Category: Nursing Theory

In this article, the researches main purpose is to analyze the competence and experience level of professional nurse practitioners and new graduated nurses. The study has been conducted according to Benners model consisting in the identification of relations between nurses competence and their experience. The examination has been accomplished by means of chi-square analysis. The article is of great importance for research paper as the given study directly relates to Benners theory.

In the article, Altmann summarizes the main concepts of Patricia Benner work From Novice to Expert in order to identify whether this book is a philosophy but a theory. To do that, the authors goal is to define the difference between a theory and a philosophy and to the stages of epistemological process occurring in the health care environment. Therefore, this summary directly relates to my research as it is based on Benners book.

This paper describes clinical decision support systems (CDSS), software aimed at improving the quality of care and providing an easier access to medical digital data. The authors believe that this program is not always efficient for those who lack experience. This article is not appropriate for my work, as the merits of CDSS are vaguely defined.

The authors state that clinical environment help novice nurses to apply the theoretical principles in practice and to view different situation in a full context. However, the problem is that nurse graduates are frequently guided by more experienced nurse practitioners that deprive them of possibility to make independent decisions, which is the reason of novice nurse leaving the profession. Therefore, the researchers discuss the necessity to insert decision-making training programs to health care environment. This work is, therefore, relevant to my own research, as it refers to Benners concepts of nurse transaction from novice to experts.

In the article, the researches touch upon the necessity to support novice nurse faculty members and their engagement into clinical environment. They also believe that mentoring is the key point triggering the novice nurse into academic life. The work implicitly reveals the Benners concepts of novice nurses penetration to experienced nurse stuff.

In the article, the authors intend to define the effectiveness of novice nurse transition to the role of intense care unit nurse if working with more experienced nurses. In particular, they discuss quantitative and qualitative results of Shadow-A-Nurse ICU Program after two years of its implementation. This source is rather helpful for further research in that field, as the program accomplishment is based on Benners application of skill acquisition model.

Reference

Alber, L., Augustus, L., Hahn, S., Penkert, J. (2009). Applying Benners Model to Psychiatric Mental Health Nurse Practitioner Self-Ratings of Role Competence. J Am Psyhiatr Nurses Assoc, 15(2), 126-137.

Altmann, Tanya. (2007). An Evaluation of the Seminal Work of Patricia Benner: Theory or Philosophy? Contemporary Nurse. 25, 114-123.

Courtney K. L., Alexander G. L. Demiris, G. (2008). Information Technology from Novice to Expert: Implementation Implications. J Nurse Manag. 16(6) 692-699.

Gillespie, M., and Paterson, B. (2009). Helping Novice Nurses Make Effective Clinical Decisions: The Situated Clinical Decision-Making Framework. Nursing Education Perspectives. 30(3). 164-170.

Hawkins, J. W., and Fontenot, H. (2009). What do you mean me to teach, do research, engage in service, and clinical practice? Views from the trenches: The novice, the expert. Journal of the American Academy of Nurse Practitioners. 25, 358-361.

Messmer, P. M., Jones, S. G., Taylor, B. A. (2004). Enhancing Knowledge and Self-Confidence of Novice Nurses: The Shadow-a-nurse ICU Program. Nursing Education Perspectives. 25(3). 131-136.

Nursing theories are useful in solving issues related to the nursing profession. This essay aims to describe the Comfort Theory of Nursing and the use of the theory in addressing problems encountered in nursing education. I have applied this theory in solving problems of this nature throughout my practice as a nurse. I also have a lot of experience through witnessing lecturers use the same principle in helping their nursing students. I will use a case study from one of the experiences to explain the applicability of the theory.

Overview of Nursing Theory in Nursing Practice

The profession of nursing has developed significantly over time. Initially, nurses used to depend wholly on medical directions from physicians to provide necessary medical assistance. However, the profession has now grown to have independent modalities of practice, with its theories that define its practice, its nursing models, as well as distinct nursing interventions. Nurses and researchers in the field of nursing have developed several theories over time due to the need for the development of policies that will shape the field of nursing. The theories have changed and shaped the current nursing profession (Sitzman & Eichelberger, 2011).

A theory projects a systematic, purposive view of a given subject. It is specially designed to explain, describe, predict, or prescribe a given analogy. All theories are made of models, concepts, propositions, definitions, and developed based on assumptions. They are drafted in two main ways; deductive and inductive reasoning. The theories are developed for various purposes. The main reason for developing them is the description, explanation, and prediction of the field of practice known as nursing. In this perspective, the theories help establish the basis for nursing practice, provide more information required in the same area, as well as predict the direction towards which the nursing profession is headed. The theories also help nurses to make decisions on what is known and determine what needs to be known (Sitzman & Eichelberger, 2011).

According to Sitzman and Eichelberger (2011), there are three main types of nursing theories, which are classified according to the scope of practice the theories cover. They include the Grand Nursing theories, Mid-Range Nursing theories, and the Nursing Practice theories. The nursing theories in the category of the Grand Nursing theories provide and the insights that are useful in the nursing profession, but they do not provide specific information for a particular intervention. Such broad coverage always limits the applicability of the theories in explaining, directing, and predicting nursing practice in particular circumstances.

The scope of practice of Mid-range theories is narrower compared to the Grand Nursing theories. They are designed to bridge the gap between the Grand Theories and the Nursing Practice theories. This category of nursing theories is research-oriented; thus, it the theories enhance evidence-based practice. The Nursing Practice theories have the narrowest scope of the three categories of theories, providing an abstraction level that is highly specific to a particular form of nursing intervention. They mainly direct the framework for the specific intervention to be used. In other words, they help to predict the actual outcome of the applied intervention, as well as the impact of the applied practice (Sitzman & Eichelberger, 2011).

Case Scenario

This is a case where a young lecturer in one of the nursing schools in the United States was expected to take Nursing class through the topic of cultural competency in nursing. It was a class composed of various students, in terms of age, social status, race, sex, and levels of education. The class had fresh students pursuing their first degree, as well as those seeking second degrees or advanced studies in nursing. The class had a broad range of cultural diversity due to the high diversity of the American residents; comprised of African Americans, Latin Americans, as well as American Whites, and a large influx of students from third world countries who travel to the US to advance their studies.

