Contributor: Maya Zumstein-Shaha
The Expert Panel Nursing Theory-Guided Practice of the American Academy of Nursing regularly organizes webinars on nursing theories. The developers of these theories present their work. Subsequently, there is time for discussion with the attending audience. In February 2024, I was able to present my theory called The Omnipresence of Cancer. Below, I am going to share my experience and some of my learnings.
My doctoral thesis was the starting point for the development of this theory. In this thesis, I wanted to elicit patients’ experience of being diagnosed with colorectal cancer (CRC). As a junior med-surg nurse, I would see patients for colon cancer surgery. In case the surgery was successful, the person would be free of cancer and I would not see them again. Patients with recurrence and cancer progression would return. I often felt that I missed an important part of patients’ lives as I only saw them during hospitalization. Hence, I decided to delve deeper and to explore patients’ experiences (Zumstein-Shaha & Cox, 2017).
Over the past decades, I conducted several studies, from which the theory emerged (Zumstein-Shaha et al., 2020). At present, the theory comprises four main concepts: Toward Authentic Dasein, Mapping Out the Future, Living with Cancer and Influencing Factors. The first concept, Toward Authentic Dasein, refers to patients’ experiences of discovering the health problem, being diagnosed with cancer and the subsequent surgical intervention. At this early stage into the illness trajectory, patients had many questions concerning the cancer’s etiology, the impact of cancer treatment and of cancer on their lives. Mapping Out the Future encompasses patients’ realization that life would continue. They were trying to find ways to deal with the cancer and its impact on them and their lives. All patients felt that cancer was omnipresent and had a profound impact on their lives as is described in the concept of Living with Cancer. This concept refers to the outcomes of cancer on patients’ wellbeing and quality of life, including the influence on spirituality. Influencing Factors, the fourth concept, comprises socio-demographic, disease-related and setting-related factors.
There is evidence that the experience of being diagnosed with cancer is influenced by the person’s age and level of education, the type of cancer and respective treatment as well as the place treatments occur, be they in hospital or in outpatients’ (Zumstein-Shaha & Cox, 2017; Zumstein-Shaha et al., 2020). Across all studies, the focus was on persons diagnosed with CRC. In addition, persons with other forms of cancer such as lung, hepatocellular or liver cancer or hemato-oncological cancer were included in the studies (Bussy et al., 2018; Cudre, 2016; Roos, 2012; Shaha et al., 2010; Tavares Sobral, 2015; Toniolo et al., 2022).
This theory is currently being taught in various Master of Science in Nursing (MScN) programs in Europe and the United States of America. In particular, students of the MScN in Switzerland develop research questions based on the Omnipresence of Cancer and conduct empirical studies with cancer patients and their relatives. Some of the studies conducted between 2010 and 2016 were integrated into the development of the theory (Zumstein-Shaha & Cox, 2017).
The theory ‘The Omnipresence of Cancer’ has also informed the development of the cross-sectoral treatment pathway for persons with CRC in Switzerland (see: https://www.fmh.ch/themen/qualitaet-saqm/projekte.cfm#, only in German, French and Italian).
Figure 1: Representation of the Colorectal Treatment Pathway. Each header (in each box) links to a separate page in this file with the respective information. This means, e.g., that the header “basic assessment/information” is linked to the page in this document reporting on recommendations for assessments that should be conducted with patients with colorectal cancer. In these basic assessments, there are also nursing assessments leading to nursing diagnosis and respective interventions and outcom
This treatment pathway was elaborated by an interprofessional group of healthcare professionals involved in the treatment and care of persons with CRC in Switzerland. As in many other countries, CRC is also the fourth most frequent cancer in Switzerland following prostate, breast and lung cancer. For diagnosis and treatment of this patient group, many different medical specialties, nurses and other healthcare professionals are involved. So, the Swiss Academy for Quality in Medicine called for this pathway development. Along with representatives of all relevant healthcare sectors and specialties, I was representing the nursing community (Kraft et al., 2018; Stiftung Dialog Ethik & Verbindung der Schweizer Ärztinnen und Ärzte (FMH), 2018). As such, I was able to present the nursing view and priorities of care in this patient group as well as include my expertise drawing on my theory. To date, this pathway is published online. At present, its complete implementation has yet to be established. However, I am confident that it will be implemented more fully in the near future also due to the rising constraints in our healthcare system.
