Category: Nursing Theory

John Kotter was born in California on 25th February 1947. He graduated from Massachusetts Institute of technology in 1968 with a Bachelor of Science in electrical engineering and a Master of Science later in 1970. In 1972, John completed his Doctor in Business Administration at Harvard Business School. He joined Harvard Business School faculty and in 1981 he received tenure and a full professorship. He retired from full-time faculty member in 2001.

John Kotter co-founded a business consultancy firm (Kotter International) in 2008. This firm applies Kotter’s research on strategy execution, leadership and other large scale modifications. Kotter is a biographer of 20 books. John’s book ‘Leading Change’ became a global bestseller in 1995. Kotter illustrates an 8-step progression for cultural change in this book. Kotter later changed his idea on structural change from top-down to deliberate bottom up development (Clay & Brett, 2017).

Overview of Kotter’s Change Theory

The escalated rate of technology dictates changes in organisational undertakings. Preparing people to receive and implement fresh methods of working is thus necessary. Dr. John Kotter expounds on eight basic steps for effective transformation. First, one needs to convince people that the change is urgently needed. Second, a team of influential leaders is to be created to represent the whole organisation. Third step is developing realistic and attainable idea of the change. Fourth, involves publicizing the vision to the desired audience. Fifth, unravel any obstructions to the change and find their solutions beforehand. In the sixth step, one needs to create rapid successes and overcome resistance. Seventh, keep stirring the change frontward regardless of new opposition along the way. Lastly, infuse the new amendments into the group culture.

Purpose of Kotter’s Change Theory

Often, unceasing success in any institution demands vital changes. Most change actions fail due to diverse mistakes which includes; tolerating too much complacency, failing to form a competent coalition, poor choice of a vision, allowing obstacles to choke the change process, inability to get short-term triumphs, declaring success impulsively and lastly, not diffusing the changes in the communal culture. Kotter’s change theory is thus designed to help organisations avoid such errors.

Thesis Statement

This papers focuses on the account of Kotter’s change theory, its diffusion in nursing practise and consequences of change in nursing field.

Discussion

Major Components of Kotter’s Change Theory

Kotter’s change model has eight key steps. Consistent with Kotter, following the exact order of steps is crucial in attaining success. Below are the components of Kotter’s change theory in sequence.

• Step one: Establish an impression of urgency. A high level of motivation in the target audience is crucial for the change process to succeed. Therefore, people need to be convinced that the change is necessary now. This sense of urgency will propel them towards accepting and finally implementing the change.
• Step two: Formation of guiding associations. One needs to create a team of competent and persuasive leaders from the organisation. The team should be well informed about the change. This is because, the team is supposed to influence the entire system in embracing and applying the change.
• Step three: Develop a vision for the change. The aim of change should be realistic and essential. Having precise strategies for attaining the goal is also key. One should explain the means of achieving the change while focusing on the vision.
• Step four: Discuss the vision with target people. Boldly talk about the vision with an aim of winning people. Breakdown the change into simpler languages for easy understanding. Create an environment that encourages dialogue with your audience. Strive to ensure that all the components of change are clearly understood.
• Step five: Encourage others to act. Determining barriers to change such as workers’ skillsets and organisations’ structures is important. Working to remove these barriers quickly will empower the employees to act in accordance with the change.
• Step six: Create short-term wins. Prior planning on how to create quick wins is vital. This is because, short-term wins plays helps in overcoming obstructions. The wins leads the change process to long-term victories.
• Step seven: Don’t stop the change process. Re-emergence of obstructions later in the process should not cause the collapse of the process. One should instead focus on the vision and the laid-down plans to keep moving. The earnestness to change should be elevated to empower and inspire the employees to welcome the change.
• Step eight: Incorporate the change into the culture. Ensure that the change becomes part of the norm in the organisation. Present staff should view the change as a benefit over the previous way of working. New employees should clearly see the change as part of the culture. Generally, the change should supersede the former styles in advantage (Libby & Betsy, 2017).

Dr. John Kotter insists that to achieve success in change process, the above steps must be implemented in the above order.

According to research, 70% of change projects miscarry. This implies that, a majority of people are really bad at adopting new ideas. Kotter identifies 8 mistakes that stumbles change efforts consequently leading to failure of projects as listed below.

• Accepting too much contentment, therefore people have no good reason to change.
• Failure to come up with a powerful helping coalition. For any change to be effective, one needs a helping hand from competent leaders, without which, failure is sure.
• Having unclear vision and failing to precisely unveil to people the details of the change.
• Failure to communicate the components of the vision clearly. Proper communications should grab minds and hearts of target audience.
• Allowing obstacles to stop the vision. Achieving success in implementing any change is not easy due to the emergence of change blockers throughout the process.
• Inability to create quick wins. Quick wins acts as motivators and signs that one is on the right track. Failure to create such wins, automatically leads to failure of the process.
• Declaring victory at sight of the first positive sign can terribly crumble the whole process due to prejudgement. Assuming that the project is already a sure success leads to reluctance and non-preparation to counter any problems. Therefore, if faced with any challenge, the process will certainly stop leading to failure.
• Neglecting to infuse the changes in the organisational culture. For any change to be successful, it must be anchored firmly.

Implementation of Kotters Change Theory in Nursing

A need for constant improvement of services in the health care sector necessitates that nurses should embrace changes. This need has led to application of Kotter’s theory in the nursing field to enhance the value of services. Nurse Coaches, have played a crucial role in bringing about the needed changes in the nursing profession. Further down is a description on how Kotter’s change model has been used to communicate relevant information at bedside while changing shifts (Chowthi et al., 2016).

• Step 1: Creating a sense of urgency. This step entails motivating the workers to embrace change as a way of solving current problems. Viewing a problem as a chance to change and clearly addressing it assures one of positive results. For instance, administration in the nursing field realised the need of precise communication at bedside. Implementation of Kotter’s first step was effected by exposing the demerits of poor communication during handoff process. By discussing risk for harming patients, nurses were willing to foster bedside communication.
• Step 2: Formation of a guiding coalition. Competent leaders are required to persuade others to adopt a change. In the infusion of this step in nursing field, nurse leaders (nurse manager, nurse educator, senior bedside nurse) were educated about the eight steps of Kotter’s change theory by a nurse director. Additionally, leaders used literature on safety initiatives from the institute of medicine. With all the relevant information at hand, the cohesive leaders were equipped to create a vision for change.
• Step 3: Creating a vision. This stage involves shaping the vision and coming up with strategies to achieve it. This step was implemented by coming up with 3-step process that included explaining the roles of incoming and outgoing nurse and officiating communication structure for the handoff procedure at bedside. The results were better communication among nurses, patients and relatives at bedside.
• Step 4: Disseminating the vision. After establishing the vision, it is important to share it to the execution team. In the nursing field, articles explaining the significance of bedside handoffs and implementation of change concurrent with Kotter’s model were availed to the staff. Thorough education of the staff on the vision of change was conducted during staff meetings and other education sessions.
• Step 5: Empowering others to act. Effective communication and direct assistance from others are key during adoption of a concept. To implement this step in nursing, the staff were empowered to embrace the vision by reinforcing home grown system. Nursing groups were convened daily to assess the efficacy of countermeasure until full adoption was achieved. Nursing leadership provided relevant support to employees who were unpleased with change. This was a continuous process until all setbacks to change in staff fraternity were resolved.
• Step 6: Creating quick wins. In order to sustain change processes, a team is encouraged to create immediate and visible wins. During the application of this step in the nursing practice, two examples of instant wins were identified. First, staff were able to identify missed prescriptions on the electronic medication record at the start of the shift. Second, the staff realised an improvement in efficiency in work completion and that they were able to leave on time. By emphasising on such wins, the motion of the project was strengthened.
• Step 7: Building on the change. Coming up with inventions that boost changes while focusing on the vision is key in change process. In the nursing field, nurse leaders trained and supported the staff while maintaining the change. Additionally, the leaders emphasized on the need to uphold critical thinking which resulted into emergence of new procedures. Implementation of this step in the daily management system improved patient care services. For instance, by revising the assignments of the staff, patients were organised according to bed location, leading to reduced walking and moving nurses near their patients.
• Step 8: Institutionalizing the change. Full compliance to the change requires a cultural initiative to enable the vision to become a norm. This step was applied in the nursing practice by integrating bedside handoff change into new nurse orientations and education of nurses. Consequently, bedside handoff became a cultural practice in the unit. Acceptance from the majority propelled the change regardless of a few oppositions from a few nurses who were resistant. Eventually, the new practise enhanced communication and patient satisfaction, making a nursing field a better working place (Small et al., 2016).

Potential Driving Forces in Kotter’s Change Theory.

Application of Kotter’s 8-steps into the nursing field was possible because of the nature of the model as outlined below.

• The implementation process is an easy step-by-step procedure.
• Kotter provided clear steps which are easy to understand and apply.
• The model focuses on preparing and embracing the change
• Kotter’s change theory allows for easy transition.
• The focus of the model is on buy-in of employees leading to success.
• The model is flexible enough to fit into the cultures of most classical ladders.

According to Kotter, Change agents are essential in supporting the process of change. In the nursing field the change agents are the leaders of various departments and units. First, the agents play a critical character of consultant. They provide nurses with relevant data from both internal and external sources. This data is essential in building of predictive models by the management and employees. Agents can also answer any questions from employees hence clearing all doubts concerning the change. Second, the agents are trainers. The nurse leaders educates employees on new skillset to enable the staff to solve various problems in their units. Lastly, agents are researchers. As researchers, the nurse leaders develop evaluation systems that asses the efficiency of the change process in their respective staff members.

Restraining Forces in Kotter’s Change Theory

Restraining forces are barriers to change. Resistance comes in mainly at transition level. In the Nursing practise, the staff are not flexible enough to abandon the old practises. Competent nurses in particular, tend to be rigid as they cherish their long term experience in their routine procedures. Sometimes this leads to professional negligence such as negligence in double checking of high alert medications. Such nurses believe that they don’t need to change, experience in old ways is more important to them.

Nurses are often hesitant to change their old practises due to various reasons. To begin with, failure to appreciate the need to change. The aim of modernisation might have been misunderstood or considered irrelevant and incapable of solving current problems. Second, some nurses might be against the tactics of applying the amendments rather than the change itself. Additionally, some nurses perceive the change as an embarrassment and threat to their self-esteem or interest thus becoming intolerant to change. Furthermore, lack of trust in the nurse educators and other change agents based on past failures in implementing changes. The nature of the Kotter’s model such as strict following of steps, long implementation time, and lack of room for co-creation can lead to frustration among the nurses if their needs are overlooked. Lastly, change agents in the nursing practise have reported lack of resources as one of the major restraining force (Tang & Ngang, 2019).

Ways of Overcoming Resistance to Change

There are a number of strategies that can be adopted to overcome resistance to change. First, empirical-rational approach which assumes that the behaviour of nurses is driven by rational self-interest. Nurses can embrace a change if its benefits are well explained and justified. Proper communication and enticements are necessary in this strategy. Research have revealed that some nurses are usually convinced in the change. Nurse educators are thus advised to target such converts and use them as influencers.

