According to some, the use of theory offers “structure and organization to nursing knowledge and provides a systematic means of collecting data to describe, explain, and predict nursing practice” (McEwen & Wills, 2014, p. 25). As a result, there have been many nursing theories that have been developed and have been applied to clinical practice. When considering theory and the nursing process, concepts are often introduced and utilized. Concepts may be a phrase, words or just a simple word, and are often variables used to test theories and hypotheses. There are many different ways in which concepts can be explained or classified. Concepts are constantly being used in nursing and can include the following: practice, research, education, and administration.
Concept analysis, adopted by Walker and Avant, is utilized to define and clarify the meanings of terms in order to create a common knowledge so that both readers and writers can understand the message this being conveyed. Analysis occurs when concepts require further development or clarification (McEwen & Wills, 2014). This paper will discuss an article that utilizes the theory of Rodgers and provide an introduction to Rodgers, a concept analysis that describes the steps of the process, the results for each step, application of the concept to a practice situation and include a conclusion. Introduction to Rodgers
When considering health and illness, death can be a defining moment in a person’s life. It can cause significant change and can affect a person mentally, physically and emotionally. As a result, there are a variety of emotions that are invoked when concerning death, such as anxiety. Death is an important subject for the nurse as many nurses are forced to face the death of their patient despite the advancements of modern technology and the interventions of the interdisciplinary team. The evolutionary method for concept analysis, developed by Martha Rodgers in 1989 was chosen.
Rogers attempted to examine two viewpoints or schools of thought regarding concept development and identified them as “essentialism” and “evolutionary” (McEwen and Wills, 2014). As a result, the concept analysis of Rodgers includes six steps: identification of the concept and the associated terms, selection of an appropriate realm for the purposes of data collection, the collection of data, the analysis of data, identification of an exemplar of the concept, and the identification of hypotheses that provide implications for further development. Steps of Process
For the purposes of data collection multiple databases were utilized to conduct a search utilizing the key words “death anxiety.” The study conducted literature on for the years 1980-2007 that have been published in English and consisted primarily of journal articles and eight foundational books which were examined. The search included publications from CINAHL, EBM Review, Health and Wellness Resource Center, Um-Medsearch, psychINFO and PubMed. 135 citations were initially found, however only 89 articles actually met the inclusion criteria. Articles were then summarized and coded. Analysis resulted in defining attributes such as “emotion, cognitive, experiential, developmental, sociocultural shaping, and source of motivation,” antecedents such as “stressful environments and the experience of unpredictable circumstances, diagnosis of a life-threatening illness or the experience of a life-threatening event, and experiences with death and dying,” and consequences such as “adaptive and maladaptive presentations” (Lehto, Stein & Arbor, 2009, p. 23). The results of this analysis are important because little systematic inquiry of death anxiety exists in nursing literature. Results of the Process
The analysis included six attributes of death anxiety: cognitive, emotion, developmental, experiential, source of motivation and sociocultural shaping. The results indicate that death anxiety is “is closely related to core fear related to the annihilation of one’s existence” and stems from “fundamental limbic structures that are ancient, hardwired, and adaptive to survival.” It has also been determined that emotional memory structures, both implicit and explicit, “play important roles in the signaling and regulation of perceived threat” (Lehto, Stein, & Arbor, 2009, p. 26). It is only natural then that death and anxiety go hand in hand and are intertwined with one another. However, nurses can affect the patients’ perspective of death and how friends and family members deal with death in the acute care setting. When considering the antecedents of death anxiety, the research determined that it is initiated by an increased awareness of mortality.
In addition, it was determined that the following three characteristics overlapped when considering death anxiety: diagnosis of a life-threatening illness or experiencing a life-threatening event, stressful environments or unpredictable circumstances, and experiences with death. The research conducted indicates that there may be several consequences, both positive and negative, as a result of death anxiety. Individuals may respond in a positive manner by intensifying or defending their cultural beliefs, strengthening their social ties or commitments, embracing certain gender stereotypes, and increasing compassionate responses. Negative consequences may include mental health problems, negative attitudes toward various people (such as the elderly), a disruption or withdrawal from personal relationships, miscommunication, eating disorders, self-mutilation disorders, and ambivalence.
While death anxiety is not a new concept, the analysis indicates that further research should be conducted that focuses on the active treatment and curative management of death anxiety. Qualitative measures that focus on the assessment of age, culture of origin, gender, and personal experiences, should be utilized to further examine death anxiety. Therapeutic goals should also be further researched as the term was used loosely, however was not further expanded or were examples provided. Application to a Practice Setting
According to Carpenito-Moyet, the nursing diagnosis of death anxiety is defined as “the state in which an individual experiences apprehension, worry, or fear related to death and dying” (2008, p. 39). As a result, it is important for nurses and health care providers to incorporate death anxiety as an important emotion and nursing diagnosis when providing care to a patient or providing support to patient’s friend or family member. It is also suggested that the nurse provide therapeutic goals and palliative goals since death anxiety can have a variety of repercussions, some of which may affect the developmental stages of a healthy individual.
Death anxiety is also of clinical importance for the nurse who is responsible for the patient. Just as patients seeking treatment in the acute care setting suffer from death anxiety, those health care workers or members of the interdisciplinary team can also suffer from death anxiety. Therapeutic goals are also important for the nurse as well. Unresolved death anxiety can result in unnecessary and exacerbated stress for the nurse or burnout. It is recommended that educators and managers of an organization consider the importance of death anxiety and help health care workers discuss death. Conclusion
Utilizing the evolutionary method of concept analysis developed by Martha Rodgers provides some insight on the concept of death anxiety as it relates to the science of nursing. While it may limited and based on time and context, it is an important emotion that should be considered in nursing practice. It has also been suggested that ongoing research regarding death anxiety should continue so that successful interventions can be developed.
Carpenito-Moyet, L. J. (2008). Handbook of nursing diagnosis. Philadelphia: Lippincott, Williams and Wilkins. Lehto, R., Stein, K., Arbor, A. (2009). Death Anxiety: An Analysis of an Evolving Concept. Research and Theory for Nursing Practice: An International Journal, 23,1, 23-37. McEwen, M. & Wills, E. M. (2014). Theoretical basis for nursing (4th Ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins