Evaluating Two Middle Range Theories Nursing Essay

Evaluating Two Middle Range Theories Nursing EssayThe manipulation of this paper is to evaluate two shopping mall localise theories abilities to turn up the place of sympathizer for the practice question Do neonatal harbours who explosive charge for expiry infants who cling an end of carriage caveat directional instruction platform comp bed to neonatal nurses who do non attend the program experience a difference in console aims ( sympathiser take aim for caring for Dying Infants (CLCDI)) when c ar for a end infant? A summary of two middle range theories the puff of air conjecture (Kolcaba, 1994) and the scheme of Self-Efficacy (Resnick, xxxx) give be summarized and and so critiqued apply Smith and Liehrs (xxxx) Framework for Evaluating Middle Range possible action. The discussion allow conclude with a summary of strengths and weakness of the theories and a look into guesswork to reflect that reflects the most appropriate theories fantasyionual de finitions and propositions.IntroductionBackground condescension nurses as frontline cargongivers for dying long-sufferings and their families legion(predicate) nurses chip in determine that they struggle with the responding competently to the emotional devastation to p arnts and siblings when caring for a neonate with an unresolved conclusion condition (Frommet, 1991). With the advances in neonatal cargon and action sustaining discourses, sick and genuinely preterm infants do not often die in utero, at birth, or shortly after birth, but instead they often live very much longer in a healthc ar paradigm of puff care and dignified death. This relatively new emersion of the end of conduct feign integrates a more holistic approach which considers a more ecumenical view of the perseverings demand (emotional, spiritual, and medical) (M totallyory, 2002 Mallory, 2003 WHO, 2002). With this paradigm shift, health care professionals are cause to assess the adequacy of th eir own knowledge, attitudes, and beliefs ab break death and dying. Multiple studies regarding nurses readiness for dealing with death and dying wee self-importance-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 unless observation that nurses caring for these difficult patients regularly experience good bother from competing principles of their soulal, collegial, organizational, and religious/spiritual ethics (Frommet, 1991).Practice ProblemTo protagonist ease this chaste discommode an evidence base end-of -life educational training program for NICU nurses has been successfully implemented in several neonatal intensive care units (NICUs) to maturation the nurses sola ce take aim of caring for neonates and their families at the end of life (Bagbi, Rogers, Gomez, McMahon, 2008). To determine if an evidence found end of life educational program pertains nurses facilitate aims in caring for dying infants and their families a question was substantial employ the population (P) interjection (I) compared to (C) outcome (O) initialise (Newhouse, Dearhold, 1997). The following discussion will centering 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 cheer levels ( treasure Level for Caring for Dying Infants (CLCDI)) when caring for a dying infant? During the preventive a monthly 1 hour, neonatal end of life education program will be conducted over a 6 month period of time establish on seek about what nurses would equivalent to know about caring for a dying infant (Robinson, 20 04).For the purpose of this problem, console is delimit 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 quilt will be measured as a score on the ordinal scale of relief 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= or so generation 4=often, 5=always measures the level of foster 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 heavy(p)er level of quilt NICU nurses have in caring for dying babies.examination the Concept of cheerA portion of Kolbacas (1991) possibility of harbor and Resnicks (2008) conjecture of Self-Efficacy, two middle range theories, will be utilize to test the fancy of repose for providing an organizing structure. Based on previous studies about nurses comfort when caring for patients, propositions five and six of Kolbacas guess of relieve seem to be a promising fit for this problem (Kolbaca, 1991, Kolbaca, XXX). These propositions collectively propose that patients, nurses, and separate members of the healthcare team agree upon delectable and vivid health quest behaviors (HSBs) and if compound comfort is achieved, patients, family members, and/or nurses are reinforced to engage in HSBs, comfort is further upraised (Kolbaca, 1991). However, comfort as defined judgmentually in this case as knowledge and skill move alternatively be equated with a sense of competence or self- readiness of the NICU nurse to care for a dying infant and their family. There are many examples in the care for literature intimacying self-efficacy to knowledge and skill (xxxx, xxxxx).) Self-efficacy, knowledge, and skills are excessively central to B anduras surmise, which is the basis for Resnicks (xxxx) Self-Efficacy scheme. Self-efficacy as draw in Resnicks (xxxx) Theory of Self-Efficacy for this stage setting is described as the judgment about the nurses ability to organize and be given a course of action postulate to attain designated types of achievements. The possible action advances that comprehend self-efficacy, defined as the respective(prenominal)s judgment of his or her capabilities to organize and execute courses of action, is a determinant of instruction execution (Resnick, xxxx). Self-efficacy beliefs provide the cornerstone for human motivation, considerably-being, and in-person accomplishment (Resnick, xxxx). According to Resnick (XXXX) theory one-on-ones with higher levels of self-efficacy for a specific behavior (caring for a dying infant) are more plausibly to attempt that behavior. There are many examples in the literature use the Theory of Self-Efficacy to run on treat education interve ntions (xxxxx, xxxxx). For these reasons, Resnicks Theory of Self-Efficacy (xxx) will be apply 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 military rank of Middle Range Theories (Smith, 2008) and conclude with a synthesis and research assumption to reflect conceptual definitions and propositions of the theory with the best fit.Theory Summaries Comfort and Self-EfficacyKolcabas Comfort TheoryThe Comfort Theory is a humanistic, holistic, patient need found care for derived middle range theory (Kolbaca, xxxx). The concept of comfort has had a historic and consistent presence in treat. In the early 1900s , comfort was considered to be a goal for both nursing and medicine, as it was commitd that comfort led to recovery (McIlveen Morse, 1995). Over time comfort has becom e an more and more 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 as well used as a prejudicial (absence of discomfort), neutral (ease), or positive (hope inspiring). Webster (1990) defines comfort as relief from sorrow to soothe in sorrow or distress a person or thing that comforts a state of ease and serenity enjoyment free from worry anything that makes life user-friendly and the lessening of blow or grief by calming or inspiring with hope. The melody of comfort is confortrare which means to modify greatly(Kolcaba, 