1. Part II. Theory reflection in research
Research purpose
Examine relationship of stress, severity, uncertainty, coping, and adaptation in families of children undergoing liver transplantation
Research question
Three main questions looking at variables over the pre and post- transplantation time periods
Research methods
Descriptive, longitudinal study of 15 mothers whose children were at least 5 years post-transplantation
Instruments used: FILE, POMS, CHIP, FAD, PPUS
(Lobiondo-Wood, 2003; Lobiondo-Wood, Williams, & McGhee, 2004)

2. Theoretical framework
Nursing theories offer a framework for nurses to apply to their practice. The framework is the knowledge that guides nursing actions when caring for patients (Cody, 2013).
Lobiondo-Woods theory
Based on Double ABCX Model by McCubbin
Used in 2000 by Van Riper to study family stress in families with a sibling with Downs syndrome (Smith & Liehr, 2003)

3. Theoretical framework cont’d
Relevant today with transplant patients
Essential to teach, assess early intercessions, and provide support to families during all phases of the transplant course
Without the framework, it would be difficult to assess family stress during transplantation

4. Theory in practice
Nurses often care for patients and families who are faced with a stressful situation such as:
Sickness
Death
Financial hardships
Strained Relationships
Surgery
Nurses can alter patient’s and families perception of the stressor
Education is the key to avoid crisis and to help families cope when dealing with a crisis
Nurses can introduce new resources and facilitate coping and adaptation

5. Theory in practice cont’d
Practice example: Patient is preparing for a complex surgery
Complex surgery is the stressor
The nurse alters the family’s perception of the surgery through education and open conversation
The education that continues through the post-operative period and prior to discharge facilitates coping and adaptation
The nurse introduces new resources such as home care and physical therapy to aide in the adaptation process

6. Tie between theory and practice
Theory provides framework for how nurses can help families through an extended period of the liver transplantation process (Lobiondo-Wood et al., 2004)
Acknowledge stress and uncertainty
Early information dispersal and teaching
Allow mother time to recognize issues in order to build rapport
Importance of nursing knowledge (Lobiondo-Wood, et al., 2004)
Nurses are involved for an extended period
Rapport is essential to identify needs and provide interventions
Holistic approach to help patient and family
Help families with long term aspects of care during times of uncertainty

7. Contributions to nursing
Contributions (Lobiondo-Wood et al., 2004)
Maternal stress, coping, and uncertainty had significant changes over time
Family stress did not have significant changes
Supports the need for testing nursing interventions focused on education and support
Early and long term support as needs change
First step towards investigation of short and long term family implications of having a child that received a transplant
Set the state for further development of research based nursing interventions for children and their families

8. Conclusion
This presentation was designed to provide a better understanding of a middle range nursing theory, and it’s implications for nursing practice. We hope these findings can be a benefit to your own personal practice as you assist patients and families during stressful situations

9. References
Cody, W. (2013). Philosophical and theoretical perspectives for advanced nursing practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.
Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation nursing models and theories (2nd ed.). Philadelphia, PA: F. A. Davis.
Lobiondo-Wood, G. (2003). Theory of family stress and adaptation. In Goosby, B. J., Caldwell, C. H., Bellatorre, A., & Jackson, J. S. (2011). Ethnic differences in family stress processes among African-American and black caribbeans. Journal of African American Studies 16(3),
Lobiondo-Wood, G., Williams, L., & McGhee, C. (2004). Liver transplantation in children: Maternal and family stress, coping, and adaptation. Journal for Specialists in Pediatric Nursing 9(2),

10. References cont’d
LoBiondo-Wood, G. (2008). Theory of family stress and adaptation. In  P. R. Liehr & M. J. Smith (Eds.), Middle Range Theory for Nursing (2nd ed.).(pp ). New York, NY: Springer Publishing Company.
Peterson, S., & Bredow, T. (2009). Middle range theories: Application to nursing research. (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.
Smith, M., & Liehr, P. (2003). Middle range theory for nursing. New York, NY: Springer Publishing Company.