The treatment of oncology in modern medical practice is the task that requires a responsible approach since cancer patients experience severe inconvenience caused by both moral depression and physical pain. The search for relevant methods of solving this issue is a current objective in most specialized healthcare facilities. Special attention should be paid to not only practical assistance aimed at strengthening the body of cancer patients but also moral support in order to alleviate temporary difficulties caused by serious inconveniences and new surrounding. For this purpose, techniques and methods can be used as the effective mechanisms of interaction, and one of these approaches is the attachment theory that is rather a psychological concept than a medical one.
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The attachment theory is one of the concepts that help the nursing staff to interact with patients and allows employees in medical settings to keep in touch with those who need moral support. Based on the literature review of scholarly articles, the evidence is found in favor of this approach regarding the oncological practice of the junior staff. Also, the relationship of the theory with other principles of interaction is evaluated.
This work is aimed at finding theoretical and methodological problems related to the concept in question and found during the literature review. The assessment of the relevance of the theory within a specific medical facility can provide the comprehensive picture of the merits that gives utilizing this approach and its features. When applying the attachment theory to the oncological setting, patients have an opportunity to receive competent psychological help, and nurses expand their knowledge about using this concept and providing appropriate support.
The Literature Search
Due to the analysis of existing scholarly sources that are freely available, a range of studies have been considered. When choosing resources, special attention was paid to their relevance, and all their submitted works are not older than five years. Google.Scholar is the database where all the articles were found and selected according to the year of publication filter. The basic keywords and phrases used in the search process – “attachment theory,” “oncology,” “oncological care,” and “cancer patients.” Peer-reviewed articles are selected as those that are credible and have verified information approved by professional editors.
During the search, many scholarly papers have been selected, but when analyzing their content and research methods, some sources were rejected. Some of them had topics that were close to the issue under study. However, they contained irrelevant information, in particular, statistical reports that were older than five years. The use of these resources would be incorrect since the information could become outdated during this time, and the reliability of facts could be questioned.
As a basis for the analysis of the attachment theory within oncology departments, the studies were selected that corresponded to the stated principle of selection, in particular, the assessment of this concept’s relevance in helping patients. Also, all the sources were found manually, and no automated selection tools were used, with the exception of the electronic database Google.Scholar. Fifteen articles with relevant data were selected as sources for analysis. The attachment theory is the key object of all the findings presented. The results of the work conducted are effective since a number of facts have been obtained due to the literature review.
Historical Evolution of the Theory
The development of the attachment theory in medicine is considered by different authors as the process of introducing additional methods of care in nursing practice. According to Calvo, Palmieri, Marinelli, Bianco, and Kleinbub (2014), this approach represents special interaction skills that can be traced in early childhood when appropriate care is provided. In other words, the attachment theory is closely related to those care principles that are observed in the relationships between a mother and a child.
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As Milberg and Friedrichsen (2017) note, this concept has become widespread recently due to an opportunity to provide patients with better adaptation to the difficult conditions of the disease. The application of such a methodology is logical since oncology is associated with “emotional distress, such as anxiety, depression and other emotional regulation disorders” (Ouakinin et al., 2015, p. 424).
Nicholls, Hulbert-Williams, and Bramwell (2014) also consider this theory from the point of view of parent-child relationships and argue that the principles of upbringing promoted by psychologists are largely applicable in the context of nursing care for cancer patients. At the hospital environment, a person needs moral support acutely, and the assistance that is demonstrated by the medical staff can be the effective means of reducing emotional depression.
As Maunder and Hunter (2016) remark, “individual differences in attachment behaviour develop, manifested as stable patterns” (p. e011068). Borrowing such a concept from pediatric psychology is due to an urgent need to give people in oncology departments the assurance that they are under reliable protection. It is this principle of support that is promoted as a rationale for the introduction of the theory into nursing practice.