Second, we have the normative re-educative strategy which banks on the assumption that nurses act in line with socio-cultural norms. Nurse educators are expected to focus on the impact of alteration in the already existing cultural activities of the staff. The strategy should not distort the skills, attitudes, values and relationship among the nurses. Since culture does not evolve quickly, this strategy is effective for middle and long term projects such as establishment of a Magnet Recognition Program which takes up to five years to achieve.

Third, educators can use power-coercive policy whereby changes are imposed on nurses by the management. Defiant nurses are often subject to disciplinary actions. This strategy is considered effective especially for the changes that are urgent and a must do nursing policies that explain the standards of care. Changes in policies such as patient identification before administering medicine should use this approach too.

The fourth strategy is called environmental adaptive scheme. This involves construction of a new organisation and thereafter transferring staff from old building to new one. This strategy is therefore considered impractical for the nurse educator (Salam et al., 2016).

Need of Change in Nursing Practice

Changes in the nursing practice are inevitable and paramount. This is due to the ever-evolving techniques in the field that are aimed at improving the quality of services and enhance efficiency at work. Regulations in the nursing practise are constantly evolving to improve on the quality and safety of health care services. The old methods are prone to errors thus nurses are instructed to embrace modifications to evade such errors. Any nursing system that is reluctant to adjustment is considered obsolete and with a limited chance to advance. Just like any other business, nursing practises should aim at satisfying its clients (patients). Therefore, any beneficial and justified change in nursing practice should be embraced (Joseph & Joyce, 2017).

Implication of Change in Nursing Practise

Changes that have been introduced in the nursing practice have improved the quality of health care services and elevated the standards of hospitals. For instance the introduction of clear communication at bedside while changing shifts have increased the level of accuracy while handling patients. Additionally, safety to the patients have improved. This is evidenced by prior identification of patients by the nurse on duty before administration of medicine. Furthermore, the transition of shift has been made easier by clearly defining the roles of each nurse thus eliminating the possibilities of role mix-ups or exchange. The nurses have also been relieved of too much walking as they are stationed closer to their respective patients. Education of nurses on the new skillsets have also improved their level of expertise thus equipping them to handle problems in their field of operation. Generally, adoption of new procedures in the nursing practise have steered growth in the profession (Baloh et al., 2018).

Conclusion

A change theory is essential when anticipating modifications in nursing practice. Selecting a model that effectively fits the needs of administration, staff and patients is crucial for sustainability. The chief cause of failure in most change progressions in nursing practice are reluctance to support and empower the nurses to adopt the new procedures. Embracing planned changes in nursing practice is necessary but it can be demanding due to resistance. Therefore one need to have in place proper strategies to aid in dealing with the barriers to revolution. Kotter’s 8-step model is easy to understand and can be easily applied for effective change.

Merle Mishel was born in Boston Massachusetts in 1939 and much of her practice in nursing was geared towards her theory of perceived ambiguity in illness scale, later named uncertainty of illness (Bailey & Stewart, 2017). This uncertainty of illness focuses on one’s outlook of what is happening to them, whether it is a new diagnosis or a chronic illness, one’s perception is the determining factor of the expected outcome. If the perspective is not clear, there will be some uncertainty of what to expect, how to care for themselves after the illness, and the information that is given to the patient through the healthcare team needs to be concise to give the patient comfort in knowing the response time to the illness is meaningful to the care team just as much as to the patient (Bailey & Stewart, 2017). There are a plethora of things that impact one’s uncertainty as well as things that help lessen uncertainty. When uncertainty creeps into one’s life, they begin to become unbalanced and start to question their future. As a healthcare team, we must provide as much certainty as we are able to and let them know that even with the realm of the unknown that they still can have as much quality of life as they choose to have.

Mishel conceptualized the uncertainty of illness, in the beginning, to connect the psyche of the mind with the illness one is facing (Bailey & Stewart 2017). Mishel’s training in nursing was in the psychiatric unit, she came across a lot of uncertainty with helping her patients (Bailey & Stewart 2017). In 1990, Mishel re-structured her theory to connect much of what we see in our healthcare patient’s today which is summed up by the phrase, “See it to believe it”. People in today’s time want to know what is ahead of them, they want to see the treatment plan make them feel better, and they want to have as much certainty as they can to outweigh the uncertainty (Bailey & Stewart 2017). As we study Mishel’s theory of uncertainty of illness, we will view it in light of how ambiguity arises with COPD, heart failure, and chronic kidney disease. There are plenty of other areas in healthcare that arise many questions that leave our patients wandering, we need to provide as much certainty as possible, as they are faced with the unknown.

Description of Nursing Theorist and Theory

Mishel’s re-structured theory adds a dimension of uncertainty, this does not mean that uncertainty is ruled out in every case, even though each illness presents with uncertainty, it allows the patient to grasp what is happening and formulate an outcome in spite of the uncertainty (Bailey & Stewart 2017). When a patient exhibits uncertainty, this will inhibit what they learn due to the fact of not being able to get a solid foundation of the value of the illness. When there’s not a solid foundation, then one’s mind can only wonder; this can lead to misunderstanding the diagnosis due to not enough information is provided, physicians assuming the patient already knows about the diagnosis and that will lead to even more uncertainty (Cherry, B. & Jacob, S., 2017). Although ambiguity cannot be ruled out completely, this will bring together the healthcare team working with the patient to achieve desired outcomes.

