I.

Introduction

Concepts are building blocks for theoretical development (Tomey &

Alligood, 2002). A concept analysis provides a clear definition of the selected

concept, including its uses, defining attributes, related concepts, and its

applicability to the selected discipline (Walker & Avant, 1995). According to Knafl

and Deatrick (2000: 39) concept analysis typically “entails synthesizing existing

views of a concept and distinguishing it from other concepts’ with the purpose of

resolving gaps or inconsistencies in the knowledge base of the discipline. It is

one means whereby members of the discipline can define or clarify concepts that

relate to their phenomena of interest and make clear their pattern of usage,

which in turn can become a precursor of theory and knowledge development, to

ultimately improve practice. Thus, concept analysis is concerned with boundary

work that guides the discipline and forms the links between research, theory and

practice. The concept of reassurance was selected for analysis because of its

relevance to practice. It is an overused but little understood concept.

Reassurance is frequently mentioned in nursing literature and in nursing practice.

However, there is no generally accepted definition of its range of

meanings, and some controversy over its therapeutic value. Health care

providers always employ the act of “reassuring the patient” but the complexity of

the concept made its use to have different outcomes. The aim of this concept

analysis is to provide a clear definition of reassurance as it relates to nursing,

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identify its characteristics, describe cases, and expand on the existing literature

and creating a distinction from its use in other disciplines. A deeper look into this

important term will improve nursing practice and positive use these phrase to

“reassure the patient.”

I. Definition of the Term

Webster’s Third New International Dictionary defines reassurance as,

“having confidence restored or freed from any fear or anxiety” (page 1,023). The

Free Online Dictionary by Farlex defines reassurance as, “to restore confidence

to, to assure again and to reinsure”. In this concept analysis, it is crucial to define

the term assurance. Merriam Webster’s Pocket Dictionary defines the word as,

“to give confidence or conviction to, to guarantee” (page 21). The Free Online

Dictionary by Farlex defines it as, “a statement or indication that inspires

confidence; a guarantee or pledge”. The term assurance can be applied if there

is no doubt, fear or anxiety present and needs to gain confidence whereas

reassurance can be applied if there is alteration in the confidence level and

needs it to be refurbished. An example of assurance used is “the supplier gave

an assurance that all his products is of quality”. An example of reassurance used

is “the tutor reassured the parents that they will do the best they can to get their

daughter back to the dean’s list”.

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 In nursing context, health care providers frequently say the phrase,

“reassure the patient,” commonly heard from the nurses but often become a

vague statement. According to Teasdale’s research (1989) the concept of

reassurance is defined into three different understanding. The first definition

stated that reassurance is seen as a state of mind in which it is emphasized on

the outcome of having restored confidence. The second definition is used as a

verb wherein it is posed as a purposeful attempt in restoring confidence by

means of creating and initiating a plan to fulfill the overall outcome. The last

definition stated that reassurance is an optimistic assertion, meaning words are

deliberately used to induce optimism in the patient, but the intent to relieve stress

and anxiety is not implied. An example of giving reassurance to patients is when

he needs to undergo MRI of the brain. The patient became anxious because he

has an idea that he will be on a tunnel-shaped bed all throughout the procedure.

Now, as a nurse, you will reassure the patient and describe what he has to feel

during the procedure like he will hear a drum-like sound inside the tunnel and it is

normal. In that way, you were able to reassure the patient that he/she will be safe

throughout the procedure.

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 II. Uses of the Concept

Several definitions for reassurance can be found in dictionaries and

throughout the literature related to various disciplines. The meaning of the

concept of reassurance is directly dependent upon the discipline and the context

in which it is used.

In mass media, the concept is used when they are giving information to

the public through the use of Internet, television, newspapers, and radio when

there are false predicted dangers such as calamities, shortage of supplies,

epidemics and the likes. An example would be of concept of reassurance in

mass media was during the phenomenal tsunami happened in Japan last March

11, 2011, Friday. The tsunami caused an earthquake of 8.9 magnitude in Richter

scale. Tall building structures in Japan were destructed, many people were

wounded and there were a big number of casualties. Knowing that the

Philippines is just few miles away from the core of the disaster, there were

speculations that huge tsunami will hit Philippines. Many people became anxious

about the speculations. The Philippine Institute of Volcanology and Seismology

reassured the public through the utilization of mass media that the public should

not be too much worried because they received reports of sea level data

indicating that current trend of observed wave heights suggest that the threat of a

hazardous tsunami has passed. However, they said that the public is still advised

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to avoid going to the beach and sailing out to the sea. The media addressed the

report from Phivolcs to reassure the public and diffuse any panic.