Cultural competency has emerged as one of the core units in nursing education required to be undertaken by all nurses. Each of the student nurses is expected to pass highly to be allowed to graduate from the Nursing School. However, the subject has become a nightmare for many students due to the complexity and diversity of cultures present in the US and across the globe; understanding all these cultures to provide care that respects the values and customs of all communities is challenging. The need for culturally competent nursing is heightened by the fact that even the working environment is now characterized by cultural diversity, with nurses working with people with diverse backgrounds (Lucero, Lake, & Aiken, 2010).

During the classes, there was one nursing student from the African continent who had a serious problem handling this subject. She told us how people had discouraged her by explaining the difficulties in the unit. Her condition worsened when she landed in the school and realized the unit was compulsory, and one had to pass highly to graduate from the school. Furthermore, it appeared to be a nightmare when the tutor took almost an hour of the first lesson describing to us the importance of the unit and the need to pass sufficiently. The student was so anxious that getting the concept of the unit became almost impossible. She failed terribly in the first year and was forced to retake the unit for another year. The next year proved to be worse, as her stress increased to include the fear of her scholarship being terminated.

The problems of the student seemed to grow day by day. The real challenge that almost made her drop out of the nursing school was when we visited a clinic during our usual clinic visits. Her first stumbling block came up when the white nurses gave her a cold welcome at the hospital. No hospital nurse was willing to develop a personal relationship with her and mentor her during the visits. Her concerns were also addressed poorly whenever she raised them. She came face to face with racial discrimination. The worst part was when we visited the wards and a white patient publicly declined to be examined by a black student nurse because the patient deemed her to be unqualified. Being her second year and with no hope of improving, she got frustrated day by day and attending classes became a problem. The situation changed when she met a school counselor who was familiar with the comfort theory of nursing. She listened to the student and addressed her concerns in line with the principles outlined in the comfort theory.

Application of the Comfort Theory in Resolving the Issue

It is crucial that the principles of the comfort theory are fully understood to know how the counselor applied the theory in helping the student improve her performance. Initially, comfort was considered one of the primary goals of the nursing profession and medicine, in general. However, comfort has been viewed as having a minor importance due to challenges such as increased workload in nursing institutions. It is now a reserve for patients who cannot be addressed through any other intervention. Comfort is highly neglected even in designing working and learning environments. Comfort is lowly viewed, despite the fact that studies have shown that attainment of comfort is associated with positive activities that promote positive thinking, while strengthening and nurturing the patient (Krinsky, Murillo, & Johnson, 2014). According to the comfort theory, three forms of comfort exist, namely; relief, ease, and transcendence (Holland, Gray, & Pierce, 2011).

As explained Holland et al. (2011), a person experiences relief whenever the particular needs of the individual are met. On the other hand, ease is experienced whenever the person achieves the state of satisfaction. For instance, someone having lots of anxiety over a particular issue will be at ease if the cause of the anxiety is addressed adequately. Finally, a state of transcendence is experienced when the affected person is made to overcome the challenge that is pinning them down and rise above it successfully. Although these concepts have been applied solely in patients who experience physical discomfort, it has been shown that addressing the individual needs of nurses or students, like the above case, addressing their sources of anxiety, and encouraging them to overcome the forces that affect their performance results in improved performance (Krinsky et al., 2014).

Comfort, according to this theory, can be experienced in four contexts; psychospiritual, physical, environmental, and sociocultural. Psycho-spiritual comfort mainly entails the realization of self, such as personal identity, self-esteem, sexuality, relationship with higher beings, and meaning of life to oneself. The physical context entails addressing the needs of ones body, while the environmental context refers to the external factors surrounding the person. Lastly, the sociocultural context involves family, interpersonal, and societal relationships (Holland et al., 2011).

A thorough understanding of this theory was the basis for the effective management of the students problems in the study subject. The primary strategy applied by the counselor was skillful listening to the student to understand why her performance in the subject was so dismal that it threatened the continuation of her studies. This gave the student an opportunity to feel cared for, which made her express her needs to the counselor; none of which had been addressed by the teacher or the nurses in the hospitals she visited. The fact that she received a discouragement from home meant that she needed somebody to deal with this need. Consequently, the systematic explanation from the counselor brought a sense of relief to the student.

However, the bigger burden was the elevated anxiety that grew when she was supposed to retake the unit and the fear of losing the scholarship. To help out, the counselor, having understood the need for a sense of ease as explained in the comfort theory, reassured the student that a retake does not mean failure. Instead, the retake was an opportunity for her to better her grades. The counselor also managed to intervene and ensured that her scholarship was not canceled. As a result, the anxiety disappeared and the student felt satisfied and contented with the situation.

Finally, the counselor addressed the feeling of racial discrimination to reinstate comfort fully in the student. To address the concern, the counselor used the situation as an appropriate opportunity to emphasize the need for cultural competence and the training of culturally competent nurses. In explaining the behavior of the nurses who discriminated the student, the counselor insisted that the use of that subject of study was to ensure that such incompetent nurses are not released to practice. Moreover, such behaviors should encourage her to work harder to eradicate the vice in the society.

The counselor equipped the student with tactics of handling such challenges, where the main tactic was to condemn the act boldly and inform the offending nurse and the patient the need for respecting every person, irrespective of gender or race. At last, the student was able to overcome the challenges and developed a sense of transcendence. The student emerged the best in the unit by the end of the academic year. She also received university recognition, which raised her self-esteem further and shaped her future; thanks to the Kolcabas Comfort theory of nursing.

Conclusion

Nursing theories are necessary tools in the nursing profession, as they help in shaping the type of nursing services and interventions provided, as well as predicting the future direction in the field of nursing. Among the different theories formulated, the Kolcabas Comfort theory of nursing is one of the best in ensuring full patient recovery, including nurturing and strengthening the affected person. Though applied mainly in physically discomforted patients, the above student case study shows that proper application of this theory in the field of nursing education can improve the learning outcome of different nursing students, as well as medical students. It is mandatory that the students experience relief, ease, and transcendence in physical, sociocultural, environmental, and psycho-spiritual comfort. It ensures the students are nurtured sufficiently and strengthened in their line of study.

References

Holland, B. E., Gray, J., & Pierce, T. G. (2011). The client experience model: Synthesis and application to African Americans with multiple sclerosis. Journal of Theory Construction & Testing, 15(2), 36-40.

Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcabas comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-50.