The development of the theory in activities related to caring for cancer patients is due to the advancement of relevant scientific studies. Ávila, Coimbra, Park, and Matos (2017) cite the concept of attachment anxiety and argue that such behavior consisting in a strong connection between patients and caregivers stimulates a favorable treatment environment. The lack of contact, on the contrary, affects the nature of recovery negatively, which distracts medical specialists and brings significant discomfort to both parties. Therefore, the promotion of the attachment theory has become widespread among oncology nurses, and one of the primary reasons for introducing this concept is the need to maintain consistently high motivation for recovery.
One of the evident weaknesses of nursing care for cancer patients is a decrease in well-being caused by an emotional-depressive disorder. As a consequence, a significant need arises to ensure that morale is not the variable that may reduce the effect of treatment. The study conducted by Alonso, Ezama, and Fontanil (2015) confirms “the importance of interventions aimed at improving emotional state through improved relationships during cancer treatments” (p. 32). The rationale for the effectiveness of the development of this methodology is given in scholarly articles about patient satisfaction with this principle of care. Hasson-Ohayon et al. (2013) remark that the feedback received after applying the relevant practice in oncological settings confirms the positive assessment of the attachment theory. As the authors argue, “the relationship between attachment styles and distress or depression is mediated by social support” (Hasson-Ohayon et al., 2013, p. 528).
Conceptual, Theoretical, and/or Methodological Research Issues
The relevance of the attachment theory in the treatment of cancer patients is described in academic sources and is referred to as the technique used by medical personnel. Despite the advantages of this model of care in the framework of oncology departments, some ambiguous nuances have been discovered in the process of the literature review. Three issues have been evaluated – a methodological, conceptual, and theoretical one. Assessing these problems may help to identify the potentially effective ways of eliminating them in order to improve the quality of nursing care and ensure successful interaction between patients and the staff, which contributes to a more rapid recovery of the body after chemotherapy and other procedures.
Lack of Trust – A Methodological Issue
One of the conceptual problems that have been revealed in the research process is the degree of trust between patients and caregivers. As Holwerda et al. (2013) note, “studies of patients’ trust in their physician when confronted with cancer are relatively scarce” (p. 110). However, the authors remark that individual cases described in nursing practice are related to the insufficient degree of interaction of medical personnel with their target population due to the lack of trust of one party to the other (Holwerda et al., 2013).
As a rule, these are patients who doubt the competence of caregivers, the relevance of procedures, and other issues associated with the treatment process. According to Philipp et al. (2017), such a phenomenon as attachment insecurity causes the lack of trust, and patients cannot rely on the nursing staff because of personal beliefs. This problem may cause serious inconvenience for both parties since the process of care is complicated by the absence of normal communication. In this regard, the solution to this issue is an urgent task within the framework of those oncology departments where this theory is one of the key nursing approaches.
Finding the ways of maintaining understanding between caregivers and patients is an essential methodological issue. Based on the results of the analysis, adherence to certain methods of interaction may have different outcomes depending on the individual characteristics of patients, their preferences, personal convictions, and the professional competence of the staff. As Holwerda et al. (2013) remark, the lack of knowledge about how to involve the target group in cooperative work is fraught with the loss of credibility of medical staff and poor treatment outcomes. Consequently, interventions aimed at maintaining the attachment theory in oncology departments should include those techniques that allow the staff to make contact with patients easily, without experiencing any challenges caused by the aforementioned factors.
Confusion in Terms and the Objectives of Interventions – A Theoretical Issue
In the process of searching for information about the topic in question, some problems have been found that are related to the formulation of the theoretical provisions and its application among the described group of patients.
According to Beesley, Goodfellow, Holcombe, and Salmon (2016), initially, the attachment theory was developed as a psychological concept that defined the relationship between parents and children, and there is confusion in terminology and designation. In relation to cancer patients, this model of care is not similar to the approach described by child psychologists. The attachment theory used by nurses to help cancer patients has little in common with the classic form of this theoretical concept. However, for ease of use and mention, this practice has an identical name, despite different objectives.
As differences from the traditional relationships between children and parents, Ein-Dor and Hirschberger (2016) propose to consider the approach described by Bowlby as the “system that has evolved to deal with acute threats and stressors and to promote survival” (p. 223).
