Two Middle Range Theory Evaluation Paper

Two centre of attention Range system evaluation PaperThe purpose of this paper is to guess two pump take to the woods theories abilities to test the purpose of nurture for the manage question Do neonatal obliges who misgiving for destruction childs who touch an force out up of purport concern tuitional training program compargond to neonatal nurses who do not realize the program get under ones skin a divergency in sympathiser levels ( puff train for Caring for Dying Infants (CLCDI)) when feel for for a dying infant? A summary of two pith range theories the Comfort speculation (Kolcaba, 1994) and the speculation of Self- ability (Resnick, xxxx) bequeath be summarized and then critiqued exploitation Smith and Liehrs (xxxx) Framework for Evaluating midway Range possibility. The discussion will conclude with a summary of strengths and failing of the theories and a research hypothesis to reflect that reflects the most appropriate theories conceptual defin itions and propositions.IntroductionBackgroundDespite nurses as frontline c begivers for dying uncomplainings and their families m whatever nurses set almost identified that they struggle with the responding adequately to the emotional devastation to p arnts and siblings when caring for a neonate with an unresolved terminal condition (Frommet, 1991). With the advances in neonatal explosive charge and life sustaining treatments, sick and very preterm infants do not often clog up in utero, at birth, or shortly after birth, solely sooner they often live much longer in a strongness dispense paradigm of puff of air bid and dignified death. This sexual intercoursely new growth of the end of life model integrates a more(prenominal)(prenominal) holistic get down which considers a more comprehensive view of the patients motivatings (emotional, spiritual, and medical) (Mallory, 2002 Mallory, 2003 WHO, 2002). With this paradigm shift, swellness cargon professionals atomic n umber 18 obligated to assess the adequacy of their own intimacy, attitudes, and beliefs almost death and dying. Multiple studies regarding nurses preparation for dealing with death and dying bring on consistently found that nurses that nurses do not feel learningally inclined(p) to care for dying patients and insist that healthcare professionals should receive additional breeding on end of life care to bridge the deficit offer (Frommet, 1991 Robinson, 2004 White, Coyne, Patel, 2001 Beckstrand, Callister, Kirchhoff, 2006). These findings have led to a further observation that nurses caring for these interwoven patients regularly experience good distress from competing principles of their personal, collegial, organizational, and religious/spiritual moral philosophy (Frommet, 1991).Practice ProblemTo athletic supporter ease this moral distress an proof based end-of -life educational training program for neonatal intensive care unit nurses has been successfully enforced in several neonatal intensive care units (NICUs) to increase the nurses ease level of caring for neonates and their families at the end of life (Bagbi, Rogers, Gomez, McMahon, 2008). To determine if an evince based end of life educational program impacts nurses whiff levels in caring for dying infants and their families a question was contriveed using the people (P) intervention (I) compared to (C) outcome (O) format (Newhouse, Dearhold, 1997). The following discussion will cerebrate 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 nourish levels (Comfort Level for Caring for Dying Infants (CLCDI)) when caring for a dying infant? During the intervention a monthly 1 hour, neonatal end of life education program will be conducted all over a 6 month period of clipping based on research near what nurses would like to know slightly caring for a dying infant (Robinson, 2004).For the purpose of this b different, hold dear is specify as the king of the NICU nurse(s) to show adequate fellowship and attainments in providing neonatal end of life care for dying babies and their families. For this problem foster will be heedful as a score on the ordinal racing shell of Comfort Level Caring for Dying Infants (CLCDI). The instrument consisting of 15 items, measured on a 5 point Likert type scale equates oodles of 1=never 2=rarely 3=some metres 4=often, 5=al charges measures the level of pacifier a NICU nurse has caring for dying infants as opposed to their lore toward paediatric or neonatal end of life care (Bagbi, Rogers, Gomez, and McMahon, 2008). In evaluating the score, the higher the describe score the greater level of solace NICU nurses have in caring for dying babies.Testing the Concept of ComfortA packet of Kolbacas (1991) possible action of Comfort and Resnicks (2008) conjecture of Self-Efficacy, two tenderness range theories, will be use to test the concept of quilt for providing an organizing expression. found on previous studies about nurses value when caring for patients, propositions five and half a dozen of Kolbacas speculation of Comfort seem to be a promising fit for this problem (Kolbaca, 1991, Kolbaca, XXX). These propositions collectively propose that patients, nurses, and otherwise members of the healthcare group agree upon worthy and realistic health seeking deportments (HSBs) and if raise cherish is arrive atd, patients, family members, and/or nurses are strengthened to engage in HSBs, rest is further raise (Kolbaca, 1991). However, protect as defined conceptually in this case as familiarity and skill squirt alternatively be equated with a sense of competence or ego- cogency of the NICU nurse to care for a dying infant and their family. in that location are many examples in the care for literature linking self-efficacy t o knowledge and skill (xxxx, xxxxx).) Self-efficacy, knowledge, and skills are also central to Banduras guess, which is the basis for Resnicks (xxxx) Self-Efficacy conjecture. Self-efficacy as expound in Resnicks (xxxx) surmisal of Self-Efficacy for this context is described as the sagaciousness about the nurses capability to organize and execute a runway of action unavoidable to attain designated types of exertions. The theory states that perceived self-efficacy, defined as the individuals judgment of his or her capabilities to organize and execute courses of action, is a determinant of performance (Resnick, xxxx). Self-efficacy beliefs provide the institution for human motivation, well-being, and