In nursology, several ways of developing theories have been proposed. Among these, building on qualitative research most often involves grounded theory approaches (Fawcett & Desanto-Madeya, 2013; McEwen & Wills, 2018; Meleis, 2018). When I began with my work, I conducted a phenomenologic study drawing on Martin Heidegger. In order to determine the scope of the theory and to move forward to implementation, steps to link my theory to an existing nursing theory were undertaken. It was found that strong ties could be forged between my theory and Newman’s theory of Health as Expanding Consciousness. Newman’s theory was grounded in the experience of living with a life-impairing and -limiting disease. As such, persons in these situations experience many upsetting but equally uplifting moments. There is the possibility of personal growth despite the impact of the disease on the person’s life (Bateman & Merryfeather, 2014). In the Omnipresence of Cancer, the person also finds a way to make sense of life. Nurses in particular are called to determine with the patient and their families ways of support (Zumstein-Shaha & Cox, 2017; Zumstein-Shaha et al., 2020).
Drawing on the theory and following the recommendations by Melat Ziegler (2005), the potential for an advanced practice nurse for CRC patients was explored. Having the theory guiding this thought experiment was very interesting as the audience kindly acknowledged during the webinar. It turns out that drawing on existing material and forging ties to my own theory may be another process that could contribute to theory development in nursology.
Having had the opportunity to present my theory and engaging in discussions with the audience was at the same time nerve-wracking as it was illuminating. The discussion helped me see potential next steps to undertake.
Literature
Bateman, G. C., & Merryfeather, L. (2014). Newman’s Theory of Health as Expanding Consciousness: A Personal Evolution. Nursing Science Quarterly, 27(1), 57-61. https://doi.org/10.1177/0894318413509725
Bussy, C., Pasche, J., & Chaudhry-Schaer, A.-C. (2018). [Partial validation of the instrument Transitoriness] University of Lausanne, CHUV Centre Hospitalier Universitaire Vaudois, IUFRS]. Lausanne.
Cudre, L. (2016). [Comparison of the coping strategies of patients with first-line treatments in an outpatients’ departement vs. patients in a surgical department] University of Lausanne, CHUV Centre Hospitalier Universitaire Vaudois, IUFRS]. Lausanne.
Fawcett, J., & Desanto-Madeya, S. (2013). Contempory nursing knowledge : Analysis and evaluation of nursing models and theories (3rd ed.). F.A. Davis.
Kraft, E., Nadig, J., & Pfisterer, J. (2018). Meilenstein beim Behandlungspfad Kolorektalkarzinom erreicht! Schweizerische Ärztezeitung, 99(07), 198-201. https://doi.org/https://doi.org/10.4414/saez.2018.06435
McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (Fifth edition. ed.). Wolters Kluwer.
Melat Ziegler, S. (2005). Theory-directed nursing practice (2 ed.). Springer.
Meleis, A. I. (2018). Theoretical nursing : development and progress (6th ed.). Wolters Kluwer.
Roos, P. (2012). [Spiritual needs of patients with cancer] [Masters thesis]. University of Lausanne, CHUV Centre Hospitalier Universitaire Vaudois, IUFRS,.
Shaha, M., Pandian, V., Choti, M. A., Stotsky, E., Herman, J. M., Khan, Y., Libonati, C., Pawlik, T. M., Schulick, R. D., &
Belcher, A. E. (2010). Transitoriness in cancer patients: a cross-sectional survey of lung and gastrointestinal cancer patients. Support Care Cancer, 19(2), 271-279. https://doi.org/10.1007/s00520-010-0815-z
Stiftung Dialog Ethik, & Verbindung der Schweizer Ärztinnen und Ärzte (FMH). (2018). Qualitätskriterien für Patienteninformationsmaterialien und Entscheidungshilfe am Beispiel des interprofessionellen, sektorenübergreifenden Behandlungspfad Kolorektalkarzinom.
Tavares Sobral, G. (2015). Développement d’un instrument pour identifier l’expérience de Transitoriness University of Lausanne,]. Lausanne.
Toniolo, J., Beloni, P., & Zumstein-Shaha, M. (2022). La spiritualité: Perspective de patients atteints d’un cancer hématologique nouvellement diagnostiqués et de leurs proches. Une étude qualitative exploratoire. Recherche en Soins Infirmiers, 1(148), 8-21. https://www.cairn.info/revue-recherche-en-soins-infirmiers-2022-1-page-8.htm
Zumstein-Shaha, M., & Cox, C. L. (2017). A theory of cancer care in healthcare settings (1st ed.). Routledge.
Zumstein-Shaha, M., Cox, C. L., & Fawcett, J. (2020). The Omnipresence of Cancer: Two Perspectives. ANS Adv Nurs Sci. https://doi.org/10.1097/ANS.0000000000000314
About Maya Zumstein-Shaha
As a deputy head of the Master of Science in Nursing program, I teach philosophy of science and advise students in the process of conducting their Masters’ theses. Additionally, I conduct research on advanced practice nurses and new models of care, cancer care, spirituality, theory development and progression in nursology.