to critique, understand and do research. Kate works in a coronary care unit (CCU). She has worked in this unit for nearly three years, since she graduated with a baccalaureate degree in nursing. She has grown more comfortable over time and now believes that she can readily manage whatever comes her way with the complexities of patient care in the CCU. Recently, she has been observing the pattern of blood pressure (BP) change when healthcare providers enter a patient’s room. This observation began when Kate noticed that one of her patients a 62 year old African-American woman who had continuous arterial monitoring, had dramatic increases in BP, as much as 100%, each time the healthcare team made rounds in the CCU. Furthermore, this elevated BP persisted after the team left her room and slowly decreased to reach pre-round levels within the following hour. Conversely, the same patient, when visited by the nurse manager on her usual daily rounds, engaged calmly in conversation and was often left with lower BP when the nurse-manager moved on to the next patient. Kate thought about what was happening and adjusted her work so that she could closely observe the details of this phenomenon over several days. Team rounds were led by the attending cardiologist and included nurses, pharmacists, social workers, medical students and nursing students. The nurse-manager’s visit occurred one-on-one. During team rounds the patient was discussed and occasionally, she was asked to respond to a question about her history of heart disease or her current experience of chest discomfort. Participants took turns listening to her heart and students responded to questions related to her case. During the nurse manager conversation, the patient had the nurse’s attention. In fact, the nurse usually sat and spent time. Kate noticed that the nurse manager was especially attentive to the patient’s experience. She spent time talking to the patient about how her day was going, what she was thinking about while lying in bed and what feelings were surfacing as she began to consider how life would be when she returned home. Kate decided to talk to the nurse manager about her observation. The nurse manager, Alison, was pleased that Kate had noticed these BP changes associated with interaction. She told Kate that she, too, noticed these change during her 8 year experience of working in CCU. Her observation led her to a theory, which seemed applicable to the observation. As a first year Master’s student Alison learned the theory, attentively embracing story (Smith & Liehr, 1999; Liehr & Smith, 2000). She was applying the theory in practice and beginning plans to use the theory to guide her thesis research. Attentively embracing story proposes that intentional nurse-client dialogue, which engages the human story, enables connecting with self-in-relation to create ease (Figure 1). As depicted by the theory model, the central concept of the theory is intentional dialogue. It is what Kate had first observed when she noticed Alison interacting with the patient. Alison was there with full attention, following the patient’s lead and pursuing what mattered most to the patient. Alison seemed to get a lot of information in a short time and the patient seemed willing to share things, which she wasn’t sharing with other people. According to the theory, each of the three concepts, intentional dialogue, connecting with self-in-relation, and creating ease are intricately connected. So, when Kate observed intentional dialogue, she also observed connecting with self-in-relation as the patient reflected on her experience in the moment; and, creating ease, when she saw lowered BP as...
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