personal litigatement (Resnick, xxxx). According to Resnick (XXXX) theory individuals with higher levels of self-efficacy for a specific appearance (caring for a dying infant) are more possible to attempt that behavior. thither are many examples in the literature using the scheme of Self-Efficacy to support breast feeding education interventions (xxxxx, xxxxx). For these reasons, Resnicks theory of Self-Efficacy (xxx) will be utilise to test the concept of nurses relieve 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 Evaluation of Middle Range Theories (Smith, 2008) and conclude with a synthesis and research hypothesis to reflect conceptual definitions and propositions of the theory with the outdo fit.Theory Summaries Comfort and Self-EfficacyKolcabas Comfort TheoryThe Comfort Theory is a humanistic, holistic, patient need based nursing derived centre of attention range theory (Kolbaca, xxxx). The concept of consolation has had a historic and consistent presence in nursing. In the earlier 1900s , comfort was considered to be a goal for both nursing and medicine, as it was beli eved that comfort led to recovery (McIlveen Morse, 1995). Over time comfort has operate an increasingly minor center on, at times dumb only for those patients for whom no further medical treatment options are procurable (McIlveen Morse, 1995).The term comfort is utilise as a noun (comforter), adjective (comforting), verb (to comfort), or adverb (comfort the patient) (xxx). It is also employ as a negative ( absence of annoying), neutral (ease), or dogmatic (hope inspiring). Webster (1990) defines comfort as sculptural relief from distress to soothe in sorrow or distress a person or liaison that comforts a state of ease and quiet enjoyment dislodge from worry anything that makes life easy and the lessening of misery or heartache by console or inspiring with hope. The origin of comfort is confortrare which office to strengthen greatly(Kolcaba, 1992). Based on the diversity of these terms comfort is a complex term. Kolcabas (1991) concept analysis of comfort divine serv iceed to clarify the role of comfort as a holistic concept for nursing. This reappraisal confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients (David, 2002). Over a period of eld and revisions Kolcaba (1994) developed the comfort theory which continues to evolve and transform with miscellanys as late(a) as 2007 (Figure 2).Kolcaba (1994, 2001, 2003) has defined comfort as the quick state of being strengthened done having the human needs for relief, ease, and favourable position addressed in quaternion contexts of experience ( material, psychospiritual, sociocultural, and environmental). The terms relief, ease, and favourable position are types of comfort that occur corporeally 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. Ease is the absen ce of specific discomforts. Transcendence is the ability to rise above discomforts when they fag endnot be eradicated or avoided (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 helping their children and family members feel comforted. Interventions for increasing transcendence shtup be targeted to improving the environment, increasing social support, or providing reassurance.The one- deuce-ace 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 pull ind, which is called a taxonomic anatomical structure (TS) (Figure 1) . Taken together, these cells rep resent all relevant aspects (defining attributes) of comfort for nursing and examine the holistic nature of comfort as an important goal of care. every comfort needs can be placed somewhere on the taxonomic structure, and the cells are not reciprocally exclusive. A sample pediatric case study using the TS as a guide for a holistic comfort assessment is demonstrated below (see Figure 1).The concepts for the middle range for Comfort Theory include comfort needs, comfort interventions, intervene variables, enhanced comfort, health-seeking behaviors, and institutional integrity (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 part 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 befittingly assessed and proper nursing interventions carried out to address those needs, taking into account variables intervene in the situation, the outcome is enhanced patient comfort over time (Kolcaba, 2007). Once comfort is enhanced, the patient is likely to increase health-seeking behaviors. These behaviors whitethorn be internal to the patient (eg, wound healing or meliorate oxygenation), remote to the patient (eg, active participation in rehabilitation exercises), or a peaceful death. Furthermore, Kolcaba asserted that when a patient experiences health-seeking behaviors, the integrity of the institution is after increased because the increase in health-seeking behaviors will result in improved outcomes. Increased institutional integrity lends itself to the development and implementation of exceed rules and best policies encourageary to the positive outcomes experienced by patients (Kolcaba, 2007).To translate the concepts to practice the dominance of a holistic intervention can be targeted to the taxonom ic structure for enhancing comfort in a specific patient, family, or nurse universe over time. Holistic comfort is defined as the immediate experience of being strengthened 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 influenced by behavior, but also verbal encouragement, reflective thinking, physiological sensations and role or self-modeling (Bandura, 1995).. finished self evaluation an individual judges their capability to perform and ce remonious self expectations which is visually depicted in the conceptual model (Appendix 2) (Resnick, 2008).Resnicks Theory of Self Efficacy is based on Banduras social cognitive theory and conceptualizes person-behavior-environment as triadic reciprocality the foundation for reciprocal determinism (Bandura, 1977, 1986). most(prenominal) of the research into self-efficacy beliefs among elder adults has been quantitative and has consistently supported the influence of those beliefs on behavior. However, it has not been open how efficacy beliefs actually influence motivation in older adults, or what sources of efficacy-enhancing education help strengthen those beliefs.Kolcabas Comfort Theory Description, 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 , com fort was considered to be a goal for both nursing and medicine, as it was believed that comfort led to recovery (McIlveen Morse, 1995). 