Concepts of the Theory

When applying this theory to our everyday life in our areas of nursing we need to thoroughly assess our patients and their support system. We need to see how they are adapting to being in a hospital with news of the new diagnosis, or ongoing chronic illnesses. If their outlook is of ‘doom and gloom’, we as a nurse should seek out the root of what makes them see it that way. Once we can determine their outlook, we need to build up a rapport with the patient while we are caring for them, this is best done by making our care client-centered and letting them know we genuinely care. When we can break through the barrier of gaining trust, we then can explore how the patient truly feels, and not just their “scripted answer”. At this point, we can collect sound objective and subjective data to help with our patient’s uncertainty. Their uncertainty can stem from various aspects involving but not limited to, knowledge, resources, adaptability, support system, emotional health, and physical health (Bailey & Stewart 2017). Using Michel’s theory of uncertainty, we as a healthcare professional can breakthrough socioeconomic barriers to lessen uncertainty in illnesses, directly impacting a continuum of health for our patient, and achieving the highest level of optimum life that the patient can attain. Putting to use the concepts of Mishel’s theory, a lot of factors play a role in how the patient will react to what is happening, and we as a healthcare provider need to bring as much positive to the patient as they may only see negativity at first. Given adequate space to process what is happening, sound teaching with thorough re-assessing, this should, in turn, give the patient a new perspective.

Assumptions of the Theory

When formulating any theory there will be a lot of different opinions due to different perspectives of the nursing field, what works in one area may not necessarily fit or work in another area. One assumption with this theory was that the present ability of the patient to make decisions and process what is happening was directly related to the uncertainty that they would experience and that past life events that brought uncertainty could not play a role in the current state of uncertainty (Bailey & Stewart 2017). Once you have faced previous trials and times of weariness of not knowing then one assumed that you could not use what you interpreted through that trial to help you through what is in front of you now. I choose to believe that one’s past struggles and fears can roll over into the current, the way you handle what was happening in the past can come to light in part of the new trial to help you cope. Another assumption is that the “not knowing” cannot be determined good or bad, the gray area so to speak is an even playing field (Bailey & Stewart 2017). Most would agree with this assumption, sometimes what you do not know won’t hurt you, although within the nursing field we are to provide evidence-based practice education that allows the patient to determine if what they are facing is good or bad. Another misconception of Mishel’s theory leads people to believe that due to the uncertainty, it would lead one to be under some sort of stress, and in the face of stress, it would make them have to change (Bailey & Stewart 2017). When anyone is faced with the unknown, we cannot assume that it will be a linear projection to get them to overcome whatever they are faced with. In terms of chronic illnesses, the patient has dealt with the illness for a while, and the result of the illness may not be a death like some. It has proven to be a process, especially with chronic illnesses, people may face ambiguity at different times but not constantly, so they must choose how to cope when presented with the unknown and that is not every day. According to Mishel, with the uncertainty not being a constant daily thing, it suggests that the person lives with what is happening to them and over time they will make choices that will keep them on the track of more peace than one of fear (Bailey & Stewart 2017).

Application of Theory to my Practice

Mishel’s theory can come into context across the various spectrum of patients along the continuum of life that are faced with an array of illnesses. In terms of heart failure, one can present with different symptoms each time due to the complexity of the cardiovascular system. The patient can get overwhelmed, which can lead to not being able to understand the connection of systems to heart failure and can give the sense of losing control to the patient. When the patient feels out of control, at times they can get depressed due to not knowing all the symptoms to look for when dealing with heart failure (Chen & Kao, 2018). During their study with patients that dealt with heart failure, not knowing what to expect at times correlated to make them feel bad and this brought on depressive symptoms, thus prolonging the healing time. (Chen & Kao, 2018). On our unit, we tend to see patients that fight with depressive states due to heart failure symptoms impeding their quality of life. In conjunction with heart failure is COPD which also has a set of symptoms that interferes with one’s life, limiting what they can do. This study correlates how COPD limits one’s interactions and social life, therefore, limiting their support system (Hoth, K. 2014). We see this almost daily on our unit, people are not able to participate in various celebrations due to a restriction of activity caused by their breathing. This can lead to ambiguity in one’s life and raise questions if they will ever be able to be ‘normal’ again? Another thing we are faced with in our unit is chronic kidney disease. There is a lot of uncertainty with this illness, even though they may get dialysis, they are unsure how long it will sustain them because it is not a cure-all for the disease. This study shows the various options available for someone that presents with CKD, with those decisions come ambiguity that will play a role in the patient’s decision of treatment plan (Harwood, L. RN, & Clark, L. Ph.D., 2014). We see various stages of CKD, some that require dialysis whether peritoneal or hemodialysis and some that are managed by medications, diet, and exercise. With all options available there is some grey area that is in the patient’s mind, will their kidneys ever get better, with proper teaching can they maintain an active lifestyle and prevent worsening of their kidneys? These questions are just a few we encounter, the mindset of the individual is one that has a lot of control with the situation at hand, if they don’t have a great mindset then it will not be a great outcome, thus with a good mindset they will be able to achieve as much as they desire.

Conclusion

We all have uncertainties that we face in life, it is almost evident that at one moment in our life we will be faced with things we have not planned. As a healthcare professional, we need to keep in mind how we felt when we were faced with unknowns. We play a crucial role in educating our patients and equipping them. I believe each of us as healthcare professionals can incorporate Mishel’s theory while we are caring for our patients, knowing that they are faced with some kind of fear of the unknown, and it is our role, if the patient will allow us to do so, to help them get over the hump and know that they can overcome in light of what they are facing.

References

1. Chen, T.-Y. & Kao, C-W (2018). Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLose ONE pages 1-13.
2. Bailey, D.E, Jr., & Stewart, J.L. (2017, February 09). Uncertainty in illness theory. Retrieved from https://nursekey.com/uncertainty-in-illness-theory/
3. Hoth, K., Wamboldt, F., Ford, D., Sandhaus, R., Strange, C., Bekelman, D., & Holm, K. (2014). The social environment and illness uncertainty in chronic obstructive pulmonary disease. International society of behavioral sciences, pages 22:223-232
4. Harwood, L. RN, & Clark, L., Ph.D. (2014). Dialysis modality decision making for older adults with CKD. Journal of clinical nursing: retrieved from https://onlinelibrary-wiley-com.proxy.longwood.edu/doi/full/10.1111/jocn.12582
5. Cherry, B. & Jacob, S. (2017). Contemporary nursing issues, trends, and management. (7th edition). St. Louis, MO. Elsevier.

