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530 UNIT IV Nursing Theories

institution. At the employee level, the administrators decision making for health care issues (Husted, 2001).
are concerned with care delivery as well as interper- The themes that emerged from this study were used to
sonal relations. Symphonology guides decision mak- develop visual analog tools to measure these feelings
ing into equitable rather than equal solutions. For in nurses and patients. In the second phase, a pilot
example, an employer may choose to forego the use study to test the tool was completed. The Cronbach
of a harsh sanction for absenteeism when the alpha was reported as 0.74 for the nurse’s tool and
employee is able to show extenuating circumstances 0.82 for the patient’s tool (Husted, 2004).
that prevented his attendance. This is also true for the Irwin (2004) used a sample of 30 participants in-
development of policy regarding employees’ behavior. volved in a variety of decisions about health care and
Ethical policy provides guidelines for examining situ- treatment during hospitalization in an acute care set-
ations rather than prescribed rules with concrete di- ting. The study included a decision support interven-
rectives for action. With regard to individual patients, tion for patients to determine the following: (1) whether
administrators act as role models and consultants key concepts of Symphonological Theory describe the
when addressing ethical issues. experience of individuals making health care decisions,
Hardt and Hopey (2001) described the problematic and (2) whether application of the decision-making
situations that occur within managed care systems. framework will enable nurses and patients to make
Difficulties that have been identified include the refusal ethically justifiable decisions. Results confirmed that
of the organization to provide care deemed appropriate patients expressed all the concepts of Symphonology
by health care professionals and the inappropriate de- when discussing their experiences with health care
mands of patients and families. Using the principles of decision making. Statistical analysis of pretest and post-
Symphonology, health care professionals can examine test scores on the Bioethical Decision Making Prefer-
the context and determine appropriate ethical actions ence Scale for Patients demonstrated that subjects had a
within the implicit and explicit agreements. more positive experience of being involved in decision
Nurse administrators and managers can also use making (p 5 0.02) and felt more sufficiency of knowl-
Symphonology to mediate inappropriate situations be- edge (p 5 0.013), less frustration (p 5 0.014), and more
tween patients and nurses (Bavier, 2007). For example, sense of power (p 5 0.009) after the intervention. These
cases in which patients wish to give an inappropriate findings support the validity of Symphonology Theory.
gift as a sign of appreciation to a particular nurse., The theory can be used to describe the experience of
being involved in decision making, and Symphonology
Research has utility as a model for assisting patients through the
Symphonology in research is useful in relation to the decision-making process.
researcher-subject agreement. The health care profes- A graduate student used the nursing visual analog
sional–patient relationship is to some extent implicit, tool to discover how nurses felt when dealing with
but the relationship between a researcher and a subject disclosure issues with patients. The Cronbach alpha
must be thoroughly explicit. Brown (2001c) suggested for this study was 0.82 (Bavier, 2003). Further testing
using the bioethical standards to develop an ethical of the theory is underway as a doctoral student is
informed consent protocol. Particularly when the analyzing data from a study designed to determine
research involves vulnerable populations, the consent the effect of a Symphonology-based educational in-
of surrogates is made more acceptable and is obtained tervention on the ethical decision-making perfor-
more easily if the good of the individual is made central mance of advanced-level nursing students, and to
by using the bioethical standards. compare how students understand the application of
Symphonology and other theories (Mraz, 2012).

Further Development
Initial testing of Symphonological Theory included Critique
two phases. First, a qualitative study examined the Clarity
perceptions and satisfaction of nurses and patients In Ethical Decision Making in Nursing (Husted & Husted,
and their significant others as they engaged in ethical 1995a), the authors presented the emerging concepts