In building relationships, it is always passé to hear that a partner needs

reassurance in a certain relationship. It means to say that a partner needs the

sense of security that he/she is protected by the relationship and his/her partner

will not leave or caused his/her pain.

By legal definition, the concept of reassurance is present when an insurer

is eager of lessening his liability; he may procure some other insurer to insure

him from loss, for the insurance he has made this is called reassurance (Burton,

2007).

In psychology, giving reassurance is non-therapeutic. This is a side

wherein reassuring the patient gives a negative outcome. Offering false

reassurance makes a barrier to ineffective therapeutic communication. An

example is when the patient is asking whether his disease will be eliminated and

the nurse’s response is “Don’t worry sir, you are in the hospital I am sure that

your cancer will be eliminated.” This type of response will disregard patient’s

needs and feelings. Statements that promote optimism are typically mechanisms

the nurse perceives an attempt to relieve the patient, but instead is an action to

relieve the nurse. The patient’s behavior may make the nurse anxious and the

nurse could use reassurance as a defensive mechanism to relieve the nurse’s

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emotions or to reduce an unwanted scene (Gregg, 1995). The nurse will use this

defensive tactic because he or she wants to make sure they say the right thing to

the patient in order to comfort them.

By further understanding and defining the concept, reassurance can be a

mechanism that will be beneficial toward the patient overcoming their fears and

anxiety.

III. Analysis of the Concept

A. Defining Characteristics

Characteristics of a particular concept that are noted to be repetitious in

the literature are referred to as its defining attributes (Walker & Avant, 1995). An

extensive review of the literature and formal analysis revealed the attributes of

the concept reassurance. The nurse knows that a certain patient needs

reassurance based on his own assessment with regards to the patients

subjective and/or objective cues. The patient should have a recognized danger or

threat. The patient should have an altered confidence, is anxious or with fear

before the concept of reassurance would take into place. The patient was in a

normal state of confidence until such time that there was presence of danger or

threat in which it alters the normal state of confidence, making the patient

wanting to restore his previous state of confidence.

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 In nursing, the concept of reassurance occurs when the nurse provides

explanation about what to expect in a certain procedure prior to execution to a

patient. The fear or anxiety of the patient can be lessened or eliminated when the

nurse gives reassurance by providing information with regards to their condition.

In that sense, verbal reassurance does not only apply in giving reassurance but

therapeutic touch can also provide reassurance to a threatened person. Both

giving of information and therapeutic touch is the first defining characteristic of

the concept.

Since reassurance cannot be measured, attainment of the desired effect

of reassurance can be subjective and varies among patients. In any case, there

is a desired effect to make the anxious patient be satisfied or have sense of relief

from the perceived threat or danger. These characteristics relates with the

working definition of the concept analysis in which a nurse attempts to

communicate with a patient, with the intention for them to feel their anxiety or fear

be lessen and restore their normal state of confidence.

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 B. Conceptual Paradigm

PERCEIVED THREAT / DANGER

Altered state of confidence

Giving of information Rendering Providing explanation

REASSURANCE

Normal state of confidence

IV. Theory Application

A theory that applies to the concept of reassurance is the Comfort Theory.