Qualitative research-based experts predetermine their interests and background relations with the topic under investigation before venturing into the study. Notably, the academician demands answers to several questions that revolve around the underlying superstitions within society. Through information obtained from the natives of environ, a conclusive report ensues to justify the unraveled experiences. However, the researcher bears the responsibility to choose an appropriate method of inquiry and a reliable scientific technique to equate the information to real life. This paper, therefore, summarizes and critiques a qualitative research method deployed in the journal “Nurses’ Perspectives Regarding the Disclosure of Errors to Patients: A Qualitative Study”.

A Summary of the Findings

Based on the rating captured on critique written summary grading, McLennan et al. (2016) clearly outline the key information entailed in the investigation within the abstract. Since the inquiry encompasses a wide range of professionals and subjects, it is appropriate to pick on the research method for the justification. Through an elaborative subject matter and a variety of preexisting underpinnings, a real-time solution exists for the research topic. Despite different views and challenges, the finding functions to provide clarity on the importance of conveying health messages to the patients within healthcare nursing. However, by assigning an individual with no prior information and unknown to the interviewees, uncompromised results occur for analysis (McLennan et al., 2016, p.18).

Moreover, uniform research-guided questions administered to the parties prevail for future reference through voice-activated devices (McLennan et al., 2016, p.18). The involvement of the healthcare leaders through selective sampling for interrogation provides a diversified knowledge base necessary for investigation. Despite entitlement to the institution’s powers, experienced medical practitioners unveil the critical issues in a restricted environment. The computation of the information conforms to the purpose of the research and categorically outlines the procedures. McLennan et al. paint out a reader-involving experience technique with clearly drawn conclusions from the literal information gathered.

The Strengths, Weaknesses, and Applicability of the Research Report

Strengths

Even though predesigned series of questions exist for the investigators, the nurses enjoy a vacuum to express their views and experiences during the inquiry session (Choy, 2014, p. 102). Surprisingly, the researcher lacks background information on the field matters, a condition that provides conversation for clarity. Besides, most of the ideologies under investigation trace back to the history of nursing practice. Therefore, a wide range of opinions exists for verification of the accepted healthcare procedures.

Weaknesses

Relocating the interviewer to the medical facilities and the learning institute’s library requires an organized duration and transportation means (Choy, 2014, p. 102). Through variable working conditions and resources, the medical managers narrate stories that fit an individual institution’s set-up. However, critical information might lack throughout the interrogating process. An invalid conclusion, therefore, characterizes most of the qualitative research approaches used.

Applicability

The research methodology is used to highlight the knowledge difference that exists within the nursing practice. Through proficiency relations between the nurse and the patient, quality and patient-friendly environment prevail in healthcare nursing. However, a departure from the intervention policy is rooted in the training module and the set working policies for medical centers. Overall, the qualitative research method unveils underlying facts that prevail in society without meaningful conclusions.

The Use of Qualitative Research Methodology to Guide Evidence-Based Practice

Nursing is a noble responsibility that requires interaction among stakeholders. Therefore, a unanimous process is required to unveil the underperformances within the practice. Moreover, the curriculum needs to address knowledge differences experienced in the field through patient-nurse interactions. Through the state department of health, the policy should be introduced to safeguard the needs of the victims. However, the criteria of administration should consider the prerequisite client understanding and perception of the opinion.

Conclusion

In summary, the qualitative research critique assumes investigation activity based on undefined principles within a defined space. The techniques deployed work in harmony with the purpose of the investigation. Through comprehensive data computation, the underlying factors evolve from the sample population interviewed. However, the method comprises both strengths and weaknesses, following the nature of the research and the tools deployed. As a result, the qualitative research procedure occasionally provides insufficient findings to justify an occurrence.

References

1. Choy, L. T. (2014). The Strengths and Weaknesses of Research Methodology: Comparison and Complimentary between Qualitative and Quantitative Approaches. IOSR Journal of Humanities and Social Science, 19(4), 99-104.
2. McLennan, S. R., Diebold, M., Rich, L. E., & Elger, B. S. (2016). Nurses’ Perspectives Regarding the Disclosure of Errors to Patients: A Qualitative Study. International Journal of Nursing Studies, 54, 16-22.

Introduction

In America, in a group of every 10 individuals, 6 of them have a chronic disease such as kidney failure, cancer, gall bladder blockage, and so forth. There are also other deadly chronic diseases that are the major causes of deaths and disability in America (Schiffrin et al., 2020). They have increased the costs of healthcare, and an example of such a disease is hypertension. Modern health care promotes change by collecting data and using the data in problem solutions. This paper uses the Direct Practice Improvement (DPI) approach to provide a solution to increase hypertension awareness and control in a period of four weeks. The following paper outlines the interaction between religious beliefs, Christian faith being the selected example, and medical practice in both nursing theory and evidence-based models.

Purpose of the Project

‘’In adult patients, 18 to 85 years old with hypertension treated in an out-patient setting (P), how does the Newest Vital Sign (NVS), Hypertension Knowledge level scale (HK-LS) questionnaire, and healthcare effectiveness Data and Information Set (HEDIS) guidelines (health literacy tools) applied in teach-back method (1) compare to traditional teaching (without teach-back) (C) improve hypertension awareness and management (O) within a four-week period (T)?’’