Lucero, R. J., Lake, E. T., & Aiken, L. H. (2010). Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing, 19(15-16), 21852195.

Sitzman, K., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists: A creative beginning. (2^nd Ed.). Sudbury, MA: Jones and Bartlett.

Nursing is a scientific field that is growing fast through models that influence nursing practices. Many theories shape the ideologies and growing transformations of nursing practices. One of the major nursing approaches that have led to great paradigm shifts is the unitary-transformative theory. The theory promotes the need for a holistic approach to nursing that handles the connection between the universe and human being hence influencing the grand theories and the metaparadigm in nursing.

The greatest impact of the unitary transformative nursing model is the push for connection between human beings and God. The theory makes people look for a higher being that is beyond the world and human beings (Smith & Fitzpatrick, 2019). The connection is key in understanding the health aspects of people. Such understanding makes nurses appreciate that human life is dependent on the environment, and social and religious aspects of life. Notably, the unitary theory makes people appreciate the connection between the universe and human beings.

Additionally, the unitary-transformative concept explains that human life is in form of an energy system that interconnects with the universe.

For example, the paradigm promotes a unitary human being that is a complex organization in matters of health. When nurses appreciate humans as open energy with universal interconnection, then health care practices are fashioned to focus on the energy and the environment (Smith & Fitzpatrick, 2019). For example, the theory helps health practitioners and scholars to understand that human health lacks direction hence people fall sick occasionally which requires care. In short, the unitary-transformative theory helps health practitioners to appreciate the transpersonal model and the sub-atomic particles that are Gods creation. Further, the theory helps nurses offer personalized care to their patients (Smith & Fitzpatrick, 2019). Through the theory, nurses can guide their patients to self-care in a manner that makes the sick understand their health state at any given moment.

Reference

Smith, M., & Fitzpatrick, J. (2019). Perspectives on the unitary transformative person-environment-health process for the knowledge base of nursing. Advances in Nursing Science, 42(1), 43-57. Web.

Nursing originated in the 19th century as a set of purely practical skills and adherence to medical guidelines. Gradually, it transformed into a science-based on theoretical knowledge, practical experience, scientific judgment, and critical thinking. According to Florence Nightingale, nursing is distinct and separate from medicine and requires a specific educational base (Theory of Florence Nightingale, n.d., para. 3). Florence Nightingale was among the first to propose a nursing theory. As time went by, nurses began to realize there was a need for developing their models. All nursing models or theories have common positions; these include such concepts as the source of patients problems, the goal of the nursing interventions, the means of nursing interventions, the role of the nurse, and the evaluation of the quality and consequences of nursing.

The development of the various nursing theories allowed extending the nursing practice from the medical model, which regarded the patient as a set of anatomical organs and physiological systems and blatantly ignored the fact that health behaviors are contingent on their socio-cultural and socio-economic contexts (Theory as Practice, n.d., para. 27), to more sophisticated theories. According to the modern concept of nursing, in addition to knowledge of basic health care, a nurse should possess sufficient knowledge of psychology, pedagogy, sociology management, and other fields.

Let us review the advantages of such a comprehensive approach on one of the advanced models of nursing proposed by Moyra Allen. According to Allen, nurses should not define health in terms of disease or illness but rather support the individual and family to focus on the health aspects of situations (Snowden, Donnell & Duffy, 2010). The main provisions of Allens nursing theory state that the health of the nation is the most valuable wealth; the individuals, families, and communities seek to improve their health, and they are guided to achieve this goal; they have the desire to live, and there are opportunities to achieve this. The theory envisages that the nurse directs the patient to explore healthy habits and healthy behaviors instead of focusing on the weaknesses and problems. According to Moyra Allen, nursing is a science aimed at improving human health and promoting the preservation of health. Its goal is the contribution to the development of healthy families throughout their lives by supporting them and encouraging them to participate actively in the process of life while being responsible for their health. This theory is the most suitable for a visiting nurse, who is not always in control of the patient. The nurses role consists in promoting the rules of a healthy lifestyle to the patient and his family and selecting the conversation and persuasion tactics optimum for the patients family. The patient and his/her family should actively participate in all phases of the nursing process. The emphasis is made on the development and consolidation of useful habits, such as physical exercises, outdoor activity, and a balanced diet.

Because the proposed theory is very simple and easy to follow, the gap between theory and practice may be avoided. Moyra Allens theory provides a framework within which to act along with the application of the discrete medical knowledge possessed by the nurses. According to Allen, it can be applied in any environment, both in the urgent care and intensive care units, schools, the institutions of long-term treatment of the chronically ill, the welfare centers, and at home.

References

Snowden, A., Donnell, A., Duffy, T. (2010). Pioneering Theories in Nursing. London, UK: Quay Books. Theory as Practice. (n.d.)

Theory of Florence Nightingale. (n.d.). Web.

It is important to note that there is a complex set of constituents when it comes to providing care to a patient. Meta paradigm essentially refers to a holistic approach, where nursing, health, and the environment of patients are taken into consideration. Dorothea Orems self-care deficit theory can incorporate meta-paradigms because both frameworks have overlapping points of interest. Meta paradigms can be implemented into the self-care deficit theorys major concepts, which include nursing, humans, and the environment.

Although there is a multitude of dimensions to the theory, it contains conceptual areas that precisely match those found in the meta paradigm. Firstly, Orems theory describes nursing as the art of providing assistance to those who are unable to care for themselves (Gonzalo, 2021). For example, giving specialized assistance to people with disabilities constitutes the nursing component of the metaparadigm. Secondly, it is stated that humans, such as men, women, and children, are material objects for nurses with the need for direct care (Gonzalo, 2021). For instance, a family nurse practitioner would view a family as a social unit emphasizing family-centered care. Thirdly, it is important to factor in the environmental elements, which include culture, family, and community (Gonzalo, 2021). For example, cultural competence would be a meta paradigm being implemented in the theory. Fourthly, health is a state that is functionally and structurally whole, appealing to comprehensive and non-invasive measures (Gonzalo, 2021). For instance, the meta paradigm focuses on holistic treatment, constituting a comprehensive understanding of health under the self-care deficit theory.

In conclusion, meta paradigms can be incorporated into the major concepts of self-care deficit theory, which include nursing, humans, and the environment. Nursing is the art of providing assistance to those who are unable to care for themselves, whereas human beings are material objects for nurses with the need for direct care. Health is structurally and functionally whole, and the environmental elements include culture, family, and community.