1992). Based on the diversity of these impairment comfort is a complex term. Kolcabas (1991) concept depth psychology of comfort helped to shed light on the role of comfort as a holistic concept for nursing. This suss out confirmed t hat comfort is a positive concept and is associated with activities that nurture and beef up patients (David, 2002). Over a period of years and revisions Kolcaba (1994) developed the comfort theory 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 reinforced done having the human needs for relief, ease, and transcendence addressed in quadruple contexts of experience ( forcible, psychospiritual, socioethnical, 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. succor is the absence of specific discomforts. Transcendence is the ability to rise above discomforts when they shtupnot be eradicated or avoid ed (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 circumstances their children and family members feel comforted. Interventions for increasing transcendence faeces be crossed to change the environment, increasing hearty 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 all-important(a) g oal 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 mind is demonstrated below (see Figure 1).The concepts for the middle range for Comfort Theory implicate comfort needs, comfort interventions, intervening variables, enhanced comfort, health-seeking behaviors, and institutional rightfulness (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 pa tient comfort over time (Kolcaba, 2007). Once comfort is enhanced, the patient is likely to adjoin health-seeking behaviors. These behaviors whitethorn be internal to the patient (eg, affront healing or improved oxygenation), external to the patient (eg, active mesh in rehabilitation exercises), or a peaceful death. Furthermore, Kolcaba asserted that when a patient experiences health-seeking behaviors, the ace of the institution is subsequently summationd because the extend in health-seeking behaviors will result in improved outcomes. Increased institutional haleness lends itself to the development and implementation of best practices and best policies secondary to the positive outcomes see by patients (Kolcaba, 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 experi ence of being strengthened through and 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-EfficacySelf 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 regularized by behavior, but also communicatory encouragement, pondering 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 visualised in the conceptual model (Appendix 2) (Resnick, 2008).Resnicks Theory o f 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 support the influence of those beliefs on behavior. However, it has not been established how efficacy beliefs actually influence motivation in older adults, or what inceptions of efficacy-enhancing information help strengthen those beliefs.Kolcabas Comfort Theory translation, Analysis, and EvaluationTheory DescriptionHistorical 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, 1 995). 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 synopsis of comfort helped to clarify the role of comfort as a holistic concept for nursing. This review confirmed that comfor t 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 theory which continues to evolve and change with changes as recent as 2007 (Figure 2).Structural Components.Assumptions. Kolcabas Theory of Comfort (1994) makes four sanctioned assumptions about reality. She assumes that humans beings have holistic responses to complex stimuli comfort is a desirable holistic state that is germane(predicate) to the control of nursing human beings actively strive to spiel, 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 jump 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 be internal, external or towards promoting a peaceful death. The final concept, institutional righteousness, added in most recently, are values, financial stability and wholeness of health care facilities at the local anaesthetic state or discipline 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 distress 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 foiling 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, theTheory Analysis and EvaluationTo 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). real foundations. Assessing the substantive foundation of a middle range theory is based on four criteria (Smith, 2003). The early measure 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 draw 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 receiver of nursing care the patient may be an individual, family, institution, or community. purlieu is considered to be the external adjoins of the patient and can be manipulated to increase patient comfort. Finally, health is viewed as the optimum functioning of the patient as they de fine 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 starting line 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 help ed 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 many 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, in particular for nurses, and most recently as a framework for working toward subject institutional recognitions. More specifically parts are all o f the theory have been used to test the effectiveness of holistic interventions for increasing comfort (xxxxxxx), to demonstrate the correlation betwixt 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 comfort 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 go of abstraction at the middle range level. They are more cover 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 twenty-five percent criterion evaluates whether the concepts and relationships among the concepts are logically presented with a model. In the Comfort Theory (1994) model th e 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 trial-and-error 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 ho listic palliative care nursing interventions, there has been a wide 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 undergoing 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 e vidence of the maturity of this theory (Smith, 2003).SummaryThe 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 EvaluationTheory DescriptionHistorical 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 accepted 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 great deal 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 spatial relation 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 confinement. solution 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 anti cipated, 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 impact 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 dissociable 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 perform ance 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 pith of exposure or experience to the behavior (least experience causes greater impact) and tally of instruction given (influence of others is greater with unclear guidelines) (Resnick Galik, 2006). Another source verbal persuasion or exhortation involves 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 exclusively to strengthen efficacy expec tations (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,