Kolcaba (1994, 2001, 2003) has defined comfort as "the immediate state of being

strengthened through having the human needs for relief, ease, and

transcendence addressed in four contexts of experience (physical,

psychospiritual, sociocultural, and environmental)" (2003, p. 251). Relief is the

state of having a discomfort mitigated or alleviated. Ease is the absence of

specific discomforts. To experience ease a child or family does not have to have

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a previous discomfort, although the nurse may be aware of predispositions to

specific discomforts (e.g., the tendency for shortness of breath in an asthmatic

child or acute anxiety in family members). Many medical and psychological

conditions disturb homeostatic mechanisms, and nurses must be aware of risk

factors for depression, stress-related illness, dehydration, bleeding, or vomiting to

name a few examples. According to the theory, comfort interventions have three

categories: (a) standard comfort interventions to maintain homeostasis and

control pain; (b) coaching, to relieve anxiety, provide reassurance and

information, instill hope, listen, and help plan for recovery; and (c) comfort food

for the soul, those extra nice things that nurses do to make children/families feel

cared for and strengthened, such as massage or guided imagery (Kolcaba,

2003).

V. Antecedents

Most of the patients that are admitted to the hospital experience a sort of

anxiety of being in the hospital. Antecedents to truly effective reassurance in

nursing vary depending upon the factors. Assessment is vital to encourage

reassurance to the patient. The nurse should identify first if there is any presence

of threat or danger based on the patient verbal and non-verbal cues. If there is

any presence of threat, the nurse must identify the cause why the patient is

having such feeling because there are many factors that may cause the

presence of threat such as environment. Another is patient’s own perception

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about their health condition. It is closely related with the patient having

experience of fear and anxiety. If appropriate assessment of the presence of

threat is not achieved, the nurse would not be successful in providing

reassurance to the patient or worse may give a bad effect to the patient. Proper

assessment of the patient emotionally, physically, mentally and even spiritually

should always be present in nursing practice.

The behavior of the nurse is a strong foundation for the concept of

reassurance to take into place. The nurse should have respect on the patient’s

values and beliefs by accepting it and establishing a trusting relationship.

Patients said that the nurse having a good attitude is an important quality when

they undergo health management. The nurse should also be good in establishing

interpersonal relationship in order to encourage verbalization with the patient so

in that sense, the nurse can identify true feelings of the patient.

Providing reassurance is not just about giving information through verbal

communication but reassurance can be established even with non-verbal

communication. Research reveals that mere presence of the nurse, allows them

to fully understand the needs of the patient (Fareed, 1996). Presence of the

nurse beside the patient was said to be a reassuring action. Effective

reassurance requires presence by the nurse. Therefore, proper assessment,

good behavior of the nurse and mere presence of the nurse are the antecedents

prior to the action of reassuring the patient.

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VI. Consequences

As what is indicated on the previous statements, the concept of

reassurance is quite hard to measure empirically that is why one way to measure

the effectiveness of reassuring is the patient’s verbalization through subjective

cues that their fear and anxiety was of relief. Another way to measure is through

biophysiological measurements like blood pressure and cardiac rates, though

there is no direct strong relationship that indicates these measurements as

affected by reassuring the patient but decrease in anxiety can cause normalize

biological process.

Reassurance can be of positive or negative results to the patient as

discussed in previous paragraphs. A positive consequence when reassuring a

patient is that the patient gains control over their body because it is believed that

when a person was hospitalized him/her loses confidence and has a sense that

they have lost over their body. Through the help of the nurse and other members

of the health care management team the patient can restore the confidence

before having hospitalized. Another positive consequence of reassurance is that

the patient will be able to cognitively reframe. It allows the patient to

psychologically cope with themselves. Reassuring acts rendered by the nurse

can cause the patient to cognitively reframe their mindset, giving them time to

view the anxiety-producing event as less threatening.

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 The type of reassurance that can cause negative consequences is false

reassurance. This is when the nurse gives statement to the patient such as

“Don’t worry”, “everything is okay”, “I assure you that you are well”. Rendering

this type of reassurance will most likely not cause the patient to feel relief from

the anxiety or fear. Consequences of reassurance are hard to predict because

each perception of an individual is distinct. The health care provider can apply

the concept of reassurance, but the patient has the final control over if the

intervention given by the health care provider is a relief.

VII. Empirical Reference

A. Model case

A model case of a concept analysis demonstrates all the defining

characteristics of the concept chosen (Walker and Avant, 2005). An example is

when during the end of shift report; the nurse from a certain shift endorsed all

activities happened to the patient including lab follow-ups or result and then

nurse makes rounds to check and receive the patients. When the nurse enters

the room of the a post cerebrovascular accident patient, the nurse notice that

the patient is anxious about his state because of raising too much questions.