Reference

Gonzalo, A. (2021). Dorothea Orem: Self-care deficit theory. Nurselabs. Web.

Introduction

Numerous issues underpin the remarkable role of the nursing profession in the modern world. Nursing should be considered a sophisticated phenomenon that implies not solely a large body of knowledge and expertise but also remarkable soft skills and personal qualities. High-performing nurses succeed due to their ability to show compassion, take responsibility, and show initiative to provide patients with the best treatment options. At the same tie, excessive emphasis on the above-mentioned qualities sometimes makes people believe that the art of nursing cannot be properly structured and taught in dedicated institutions due to its complex nature. Nevertheless, modern caregivers are medical workers that develop a comprehensive understanding of patients needs due to the high quality of theoretical knowledge acquired at dedicated institutions.

Discussion

The establishment of an extensive network of educational centers that allow future nurses to prepare for the numerous challenges they will face at work is not a bureaucratic whim or a realized business opportunity. The demand for high-quality education cannot be undermined. Hoeck and Delmar (2018) pinpoint that the future of nursing is characterized by an intensive interchange between theory and practice. Moreover, the development of new educational materials is underpinned by the rapid transformation of data and evidence into theoretical frameworks.

Even though most of the fundamental ideas that serve as the cornerstone of nursing were introduced in the 19th century, the evolution of this field of study has been remarkable. For instance, the four principles of nursing ethics can sometimes contradict each other, which may make it difficult for a nurse without theoretical background to choose the best treatment option. Therefore, it is essential to understand the reasoning behind the establishment of a hierarchy of values in nursing.

Moreover, expectations concerning the quality of service at the hospital have become extremely high recently, which does not allow to use of the same strategies as several decades ago. Modern nurses are taught numerous aspects of proper treatment and communication strategies that are essential for the establishment of a relationship based on trust. Younas and Quennell (2019) claim that theory-guided practice in nursing has proven to be highly beneficial, as it allows caregivers to articulate the reasons for choosing a specific treatment strategy consistently. In many cases, due to certain inefficiencies in the modern healthcare system, patients may trust nurses more than doctors. Therefore, caregivers should have the necessary theoretical background that helps to explain the rationale behind doctors decisions and convince patients that the time-consuming or expensive treatment is essential.

Conclusion

Nurses are expected to rely on their experience and can, in many cases, consult other medical workers on the most appropriate strategies. Moreover, their constant interaction with patients helps them acquire new expertise in a due manner. At the same time, theoretical knowledge remains the cornerstone of future successful practice, as it provides not purely medical data and terms but the highly structured and concentrated experience of generations of nurses. Therefore, given the large amount of information that a nurse has to acquire and the responsibility that is associated with the profession, it is crucial to make the initial steps as rapid and efficient as possible. Moreover, nurses who have developed a sophisticated framework that allows for proper decision-making are less inclined to experience high-stress levels and emotional breakdowns that may occur during the first months at the clinic or hospital.

References

Younas, A., & Quennell, S. (2019). Usefulness of nursing theoryguided practice: An integrative review. Scandinavian journal of caring sciences, 33(3), 540555.

Hoeck, B., & Delmar, C. (2018). Theoretical development in the context of nursing  The hidden epistemology of nursing theory. Nursing Philosophy, 19(1), e12196.

The essence of theory in the profession of nursing is to improve practice by positively influencing the health and quality of life of patients. The relationship between theory and practice is reciprocal. Practice is the basis for the development of nursing theory whereas nursing theory must be validated in practice (Saleh, 2018). To bridge the theory practice gap we must regularly review our current practices using latest research and self-reflection.

There are several theories that under pins the principles of nursing practice however, this paper will focus on Self-Care Deficit Nursing Theory which suits James case in helping him to help himself.

The central philosophy of the Self-Care Deficit Nursing Theory is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they’re able. ( Nursing Theory)

When you consider people as individuals and you take into account their desires, values, family circumstances, chosen lifestyle and social situation, you can help the person to find solutions to problems or challenges that they may face. With James it is about showing him the option and opportunities already available to him that he may not be aware of or may not know he needs.

When trying to understand James’ workplace motivation we can refer to Maslow’s hierarchy to assess their current level and see if this is a contributing factor in James difficulty in finding a job. Maslow’s stages of human motivation can be applied to many aspects of life and go from ‘physiological’ to ‘safety’ to ‘belonging and love’ to ‘social needs’ or ‘esteem’, and lastly ‘self-actualization’. James’s background, his school attendance, identification of additional learning needs and problems with holding down a job could all be linked

It is important to understand what James needs in order to construct a bespoke plan that will enable him to achieve his goals. Working together with other departments and professionals where specialist care is required ensures the best quality of care can be delivered.

James, Mum and other friends and relative should be kept updated, as they may understand patterns that will assist in providing the best care for the patient. It is important to maintain the relationship with his mother especially for this reason. Having a strong relationship will also create a secure environment in which James can feel safe and in control. James Mother should also be introduced to support groups, educative materials to support her where necessary. This will be important for James’ mother so she can help facilitate James achieve his independence.

Professionalism and ethics must be considered in relation to patient confidentiality when communicating with relatives of the patients. Although decisions may be discussed amongst the family it must be the patient making the final decisions on their treatment.

The service user’s mental health is of concern with anger, stress, pressure, self harm, disturbing thoughts, feeling isolated, lonely with a low mood and trouble sleeping this should be assessed by a nurse as soon as possible.

There is a duty of care towards James’ safety and where the patient shows signs of posing a danger to himself or others, appropriate actions must be taken to prevent harm or injury. Care, support and positive thinking will always help prevent but having healthy coping mechanisms in place will help keep everyone safe and restore calm quickly. Identifying triggers as a preventative measure is paramount in reducing incidents.

Working with James to achieve his goals a plan should be drawn up through a simultaneous evaluation of James’ psychological, emotional and physical state and his effect on his ability to perform complex and personal activities of daily living. The plan should improve the James’ mental health looking holistically at all aspects of their life. It should consider their current and future environments, studies, career, life, friends, support, medication etc. It should create an independent future allowing him ambitions and opportunities. The plan must also consider the needs to the patient and their relatives. It should provide the training and further education for his future career as well as life mentors and support groups.