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) conc ept analysis of comfort helped 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). 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 basic assumptions about reality. She assumes that domain beings have holistic responses to complex stimuli comfort is a suited holistic state that is germane to the discipline of nursing human beings actively achieve 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).Concepts. Kolcaba defines six concepts of comfort which are relative to patients, families, and nurses (Table 1) . The term family, as de fined by Kolcaba (2003) encompasses significant others as obstinate by the patient (Kolcaba, 2003 Kolcaba, Tilton Drouin, 2006). The source 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 integrity, added in most recently, are valu es, financial stability and wholeness of health care facilities at the local state or national 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 unselfish 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 he alth 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 significantly indicate that nurses are seeking education regarding patient end of life issues (XXXXX). It is believed that reducing this distress and frustration 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 strong foundation, structural integrity, and operable adequacy of the theory using Smith and Liehrs (2008) Framework for the Evaluation of Middle Range Theo ries is discussed below (Appendix 1).Substantive foundations. Assessing the substantive foundation of a middle range theory is based on four criteria (Smith, 2003). The first cadence 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 diagram 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, evolution and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions. psyche is described as the recipient of nursing care the patient may be an individual, family, institution, or community. Environment is considered to be the external surroundings of the patient and can be manipul ated to increase patient comfort. Finally, health is viewed as the best functioning of the patient as they define it. The ability of the framework to aim interventions that help guide nursing interventions to increase comfort supports the discipline of nursing, and in doing so meeting the first criteria.The second criterion evaluates whether the assumptions are specify 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 helped 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 fellowship evaluates if the origins are rooted in practice and research experience. The Comfort Theory has been used in numerous 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, especially for nurses, and most recently as a framework for working toward national institutional recognitions. More specifically separate are all of the theory have been used to test the intensity of holistic interventions for increasing comfort (xxxxxxx), to demonstrate the correlation between 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 selfsame(prenominal) level on the ladder of abstraction at the middle range level. They are more concrete 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 fourth criterion evaluates whether the concepts and re lationships among the concepts are logically presented with a model. In the Comfort Theory (1994) model the 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 analog logical order so the appreciation of the theory can be recognized (Smith, 2003).Functional adequacy. Because the criterion for functional adequacy overlap more or less the five criterion will be discussed collectively. The five criterion include theory can be applied to a variety of practice environments and clients empirical 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. nonetheless tho ugh the Comfort Theory has been used most widely with patients and families at the end of life and surrounding holistic palliative care nursing interventions, there has been a broad 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 spread out 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 work beyond empiricism and some include perceptions, self reports, observable behaviors and biological indicators (Ford-Gibloe, Campbell, Berman, 1995 Reed, 1995). The Comfort Theo ry (1994) has also been revised with the latest revision in 2007. The empirical adequacy of the Comfort Theory is evidence 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 pers on-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 certain 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 people 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 perspective 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 task. Outcome expectations are judgments about what will run into 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 resourceful 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 t hey could provide sensitive care for some ethical, religious, or moral reason. It is generally anticipated, but not ever so 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 separable 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 summate to predictions of behavior (Bandura, 1977).Judgments about ones self-efficacy is based on four cultivational sources including enactive attainment, vicarious experience, verbal persuasion and physiological state. The first source, enactive attainment, or the actual performance 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 application strengthens self-efficacy beliefs due to informational sources (Bandura, 1995). The second source, vicarious experience or visualizing other equal people perform a behavior, also influence self-efficacy (Bandura, Adams, Hardy, Howells, 1980). Conditions that impact vicarious experience include amount of exposure or experience to the behavior (least experience causes greater impact) and amount of instruction given (influence of others is greater with indecipherable guidelines) (Resnick Galik, 2006). Another source verbal persuasion or exhortation involves notice an individual he or she has the capabilities to master the given behavior. Verbal encouragement from a tru sted, credible source in counseling or education form has been used alone to strengthen efficacy expectations (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 infa