Description and Critical Reflection of Empiric Theory

Practical implementation of certain plans and treatment schemes is very important for any nursing activities in order to evaluate the effectiveness of the proposed innovations. However, the theoretical basis for making any conclusions in the sphere of medicine and nursing is even more significant. A number of accurately identified concepts and connections between them ensure quick nursing theory development and its possible application. The considered case of Mrs. Vance forms a favorable basis for the development of a corresponding nursing theory, which may assist such patients in solving the issues related to simple mastectomy complications.

The case of Mrs. Vance offered for consideration contains enough information about her state of health to develop and apply a nursing theory in terms of why she may still experience some inconveniences and pains related to her simple mastectomy and which methods can help her to stop suffering from this condition. Following Chinn and Kramer (2015) it is important to note that a nursing theory should contain a number of parameters (components) to be scientifically grounded. The aspect of an empiric theory, which is worth special attention, is concepts. Chinn and Kamer (2015) state that the description of concepts is crucial, because the quantity and character of those concepts form an understanding of the purpose of the theory. (p. 191). It is possible to define 9 main nursing concepts in the considered case: (1) a patient; (2) breast malignant tumor; (3) simple mastectomy; (4) lymph nodes testing after the surgery; (5) rehabilitation period at home; (6) physical and emotional state of a patient; (7) living conditions of a patient (where and with whom she lives); (8) edema in Mrs. Vances arm; (9) nursing education of a patient. All the enumerated concepts are closely connected and represent a sequential chain of aspects related to the patients current state of health.

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As it was mentioned above, a number of separately determined concepts are not enough to make a nursing theory applicable to different cases and efficient in analyzing the causes and consequences of the state. These concepts should be interrelated and have a clear structure. It is possible to choose three elements from the list as an example and demonstrate their interrelation. Numbers (3), (4) and (5) are directly interrelated. After the surgery of simple mastectomy, which was recommended to Mrs. Vance because of the malignant tumor, she had to have her lymph nodes tested to verify that she did not have any cancer cells left in her body (Herndon, 2012). The process of rehabilitation at home is very important as Mrs. Vance should have been told to do special exercises to function normally with her arm, and immediately complain to the physician in case of feeling sharp pain or swelling. The structure of the theory is conditioned by the interrelation between its components (Chinn & Kramer, 2015). As the interrelation of only three aspects is described, it is possible to suggest that the structure of the theory represents a straight horizontal line of Mrs. Vances state of health, which is interrupted by the point of simple mastectomy. After this point, the line becomes thinner and is divided into two parts: nodes testing and rehabilitation period at home. Adding other elements to such a graphical representation, namely the living conditions of Mrs. Vance surrounding the line and other factors influencing her current state and indicated by separate points on this circle will make the structure clearer in terms of a nursing theory defined.

There is no doubt that all concepts of a nursing theory should be explained. The definitions are to be exact and may vary a little, depending on the conditions. Three chosen concepts are defined as follows: (3) simple mastectomy is a procedure, in the course of which only the breast is removed. Axillary lymph nodesthe ones in the underarmsare generally left in place. (Herndon, 2012, para. 5); (4) lymph nodes testing (after simple mastectomy) is a procedure, which implies biopsy of the nodes to check lymph for oncological processes (Herndon, 2012); (5) rehabilitation period at home is a time period, during which a patient stays cautious about his/her health state after a surgical (or other) procedure and follows all the recommendations of his/her physician. Therefore, the goal of two mentioned concepts should be absolutely clear to the patient and he or she should strictly adhere to all the rehabilitation rules after being educated on this aspect.

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The considered case study gave students a chance to make some assumptions as for the current health problems of Mrs. Vance. There is no doubt that the procedure of simple mastectomy is stressful for the patient. However, surgeons and nurses try to do their best to avoid any risks and complications and explain the patients more about how he or she should behave after the surgery. Thus, after the surgery, Mrs. Vance spent a few days in the hospital. Nurses had to make the drains of her incisions to collect blood and fluid to prevent edemas. The next not less important stage of postoperative care is to teach the patient a special exercising program to reduce her arm stiffness (Herndon, 2012). As it was mentioned above, in case of simple mastectomy, only breast lymph nodes are removed and all other auxiliary nodes are left untouched. It means that the surgeons do not see a necessity to change any nodes located close to the breast, but not in its tissue. Herndon (2012) states that there is a risk for patients to develop lymphedema after the discussed surgery and Mrs. Vance proved all the revelations of this state by complaining about not being able to hang a rug on a clothesline. The symptoms include: heavy feeling or swelling in the arm, skin of the arm feeling tight, arm or hand numbness, reduced flexibility of the arm or hand. (Herndon, 2012, para. 10). Mrs. Vance is aware of her arm edema. However, it is possible to assume that she does not understand the severity of her state. It is not mentioned in the case whether she does any specific exercises. She is in a good emotional state. Therefore, she probably abandoned a complex of procedures to reduce her arm stiffness, though she still feels weak. Moreover, Herndon (2012) underlines the fact that lymphedema can be caused by an infection. Besides the physical exercising program, Mrs. Vance should have been informed of the main techniques to reduce the risk of getting infected after the surgery. It is understandable that a patient should quit smoking and drinking alcohol, but it is important to mention that even usual cleaning and washing should be performed in gloves (Herndon, 2012). The case does not contain any information about whether the patient followed the rules or not. In order to solve the issue of edema and weakness, Mrs. Vance should visit the surgeon and tell him or her about her state but not to continue living experiencing some pains thinking that it will end soon. I can suppose that she also needs a course of special massage.

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As it was mentioned above, a nursing theory should have a strict and logic structure. Besides the concepts and their interrelations, it is important to define the purpose of a nursing theory. Chinn and Kramer (2015) state that the general purpose of a theory is important, because it specifies the context and situations, in which this theory is useful. (p. 187). It is possible to ask why the theory was developed in order to understand its general purpose. Therefore, the purpose of the theory developed for Mrs. Vance is to determine why she still complains about arm edema and help her solve the issue. This aim is not simple as it is also value oriented (Chinn & Krammer, 2015). Pain alleviation and restored self-care ability are the core values, at which this theory is oriented. The theory developed in this paper should not necessarily be fully implemented into a clinical practice as some of its aspects, namely possible complications of simple mastectomy, are well-known to physicians. What is more important and worth paying attention to in the structure of the offered theory is Mrs. Vances behavior after the surgery. She seems to be too careless about her state of health and has no family members living with her to help her with usual activities and control her lifestyle after the surgery. Therefore, generalizing the structural concepts of the developed value-oriented theory, it is possible to state that it offers a framework for diagnosing lymphedema as a complication of simple mastectomy and defines a number of recommendations (exercising, massage and regular checks) to avoid pains and stiffness.

To conclude, it is important to affirm that simple mastectomy surgery can help patients to overcome a serious challenge of breast cancer and return back to normal life. However, for the entire procedure and rehabilitation to be effective, a patient should be attentive to his or her state and inform the physician of any suspicious revelations. Thus, if Mrs. Vance were more educated in terms of how lymphedema can be developed after simple mastectomy, she would recover after the surgery quicker. The developed theory explains how it is possible to reveal lymphedema at early stages or avoid it at all.

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