Regular monitoring to assess James progress with follow up communication enables additional support to be offered as soon as required.

In my perspective, theories are developed by analytical thinkers, who assemble a set of reports such as: proposals, models, philosophies, depictions, qualitative and quantitative data to be thoroughly tested with the support of evidenced-based research. Furthermore, I believe theories are also hypothetical opinions that encounter trial runs to be verified as reliable resources to practice in healthcare settings. The development of a theory can be derived from an experience or even an observation in clinical practice that has consistently shown a decrease in patient outcomes and quality of life. Based off the knowledge I have obtained about theory in general, its purpose is to serve as a guide to help healthcare professionals practice safe and effectively as well as make appropriate decisions using their clinical judgement. In addition, theories alone have strengthened professional practice because prior, information presented was ongoing without a resolution and now; nurses like myself, are able to utilize this large body of evidence to decide suitable interventions for patients. In saying that, theories in relation to nursing practice, should be patient-centered. Theories that are patient-centered allows the nursing process to be displayed because it helps one to analyze situations that are occurring in practice, and construct a plan of care that will become beneficial to all providers in their practice. Lastly, theories should be clear in its meaning with supporting materials and should be accessible to healthcare professionals. As stated before, theory in my point of view is a combination of data, models, and philosophies that are tested to serve as a vital tool in healthcare practice with an ultimate goal of improving patient outcomes.

According to Alligood (2014, p. 9), philosophies, concepts, and theories provide nurses with an outlook of the patient to help facilitate their decision-making process within their practice. My interpretation of theory is supported by a nursing theorist who believes just as I do that theoretical frameworks have the intentions of improving patient outcomes if used appropriately. Theory, specifically nursing, requires an analytical thinker who can prioritize data deemed important to provide appropriate interventions in a patient’s plan of care. Furthermore, my definition supports Alligood’s literature because my reasoning of its development coincides with the author and is one of the many reasons why it is currently implemented into nursing practice. Nursing theories are set in place for healthcare professionals to use in their practice to promote safety, decrease medical errors, and increase quality of life. Also, as mentioned earlier, nursing theories strengthen one’s practice because it gives healthcare providers the confidence to share the body of knowledge they’ve learned with other colleagues. Educating oneself enhances professional practice and promotes positive outcomes. Without nursing theories, I believe that research wouldn’t be valid; nurse’s opportunity for career advancement and knowledge expansion would be at a standstill and caring for patients in clinical without valid resources would be unsafe and hinder decision making. My viewpoints on theory compares to the literature in my many ways because me and the author, Alligood, can both agree that theories are used as resourceful guides to practice. One of the fascinating things about my findings and Alligood’s is that nursing theories are supported with evidence-based research that is essential to practice.

The development of nursing theory is important in professional practice and in nursing as a whole because it helps to enhance knowledge. Based off the readings and what I know thus far, nursing theory at one point of time appeared to have been a controversial topic regarding its “lack of” in clinical practice. Ahtisham and Jacoline (2015) conveyed that theories without concepts and literature in clinical settings are abstract in nature. To be abstract in nature, in my opinion, means to be nonexistent in the physical aspect and serve only as a thought or idea. Nursing theory is a necessity to practice because it can be verified in clinical with research instead of making presumptions that could lead to patient harm and increase hospital readmissions. Moreover, its development has helped construct nursing interventions for nurses to adhere to when providing direct patient care. Theoretical research and models have given the nursing profession its own identity separate from medicine. Nursing theory has given us a foundation, structure, and guidance in acquiring nursing knowledge that can be applied across the healthcare system. However, nursing knowledge alone cannot help nurses make sound clinical decisions. As stated before, nursing theories are supported by research where nurses are able to integrate such findings into their daily practices to advocate for safe and quality care. In all, if nursing theory was nonexistent then I pose the question as to how do we know what our roles and responsibilities as nurses are and also how can we be so sure that the care we provide is safe? Once again, nursing theory is vital to healthcare practice because evidence-based research has shown to considerably change patients overall health status.

When it comes to my current practice, I haven’t used theory as much due to my lack of understanding and not really knowing its importance in relation to clinical decision making. The unit that I currently reside on is an observation floor where patients are considered low acuity status without the need of emergent interventions. The thought of using theory on a daily basis on my floor in particular, never really registered in my brain because the clinical situations I have encountered were not complex in nature that required substantial evidence to make a decision. In other instances, I have utilized evidenced based research for patient education purposes. For example, I can recall having a patient with a new diagnosis who lacked understanding in symptom management, treatment compliance, diet recommendations, and lifestyle alterations. In that moment, I relied on my own nursing knowledge and supported research that I found to help promote understanding with an emphasis on positive patient outcomes. In a way, I would say nursing theory ties into that, but then again my lack thereof in this subject alone is one of the reasons why I haven’t utilized it in my practice routinely. I understand that it is a major component to the practice of nursing because it serves as a blueprint to the nursing model. Lastly, it is my hope that towards the end of my nursing theory course, I am able to develop an in depth understanding of theory and why its contribution to nursing practice aids in the prioritizing of patient care to promote patient satisfaction and quality of life.

5. The website that I reviewed on the internet that relates to and promotes theory is called Nursing Theory. Nursing Theory created by Petiprin (2016), was designed for healthcare professionals and academic students to explore models, theories, and become familiar with well-known theorists. The significance of this theory-based website is that it provides an in-depth understanding to professionals about what is nursing theory, why do we use it, and most importantly; why is it deemed important in patient care. Furthermore, the site explores theories and philosophies interrelationship and how their use is apparent in the field of nursing. Based off my interpretation of theory and its purpose to nursing practice, this website validates that my beliefs of theories origin, are mostly from experiences in nursing practice. Theories serve as a guide to nurse’s individual practice and helps to center their care that is patient-specific with realistic goals and interventions. In addition, the Nursing Theory website has a list of theories and models that are resourceful to all specialties in nursing. I was astounded to see various models targeting adults, family practice, pediatrics, mental health, public health, and holistic nursing just to name a few. What I’ve gained from researching Nursing Theory is that no matter what field you are currently practicing in, this website is an additional resource that can be utilized in your decision making process. I can attest that the website and I share similar views in our reasoning’s of theories implementation into nursing practice. The goal is to expand nursing knowledge and use models and principles that are in place to guide practice.