Hypertension has been a common problem affecting adults in the USA, which has been a common risk factor. Hypertension is a severe chronic disease that also poses a great risk of evolving other chronic conditions such as heart failure, problems of the brain, and kidney-related problems. According to data from the National Health and Nutrition Examination Survey, which was conducted between 2017 to 2018, the commonness of hypertension in adults was 45.4%, with a higher percentage affecting men at the rate of 51.0% and women at 39.0% (Wang et al., 2018). It was reported that hypertension was increasing with age as a higher percentage was reported among the aged. At the age of 18 to 39, it was at a percentage of 22.4, a percentage of 54 for the age of 40 to 59, and a percentage of 74.5 for those of 60 and above years of age (Taylor et al., 2018). The comprehensive report indicated that approximately 1.3 billion people worldwide have hypertension. The report further suggested that the majority of those with hypertension are low and middle-income earners.

Christian Worldviews

The nine beliefs are outlined within the doctrinal statements of the Grand Canyon University and reflect a number of major Christian convictions. These include the use of the old and new testament, the union of the father, son, and the holy spirit, man created in the likeness of God, the regeneration of the holy spirit, and salvation as defined by Christ’s Church. Another three beliefs are focused on Jesus, stating that salvation can only be attained through Jesus, the story of his resurrection, and the recollection of his life. These specific beliefs relate to Christian worldviews and health through the beliefs that give credence to the existence of God and that God takes a hand in the process of healing. Other aspects of the doctrinals claim that man was created in the image of God and was like God. However, having broken the moral nature that was initially given to him, all people are inheriting the sinful nature from generation to generation, and therefore, we are all condemned.

Christians, therefore, say that as a result, God takes moral actions against humans as they are sinners, and an example is the evolution of chronic diseases such as hypertension. In summary, Christians believe that there is a punishment in the form of detachment; an example is a chronic disease that may require isolation, such as the prevailing COVID-19 epidemic.

Organization’s Mission and Vision to Theory and Model

The prevalence of a chronic illness in society calls for an immediate change in the ways in which healthcare is provided in society. The current healthcare system is complicated and lacks special access to technology. Healthcare providers lack enough information on the special care required by patients with hypertension, and instead of offering the needed complex healthcare by the said patients, they emphasize advanced home-based care. This results in poor communication between the patients and the nurses, which poses the risks of the occurrence of medical severe results. According to recent revelation, most patients with chronic diseases have little or rather no knowledge at all of their condition (Mills & He 2020). In that case, most of them do not comply with the medical prescription since they do not know what they are getting treated for and how beneficial it is to them.

Connection of Mission and Vision Statement to Nursing Theory

The mission of this organization is, therefore, to do proper research on how to deliver quality healthcare, especially on hypertension, as well as find out how hypertension can be prevented and controlled. The organization begins creating awareness of the hypertension epidemic since most people lack knowledge about the disease. This will help reduce the mortality rates associated with the disease since the earlier report indicates that 59% of patients of the age of 65 and above lack adequate information on health, and overall of 80% of the patients as well (Umemura et al., 2019). Dorethea Orem’s self-care nursing theory relates to the mission of the company on the basis of individuals having the resources to improve their own wellbeing. Orem’s theory focuses on self-care as a function of people having the knowledge and ability to maintain their health, similarly, the mission of the organization aims to improve the quality of care, and by extension, the ways in which health information is provided. That will be achieved through the inclusion of improved technology and by performing quality assessments.

Connection of Mission and Vision Statement to Evidence-Based Model

The organization will as well advocate for the simplifying of medical procedures in a way that patients can understand. This calls for nurses to give a detailed report concerning the patients’ problem and how it can be managed rather than giving a complicated prescription using medical terms. This will help in the case of those patients with hypertension as they are able to understand what hypertension is, its signs and symptoms, especially when they are serious and call for urgent medical attention. The John Hopkin’s evidence-based change model prioritizes the stages of inquiry, information gathering, and translation of this data into improved medical practices that are subject to continuous analysis. Similarly, the organization’s mission and vision focus on the improvement of current procedures through the simplification and clarity f these processes for the benefit of the patients.

Who are the participants in this project?

The project targets hypertension patients and those who are at risk of getting the disease as well. It will source participants of different levels, each level with a representative. For the children, their caregivers, such as parents and guardians, will represent them. As for the adults, individuals of a given age and gender will be chosen. Still, gender balance will be put into consideration because hypertension affects both men and women. The said patients should have been having the disease for at least a year and a half so that they would be able to share enough experiences about the condition. The chosen participants should be able to communicate in English as well to avoid the problem of a language barrier.

Estimated Period

The hypertension control training cannot be a one-day thing. The DIP will therefore need a four-week period for the movement, and accordingly planning is essential in this project. The training period will as well be organized into sessions of 45 minutes, taking occasional breaks in between. In a short session, the Nursing team will be taken through the importance of the project to ensure effective content delivery. The organization’s support staff will print posters and flyers with a guide on the project’s timetable. This will ensure that there will be effective coordination of events between the participants and the organizers.

In the first week, the DPI will be taking the participants’ data. This will include running practical tests such as blood and diabetes tests. The patients will be issued with forms with the obtained information, which will be filled and filed for assessment throughout the four weeks’ period. The DPI team will assist the participants in filling the forms. The patients will be asked to provide some information on their illness experience, how they realized that they were hypertensive, their daily routine on managing the disease, and the problems they have been experiencing concerning the condition.

In the second week, the participants will be enlightened on what hypertension is. They will be taken through a vivid explanation of what the disease is, its causes, and its symptoms. They will be taken through the likely factors contributing to the development of the disease, which includes age, that is, the more one grows old, the more likely they are to become hypertensive.

In the third week, the nurses enlighten the patients on how the disease can be controlled. They will be taken through a guideline on proper dieting, inspiring them on the foods that they are supposed to take to lower hypertension and those that they are supposed to avoid. The participants will as well be provided with a guideline routine on the activities, for example, what exercises to be done at what time, either in the morning or in the evening.