The possible confusion in terms can be explained by some employees’ lack of knowledge regarding different ways of affection, and the Bowlby’s approach has little to do with the principles of care that are maintained in childhood. One of the main differences is the desire to achieve mutual understanding and trust between caregivers and patients in order to ensure productive interaction for the positive outcomes of treatment. Nevertheless, the incorrect interpretation of the theory under consideration can lead to the misconception that the principles of caring for children and cancer patients are identical.
The Lack of Opportunities for Development – A Conceptual Issue
The existing terminology and theoretical rationale in favor of supporting close communication between the nursing staff and cancer patients suggest that enough work has been done to develop the attachment theory. Salmon and Young (2017) argue that “current conceptual borders” cannot bring anything new to the practice of junior medical employees regarding improvements in work with patients (p. 1291).
However, when assessing the development opportunities of the attachment theory within oncology departments, additional methods of assistance can be developed and implemented as effective aid mechanisms. According to Milberg et al. (2014), the sense of cancer patients’ safety largely depends on how advanced palliative care is promoted. Therefore, a conceptual issue may be related to the lack of the development of the given theory and its provisions.
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The need to expand the range of influence of the theory provisions imposes certain problems. In particular, Rodin (2018) notes that psychosocial care in oncology departments may not be high enough due to “the lack of consensus about what interventions or support should be available on an urgent or routine basis” (p. 2313).
If unambiguous decisions are not made regarding the scope of tasks performed under the attachment theory to provide comprehensive care, it may have negative consequences for both patients and nurses. The medical staff of clinics will not be able to obtain relevant practice and knowledge regarding all the required aspects of working with those who need emotional support caused by depression as the consequence of a severe disease. Patients, in turn, will not be relieved due to the lack of nursing attention and the need to check the list of the theory provisions constantly.
Summary of Conceptual, Theoretical, and/or Methodological Research Issues
In the research process, conceptual, theoretical, and methodological issues can be solved if the relevant criteria are used as a basis for analyzing the topic and its individual provisions. The problems of the lack of trust, confusion in terms, and the absence of opportunities for development may be reconsidered by adhering to certain rules of the theory evaluation. In particular, the development of this methodology should not be assessed within the framework of a child’s psychological concept in order to avoid incorrect comparisons and interpretations. Conducting competent research should be carried out to provide the relevant scientific base necessary for the development of the theory and the search for the justification of its relevance at the considered medical facility.
Summary of the State of Science
The development of the attachment theory is related to the concept used in child psychology and defining the relationships between parents with children. However, in nursing practice, this model of care has received a different form, and in the context of working with cancer patients, the provisions of this methodology differ significantly from the original theory. The need to help people who undergo treatment courses in oncology departments is determined not only by physical but also psycho-emotional support based on close interaction and trust. During the research process, some issues have been found, which can limit the knowledge of nurses, thereby affecting patient outcomes negatively.
Academic studies conducted evaluate the attachment theory in relation to care in oncology departments and its relevance as an intervention methodology. However, some conceptual, theoretical, and methodological research issues hamper the theory development. The lack of knowledge about all the possibilities of this concept and the range of nurses’ responsibilities reduces the potential effectiveness of the concept (Holwerda et al., 2013).
Also, confusion in the terminology and the evaluation of this approach to a specific population group may affect the staff productivity (Beesley et al., 2016). The lack of opportunities to search for the development of the theory slows down this working area and does not allow establishing productive interaction between nurses and patients, reducing the likelihood of quality treatment (Salmon & Young, 2017).
As an area for further research, the search for the distinctive features of this concept can be carried out, and additional opportunities for the nursing staff may be listed. Researchers may point out that the attachment theory for adults has little to do with the children’s concept of care. Individual opinions concerning the quality of this approach can be assessed by conducting surveys among both the nursing staff and cancer patients. To maintain a high level of care based on the attachment theory, research can be aimed at finding measures to encourage the use of this practice. Also, special attention can be paid to terminology in order to avoid confusion when comparing the attachment theory for cancer patients in oncology departments with the classic version of this concept.
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