Annotated Bibliography

Fronczek, A. E. (2019). Nursing theory in virtual care. Nursing Science Quarterly, 32(1), 35-38.

In this peer reviewed journal on nursing theory in virtual care, Fronczek explains the benefits of nursing theory in virtual care environments. The main idea of this article is that, in this day and age, nursing actions can be conducted in nontraditional spaces and times in various regions, making achievement of wellness more convenient. This article possesses information about the principles of virtual care which can be applied when communicating with patients. The publication researches virtual care technologies from the point of using them in modern nursing undertakings and getting additional advantages for curing people. Also mentioned in this article, is how virtual care technology is a chance for progressing both theoretical and practical nursing knowledge. In the article, Fronczek discusses how nurses need to depend on present and progressing theory in order to make their clinical practice significant in the shifting healthcare setting. The author’s research further suggests that traditional nurse theorists such as Orem, and her theory of self-care, Roy’s adaptation model, and King’s theory of goal attainment can be useful for nurses in virtual care conditions and practice.

As a PhD author, Fronczek shows highly qualified knowledge about nursing theory in today’s environment. The author mentions the exploration of the frames which exist in extending the borders of nursing theory as the goal of her scientific work. The research shows that interpersonal relationships in nursing can also be studied in the context of virtual care. Mental health concerns, as one of the popular human health problems, can be advocated with the use of these technologies. Providing internet access to the rural areas and creating more providers according to this source is a potentially beneficial way to develop the opportunities for the nursing care practitioners and build the strong system of helping patients with a fast and effective approach to the cure for their diseases. The article gives clear results of the research on how modern nurses can use technologies for making the work more efficient in order to satisfy the needs of the customers while applying nursing theories. This article is current, peer reviewed and reliable as the research was done by a PhD, RN author.

Yancey, N. R. (2015). Why teach nursing theory? Nursing Science Quarterly, 28(4), 274-278.

In this peer reviewed journal article, Yancey answers the question of why it is necessary to learn and teach nursing theory. The author explains the potential weakening of theory in the nursing field and its consequences. This article is credible enough and discovers the challenges which are faced by nurses during their everyday activities. Sharing the values of nurses with students during their education and teaching them to be highly qualified professionals through sharing the theoretic basis, is shown as a significant aim for the professors. Yancey also notes that in order for nursing science to progress, nurses must have a complete understanding of the theoretical foundations of the discipline.

The main idea of the article consists of the statement that using the new teaching model (humanbecoming model), developed by the CBU School of Nursing, is an effective approach to providing a complete picture of the skills needed to become a professional nurse. The level of comprehensive learning of nursing science should be growing in society because individuals deserve to get the best knowledge during their preparation to the separate medical careers in clinics and hospitals. The theoretical foundation should be used as the solid background for creating a nursing educational program which will satisfy the need for a highly qualified knowledge for all the types of medical workers. Theoretic facts are considered to be the foundation for all the practical skills of nurses in this publication. The challenge is to find the right approach to teaching the nursing theory in the way that is understandable for all the students. The so-named “humanbecoming” theoretic model is shown in the article as the most appropriate for teaching and learning because it works in the advanced paradigm of building a beneficial perspective. This publication is recent enough and shows actual statistics analyzed in a logical way.

Power, L. (2016). Nursing theory and the delivery of compassionate care. Nursing Standard, 30(24), 41-46.

In this peer reviewed journal article, the author, Power, discusses why compassionate care is in this day and age becoming a priority for healthcare policies. The article explains that compassion can be defined as the necessity to learn, recognize and support the reasons for humans’ vulnerabilities. The roles of modern nurses have changed due to the fact that patients live longer, even with dangerous symptoms, and medical workers need to concentrate on giving the most possible comfort to these people. According to Power, the central aim of nursing is to maximize the efforts of providing support to individuals who need it.

Nursing, is discussed in the publication, as the insecure profession which is hard to assert and which needs repeated identification of skills. The medical workers contact real people and deal with their health conditions, so it gives a lot of responsibility to them. It leads to the point that nursing, as a discipline, requires the judgment of experience together with theoretical and practical knowledge. The empirical approach to nursing work is crucial for the development of all the opportunities existing in the medical care industry. The author states that healthcare practice should involve theorizing and constant adapting of the already existing models for implementing compassionate care. In such a way, patients will get the most effective treatments because theory is central for developing nursing knowledge. According to the author’s ideas, the dynamic nature of modern health care can bring the society to the aggregation of valuable observations needed for gathering the nursing evidence which is one of the basic elements of curing patients. The article is current enough and provides well researched results by the author.

Introduction

The aim of this essay is to explore key concepts impacting on mental health issues and their support. It will start by giving a brief history of the evolution of mental health and its definition. It will explore the definition of theory as well as nursing theory.

Once these have been explained two theories will be looked at one Grand Theory, Orem’s Self Care Deficit Nursing Theory (SCDNT), and, Buchanan-Baker and Baker’s Tidal Model, which is considered a mid-range theory. The two theories which will be examined in this essay are theories that put the person at centre of the care and therefore looks at the biopsychosocial aspect of nursing.

There is some confusion between the word theory and model in nursing. In this essay, theory will refer to Grand Theories which have a wide scope and Models will refer to the Mid-Range theories which have a narrower scope.

Evolution of Mental Health

“Madness” has been a term used throughout the centuries to describe the behaviour of someone who does not confirm with societal norms. In the past, anyone who would act differently, not necessarily loud or disturbed, but anyone who would voice very different ideas from the norm would be considered mad (Porter, 2013).

From Babylonian times madness has been believed to relate to magic or spirits that would invade the bodies of the people not behaving according to the society’s rules (Porter, 2013). Later in the 7th century madness was believed to be physiological. In the text by Ibrahim (19th C.E) it is believed that a physical illness that causes fever for example unless treated, would eventually reach the brain and cause the person to go mad, and therefore should be treated with the medical techniques of the time like leeches and evacuation to avoid the illness reaching the brain.

Many centuries later in the early nineteenth century, Sigmund Freud and some of his colleagues started trying to treat people by talking to them, to find out what happened in their lives that could contribute to the distinct behaviour (Eghigian, 2010).