In the final week, the patients will be given feedback on the training session. The DPI team will be testing their understanding as well by asking them relevant questions to test their knowledge of the lessons on hypertension management and control. In the end, the data before intervention and after the intervention will be outlined and analyzed to keep a record of the outcome. The documents will be securely held at the clinic as the DPI puts the patients’ confidentiality into account.

Vision

The vision of the project is to provide a hypertension-free community. Using the above-mentioned procedure in choosing the participants of the project, the organization will have established fair distribution and solutions to the problem of hypertension. For example, in the case of the caregivers, they will in return give the information to the other caregivers of the hypertensive children, and the chosen representatives of the different age groups will provide the information for their age mates through the preferred methods, either by creating hypertension care study centers or organizing seminars on hypertension awareness and control methods (Tatsumi & Ohkubo, 2017). The organization aims at establishing adherence to medication and prescription of hypertension patients; therefore, the above approaches will help with the same. The DPI employs the vision of improving hypertension awareness and management by transitioning from traditional teaching to health literacy tools applied in a teach-back method. The improving technology should be well utilized by the patients and the caregivers to make sure the hyper-tension is not a threat to lives anymore.

Pulling it Together

The teach-back method is, therefore, when applied in educating a patient, it has shown without a doubt to upgrade the knowledge and improve the communication between the health care provider and the patient (Miller 2016). The importance of increasing patients’ literacy on their health is to make the patients know their condition better, thus helping in their coherence to the laid down plans on treatment since they understand their shape better. The patients should first understand the significant role played by information about themselves concerning his/her health status. In conclusion, the teach-back method is an effective method of improving hypertension through education and assessing its significance in society.

Conclusion

The case study observed the implications of interventions in incidents of hypertension with the introduction of several evidence-based models and exterior factors such as religion. The teach-back method, which was selected as the most effective tool in decreasing hypertension through educational means, can be applied to the mission and vision statements of the organizations. They prioritize the improvement of care quality and engaging with patients in clear ways regarding medical procedures. Similarly, it will be directly related to raising awareness regarding common issues within hypertension. As such, the teach-back method aims to meet both criteria effectively.

References

Miller, T.A. (2016). Health literacy and adherence to medical treatment in chronic and acute illness: A meta- analysis. Patient Education and Counseling, 99, 1079–1086.

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223-237.

Tatsumi, Y., & Ohkubo, T. (2017). Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese. Hypertension Research, 40(9), 795-806.

Taylor, S. G., Katherine Renpenning, M., & Renpenning, K. M. (2018). Self-care science, nursing theory and evidence-based practice. Springer Publishing Company.

Wang, C., Lang, J., Xuan, L., Li, X., & Zhang, L. (2017). The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. International journal for equity in health, 16(1), 1-11.

Introduction

Self Determination Theory (SDT) describes human behavior with respect to compelling personalities (Brown 2007, p. 100). From the case study provided, various aspects of SDT are evident. Contextually, this theory tries to explain what motivates people to make critical life choices. This considers the driving force behind each choice made. Concurrently, the psychological needs of the people are also addressed in this theory. The theory explains why people grow and the causes of this growth. Every person has a motivation behind what he or she does; this is why knowledge of this theory is necessary to explain human behavior and how they react to different situations (Deci & Ryan 1985, p. 34).

Motivation is the drive that one gets to do something; people get motivated by various things and for different reasons. There are two major types of motivation; Intrinsic and extrinsic motivation (Deci & Ryan 2004, p. 123). Intrinsic motivation- this motivation comes from within. The concerned person is driven by the passion he or she has for tasks. It is usually self-inspired. Extrinsic motivation- this type of motivation is influenced by external factors such as; an increase in the salary, job promotion, fame, money, and for socializing purposes.

Main body

Evidently, SDT is a motivational theory used to describe the psychological needs of people. There are three elements of this theory (Otto 2010, p. 188). These are; autonomy, competence feedback, and relatedness. Each component has a role to play in the development of the theory.

Autonomy

Rewarding people to boost their performance tends to decrease their intrinsic drive. This in turn lowers their autonomy. The person becomes more driven by external rewards; they become less interested in their intrinsic motivation. This may be necessary to enhance the performance of the workers, but it also destroys their passion and the zeal that they have. Removal of these external rewards may also make a person less motivated and thus may tend to do a shoddy job.

Competence

Evidently, giving positive compliments to people can greatly enhance their ability to perform and do work. These compliments enhance a person’s intrinsic motivation resulting in improved delivery in his or her performance. At the same length, negative compliments demoralize a person and make them less motivated. It is important to give the employees positive remarks on perfectly performed duties. This will boost their morale with a consequent increase in performance.

Relatedness

The need for relatedness is very important. Critically, this allows one to more connect with the work that they are doing. The employer should try and relate well to his subjects and try to listen to them. This guarantee viable workplace relation as indicated earlier. Additionally, it is important to understand all knowledgeable aspects as demonstrated earlier in the paper. Considerably, people who are working in a given area should do team building to enhance relationships they have with each other (Self-determination theory.org. 2006, p. 1).

The theory also tries to explain how the human mind is different. People behave differently under different circumstances and this solely depends on their environment. People have different personalities unique to them. People are motivated differently. It is crucial to agree that motivational sources are different when considered critically. This is evident in Madeline’s case as provided in the study.

It is possible to use SDT to diagnose motivational problems experienced by the staff. Contextually, SDT (as a theory) is not only applied in the work areas but can also be used for building relationships in schools, playgrounds, families, and religious places. It aims at improving understanding of a person’s personality and psychological needs. People need understanding in all these aspects of life. The theory is very important and it should be employed by leaders who have people working under them as indicated earlier.