The nurse relays to the patient his lab results and doctor’s impression that

they’ve seen no further deterioration and that the clot on his cerebral arteries

gone smaller which revealed by magnetic resonance imaging. After the giving of

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factual information the patient verbalized that he is now of good feeling and less

anxious regarding his medical condition. In summary, there is a fear or anxiety

present in the patient, the nurse does action to alleviate the fear, and the patient

restore his confidence with regards to his condition.

B. Borderline case

Borderline cases demonstrate some defining attributes of the concept,

while lacking a sufficient number to support its true meaning (Chinn and Kramer,

2008). An example would be a patient is continuously complaining of severe

pain of her right hip, the nurse is giving her medication of fentanyl on time and

even with a rescue dose as ordered by the physician. The patient claims that the

pain medication isn’t working. The nurse reassures the patient that the pain

medication would take effect after several minutes and not right away after giving

the medication. The patient didn’t listen and keep on complaining about the pain

and became more emotionally distraught. The nurse chose to stay with the

patient to ensure her safety. This borderline case shows that the nurse

recognized the patient’s feeling and provides information but the information was

not enough for the patient to ease her feeling.

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 C. Contrary case

A contrary case demonstrates what the concept is not (Chinn and Kramer,

2008). An example would be a patient is about to go for a Coronary Artery

Bypass Graft procedure. The patient looks very relaxed and not anxious about

the procedure but deep inside he is very anxious with regards to the whole

procedure. He is just pretending to be okay because he is shy to raised

questions. The nurse recognized him as a patient not under stress so the nurse

just let him continue to relax and send him to the cardiovascular operating room.

In this situation, the nurse does not cover any defining characteristics of

reassurance. The nurse didn’t recognized any fear or anxiety present to the

patient so the nurse didn’t give any action to alleviate fear because in the first

place, the nurse knew that there was no fear present.

D. Related case

Related case represents a concept that is similar, without the defining

characteristics (Chinn and Kramer, 2008). An example would be when a new

nurse has arrived on the station and another nurse noticed that she is not

comfortable so that old nurse approached the new nurse if she is just okay and

the new nurse just nodded. The old nurse stated that if she wants to talk she is

always available. In the situation, reassurance may or may not be needed and it

could be that, giving the new nurse time to cope with the new environment.

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IX. Conclusion

This analysis present attempted to enhance the conceptual meaning of

reassurance in nursing examining its importance, definitions, characteristics,

antecedents and consequences. Gaining more knowledge and understanding

with regards to the concept and use it correctly will be extremely beneficial to the

nursing profession. Not only will the patient benefit but the nurses as well. They

will have increase clinical competence resulting to high quality of care. The

utilization of reassurance as nursing intervention will likely to decrease levels of

anxiety and enhance patient’s perceptions of nurse’s ability to care for them.

Analysis of this concept showed that the term is an important nursing skill and

should not be taken for granted. The use of reassurance cannot be avoided in

nursing practice, and with increase knowledge about the concept will surely

benefit the patient.

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X. Bibliography

Burton, G., (1958). Personalm impersonal and interpersonal relations: a guide for

nurses. New York City, NY: Springer Publishing Company.

Chinn, P. L., and Kramer, M. K. (2008). Integrated theory and knowledge

development in nursing (7th ed.). St. Louis: Mosby.

Fareed, A. (1996). The experiences of reassurance: patient’s perspectives.

Journal of Advanced Nursing. 23. 272-279.

Gregg, D. (1995) Reassurance. The American Journal of Nursing. 55 (2). 171-

174.

Kirk, K., (1992) Confidence as a factor in chronic illness care. Journal of

Advanced Nursing. 17.1238-1242.

Teasdale, K. (1996). Information and anxiety: a critical reappraisal. Journal of

Advanced Nursing. 18. 1125-1132.

Walker, L. & Avant, K. (1995). Concept analysis. In L. Walker & K. Avant,

Strategies for theory construction in nursing (3rd ed.) pp.37-54.

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