Fast forward to the early and middle twentieth century and the advance in the now discipline of psychiatry has, by experiment tried to come up with a lot of answers regarding the disturbances of the mind without much success. Then in the 1950’s when it was discovered that the ill could be helped by medication, one more step was taken in the ability to treat people. (Eghigan,2010). However still just worried about treating the symptoms not the disturbances.

We could attribute the use of the word “mad” to be as per Freud’s (1910) explanation, word mad was used as doctors back then would not know or understand the reasons behind the “mad” behaviours and therefore not be able to empathise with the patient. The lack of knowledge about the brain and mind could be said to be at fault for the stigma we see today.

Mental health is today in one way or another accepted to be as per Szazs (1960) “problems of the living” and therefore has given rise to non-medical people treating it, like psychotherapists, counsellors and psychologists.

The World Health Organization defines Mental Health as an integral part of Health, “Health is a state of complete physical, mental and social well-being and not merely the absence of

disease or infirmity.” (World Health Organization, 2013). They also accept the fact that mental health can be influenced by the socio-economic factors of one’s life.

What Is Nursing Theory?

Theory has many definitions on its own, and so does Nursing Theory. According to Parker and Smith (2010) “Theories are mental patterns and framework created to help to understand and create meaning from our experiences, organize and articulate our knowing and ask questions leading to new insights”. This definition can also be used to describe Nursing theory, McKenna et al. (2014) describe Nursing theory as “being constructed out from specific nursing phenomena represented as concepts, definitions, assumptions and propositions that help to describe explain or predict how nursing may support and help patients, families or society”.

Nursing theory helps us, as per the definitions above, to observe how things work and theorise according to the nurse’s experience and knowledge. A theory needs to be tested in practice to be deemed useful or not.

It can be said that in Nursing there are four main meta paradigms person, environment, patient and nursing. These metaparadigms are believed to be the origin of Grand Theories resulting in theories like Dorothea Orem’s the Self Care Theory, Florence Nightingale’s Environment Theory and Jane Watson’s the Human Caring theory (Branch et al. 2016), all nursing theories that explore the nursing metaparadigms to cover all the aspects of nursing care.

The earliest nursing theory is believed to be Florence Nightingale’s Environmental Theory, which she theorised when she fought for her patients’ right to have a safe and comfortable environment to get better. In her book “Notes on Nursing, what it is and what it is not” (1898), even though a theory was not per se mentioned, she explains why the environment is so important to the wellbeing of the patients. When you read about this early environmental theory, things like the role of the nurse are very different from more recent theories, however a lot of the principles described in her book regarding lighting, cleanliness and other factors are still part of the nursing profession today.

Orem’s Self Care Deficit Nursing Theory

Dorothea Orem dedicated her life to the conceptualization of nursing theory and practice. Her Grand Theory Self Care Deficit Nursing Theory (SCDNT) was developed throughout her life and career. Orem started conceptualizing back in 1949 when she noticed that nurses do nursing but could not explain what nursing meant, and people who she worked with since, have contributed to her theories, resulting in the general theory of SCDNT (Parker, E.M; Smith, C.M , 2010)

The Self Care Deficit Nursing Theory (SCDNT) by Dorothea Orem is a holistic theory where the whole patient, mind body and soul are looked after or helped, depending on the necessity (Barret. D et all.2009)

SCDNT is made up of 3 sub theories which are interconnected. They are The Theory of Self Care (Dependent Care), The Theory of Self Care Deficit (Dependent Care Deficit) and The Theory of Nursing Systems (Parker, E.M; Smith, C.M, 2010).

Self-Care theory – Assumes that the patient is capable, has the motivation and knowledge to look after himself or herself, and when what he/she needs is greater than what self-care can provide a self-care deficit (the difference between what can be done on its own and what it needs) is generated. The self-care deficit can be resolved with Dependant care (someone who may be a family member or friend who will be able to look after the person in need) (Barret. D et all.2010). This sub theory looks at the I in the relationship of care, it looks after the patient (Hood. J.L 2014)

Dorothea Orem’s theories work with eight Unique Self Care Requisites, which are the tasks or functions that a person should be able to perform unaided (Parker, E.M; Smith, C.M, 2010).

Orem’s Theory USCR (Universal Self Care Requisites) are balanced between physical health and psychosocial factors. From USCR, 1 to 4, the biomedical concerns are addressed from 5 to 8 the psychosocial factors are addressed. Because of the clear interaction and the acceptance by the Orem’s Theory that the patient is more than just its physical health the theory can be used for Mental Health practice. (Cavanagh, 1991).

The eight USCR are: 1- Sufficient intake of air, 2 -Sufficient intake of water, 3 – Sufficient intake of food, 4 – Satisfactory eliminative functions, 5 – Activity balanced with rest, 6 – Balance between solitude and social interactions, 7 – Prevention of hazards to human life, human functioning, human wellbeing, 8 – Promotion of human functioning and development within human groups in accordance with human potential, know human limitations and the desire of normalcy (Barret. D et all.2009).

The ability to perform unaided the eight USCRs, or to learn how to perform the USCRs will determine in Orem’s theory what help will be necessary, and if help is necessary, how it will be delivered and for how long.

Self-Care Deficit theory – Happens when people need nursing. Because of the lack of self-knowledge or skills to perform the self-care duties themselves or because their dependent of care lacks the same knowledge or skills to look after the person in need (Orem’s 2001). This theory looks after the “you and me” on the relationship of care. This sub theory looks after the patient and the helper (Hood. J.L 2014)

Theory of Nursing Systems – Establishes the nurse as a helper to the patient and to the dependent of care, by defining what the nurse can do and how the nurse can help to bring the person in care back to health, using her knowledge and skills, and also to educate the patient to maintain health ((Orem’s 2001). This sub theory looks after the “we”, it looks after all the parts that may influence the care being given or received (Hood. J.L 2014).

According to Cavanagh (1991), the Orem’s theory has been revolutionary as even though it does not discount entirely the medical models, it still looks at the patient as whole including the medical, psychological and social needs and accounts for them in the care planning when nursing is necessary. Also, it is pioneer on seeing the nurse as a helper and only there to complete the lack of knowledge and skills that the patient or their carer may lack to look after themselves or the ill.

The main concept on the Orem’s Theory is the two types of person as she sees it.

The Tidal Model (Mid-Range theory)

The Tidal Model was developed by Poppy Buchanan and Phil Barker in the 1990’s. It is considered to be the first mid-range theory to be recovery focused, developed by mental health nurses for mental health practice. It is said to find to be used in a crisis (Copper, 2011). Having been tested extensively in practice it was the first model to be used across all ages, from child to adults, from acute to community (Copper, 2011). A particular difference between Dorothea Orem’s Theory and the Tidal Model is how each view mental illness, the authors Buchanan-Baker and Baker (2005) uses the term popularized by Thomas Szasz “Problem of the Living” to describe a different view of what mental illness is and how it should be dealt with by the care system, while Orem’s theory looks at Mental illness in the conventional way of an illness.

The model sees the problems of the living as a tide in the ocean (hence the name) as it comes and goes, so do all the problems and situations in life. Everything is in constant change. A person with schizophrenia will not always be in a stage where care needs to be given. They will recover and, maybe in the future, they may relapse and need help again (Cooper, 2011).

Buchanan-Baker and Baker’s model completely revolves around the patient in care and therefore believes that they are the experts of their own life, health and illness and also that their priorities need to be meet before the “problems of the living” can be dealt with (Ramage et al. 2018)

To deliver the recovery model that is the Tidal Model, four assumptions are used about the person in care and the nurse. The first assumption looks to enlighten the person in care, understand the illness and health. The second assumption is that even though the people around the person in care (carers, family members, nurses) may experience some backlash of the symptoms of the illness like anger, verbal abuse, physical abuse amongst others, the only one who really experiences the distress of the illness is the patient in care. Third, both the nurse or helper and the person in care will change or evolve in the therapeutic relationship, and in the fourth assumption the aim is to deal with real life experiences through their (patient in care) stories to enable recovery. ((Baker, Buchanan-Baker, 2005)

The relationship between the patient in care and the nurse or the helper is fundamental in the model, and, because of its importance, the model has four principles to work from regarding the therapeutic relationship.

The four principles which the Model was developed from are, the focus of mental health care is to enable people to be part of or continue to be part of the “Natural Community”, whatever it may be for the person in care; Change, it enables people to notice the ever-changing world, people, own emotions, and, by knowing and acknowledging change, to accept that everyone and everything is forever changing aiding the acceptance of the self; Empowerment is everything it aims to aid people to find ways to get back in control of their lives; Therapeutic Relationship is the process of “caring with” people and also the importance of the wellbeing of the nurse or helper to be able to maintain the relationship balance of helping without being personally involved (Baker, Buchanan-Baker, 2005)

The practice of the Tidal model is driven by six principles that reign all the therapeutic relationship Curiosity – Explore what the person knows, feels, thinks about themselves. Resourcefulness – How the person in care deals with the “problems of the living”. Respect – The person is the centre of the care plan and therefore knows best herself/ himself hence they are the experts. Crisis as an Opportunity – believes that crisis is an opportunity to change how they see themselves instead of just managing the symptoms. Think Small – Believes that all goals should be celebrated and cherished, as every little goal achieved is a step closer to recovery. Think Simple – Identify what makes a difference to the person in care even if this is a very small thing to anyone other than the person in care (Baker, Buchanan-Baker, 2005).

The Model has a summary of Ten Commitments which should be used as a guide to measure if the concepts and philosophies of the model are being adhered to (Baker, Buchanan-Baker, 2005).

The Commitments as per Buchanan-Baker and Baker (2007) are:

1. Value the voice, actively listen to the stories, and try to encourage them to talk, make sure they know you are listening and that their stories matter;
2. Respect the language, do not use medical language when making a care plan, when their own language is used the person in care will have a formal, hard evidence that what they say matters as the minutes will be written in their own words;
3. Develop genuine curiosity, show interest on what the person in care is telling you, always probe to find out more information about events, about feelings, the person in care won’t quite often be willing tell you everything but with the right prompts it will be able to tell their stories for their own benefit;
4. Became the apprentice, nurse or helper needs to learn from the person what will help them as the person in care is the expert about his/her own life;
5. Use the available toolkit, the toolkit is all the stories and the actions that have worked in helping the person in care in the past. If the toolkit is not enough then evidence-based practice should be looked into;
6. Craft the step beyond, work with the person in care to decide what needs to be done now so a step forward can be achieved. Once the first step is made the path should be opened to recovery;
7. Give the gift of time, make the time spent quality time, productive time, with the person in care, and if this is done the actual amount of time spent will not be as important;
8. Reveal Personal Wisdom, is the professional’s role to help the person in care to unravel the wisdom that he/she possesses;
9. Know that change is constant, it should be the professional’s aim to help the person in care to accept that change happens and that is unavoidable. The professional role in this is to help the person in care to deal with changes, recognize them and learn how to respond to them to aid their recovery and quality of life;
10. Be transparent, the professional needs to make sure that the person in care is aware of all steps being taken, why is being taken. Transparency is the key word in the relationship between the person in care and the professional The main concept of the Tidal model is that the person is placed at the centre of care as they are the experts of their own lives. Concepts and principles above, reinforce the shift on the mental health care scenario from imposing treatment to agreeing to a treatment with the person in care. We can see shadows of the model being implemented everyday sometimes without any knowledge of the model itself because the principles and concepts just reinforce that people should be treated well, with respect, be listened to regardless of being considered mentally ill or not.

Conclusion

After reading a brief history of mental health and one of the earliest nursing theories by Florence Nightingale my idea that nursing theories have helped the profession to see the person in care as a whole has been reinforced.

The essay also reinforced my idea that in Mental Health treatment if the resource of time is not available to be able to have face to face meetings with the person in care, treatment becomes archaic, almost reverting to the old days where the patient did not have a say and had to accept what was offered, which happened because of the lack of knowledge about the brain and the mind.

Dorothea Orem’s Self Care Deficit Theory helped the nursing community to see the person in care as a whole by addressing the biomedical side as much as the psychosocial aspect of the person in care. It addresses all the needs that a person in care may have and also highlights that time with the person in care or the helper is essential to the successful design of a care plan.

The Tidal modal however even though very person centred does not address in its writings any of the biomedical needs that a person in care may have. Biomedical needs will only be identified if this is one of the priorities of the person in care.

The study of both theories reinforced my believe that mental health care is mainly the care of problems of the living which needs to be dealt with by collaborating with the person in care to get them to the optimum recovery level, whatever that may be.

Reference List

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