This theory can be applied in the case that concerns Madeline. Evidently, she could use constructive tips from this theory to help her deal with the situation in her work area. Her staff is lacking motivation in their work area. This is making them give poor results in their work and also be unhappy while they are attending to their duties. She should try and motivate her subjects so as to make them deliver better and to do a good job.

From the case study, it is notable that a good working environment, that favors the performance of the nurses, should be provided. The number of patients assigned to each nurse should be reduced so that the concerned workers can execute their duties successfully. A nurse should be assigned at most three patients at a time. This means that more personnel should be added to the staff to reduce the workload and make the staff be less frustrated while carrying out their duties. This is an extrinsic motivation since the workers’ workload is reduced and they have demands that are less. They would avoid strain hence happier in their work.

Extra allowances should also be granted to the nurses to make them more focused on their job and look forward to doing their shifts. As noted from the case, Madeline is given allowances for any extra work she does. This gives her motivation and makes her look forward to her shift. This explains the reason why she comes to work early and leaves late in the evening. The motivation to achieve greatness is evident in her; she has a driving force meant to compel her endeavors as a health practitioner. It is recommendable the same should happen to other workers in order to keep them motivated.

Evidently, Madeline admires the way Margret does her work. From the case study, it is evident that Margret loves her work and gives it her best. However, Madeline hardly tells her that she is good at what she is doing. Instead of appreciating her, she interrogates her strongly, and this really annoys Margaret. Madeline should try to encourage her and compliment her on the good work that she does. This will help to build her intrinsic motivation since she loves her work.

Compliments boost a person’s self-esteem and make them feel important. This is necessary for any work institution. Madeline does not relate to her nurses well. Margret’s effort of trying to make her open-minded is taken as a mockery (Switzky 2004, p. 34). She does not appreciate that the nurses are also knowledgeable and can give her tips on how to better her management skills. This poor relationship results in workers feeling unhappy and sad hence demoralized. She should improve her listening skills and have a teachable spirit.

Concurrently, Molly gives her best when it comes to performing her duties. However, she has a weakness in using new skills to treat patients. Molly is not up to date with modern methods of treatment. This calls for Madeline to introduce short courses that will help old nurses like Molly to be versed with the modern methods of treating patients to ensure that she delivers her best. This is a form of motivation than extrinsic.

The short courses that are done will make Molly more educated on modern technology and this will make her embrace her work well and also learn new information (Matson 2009, p. 27). This is very relevant for the growth of the hospital. The fact that she does not ask her fellow colleagues how to go about the new methods could be an indicator of poor staff relationships. Madeline should try and find ways of enhancing staff relationships. This is important as they can learn from each other and aim for greatness.

Madeline is too strict. She does not allow her workers to have chats while they are in the line of duty. This could be another reason as to why the ward is dull and the staff’s inability to grow (Christenson, Reschly & Wylie 2012, P. 152).

She should soften up and not be too hard on them. A sensible person will do her duties diligently and concentrate less on idle talk when they are busy. These chats can also brighten someone’s day and make them happy and look forward to reporting to their place of work. Madeline exempts herself from the night shifts; this is not a good thing to do. She should also have night shifts just like the rest of the staff. She should not feel too special to the other nurses.

SDT suggests that individuals are different and each person is unique. This explains the difference between Molly and Margret. Madeline should also try to read and understand different personality traits that her staff possesses so that she can be able to understand them well. Personality is a very important attribute to learn in a person and it makes motivation easier (Mcinerney & Van Etten 2004, p. 33). She will have to deal with their needs in a way that is unique to each one of them because they have different needs that need to be addressed. This calls for intelligence on how to deal with such an issue.

Madeline should not try to use the managerial systems that she saw being used in her previous workplace. She should find new ways of dealing with her staff because they are in different environments and she is dealing with different people with different personalities. She has a new position as the head of the ward, she should get more education on how to lead her staff so that they deliver and have enjoyed the work that they are doing.

Madeline feels that she is doing her best yet her subjects are hardly contented with what she does. She comes to work early and leaves late; she checks the roosters and monitors what the nurses do. She makes a lot of mistakes that are minor and yet very important. She should try and have talks with her staff to help her to evaluate herself and also to make her learn her mistakes. This is the first step towards building a relationship with her staff in the area of work. She should also try to take the course on “organizational behavior” that is offered at the University of Sydney.

SDT explains how motivation can be used to enhance the efficiency and performance of a person in the workplace. However, this theory has its own weaknesses. Extrinsic motivation may make a person lose their intrinsic motivation. The need to reward workers for well-executed duties can make some people do what they do in order to gain rewards. This in turn destroys their autonomy (Diclemente, Crosby & Kegler 2009, p. 158). Complimenting some workers may make them feel that they are better than other staff members. Thus, this can create enmity among the people working in the same office. The theory also emphasizes understanding different personalities. It may be a difficult task for the leader to try and understand each and everyone’s personality in a work environment that is very busy and big.

Conclusion

Knowledge of SDT is very relevant. It educates one on how motivation can be used to enhance efficiency in the workplace. This theory is focused on human development. It has three major components. These are; autonomy, relatedness, and competence. Madeline is not pleased with the sad mood that is at her workplace. She has identified the problems that she is not pleased with hence should try to work on the issues related. The knowledge on SDT is very handy since it equips her to be able to solve the problems that she is facing at her workplace (Johnson 2009, p. 90). Margret and Molly both need motivation. Despite working in the same environment, they have different needs and should be motivated differently.

List of References

Brown, L 2007, Psychology of motivation, Nova Science Publ., New York, NY.

Christenson, S., Reschly, A & Wylie, C 2012, Handbook of research on student engagement, Springer,. New York, NY.

Deci, E & Ryan, R 1985, Intrinsic motivation and self-determination in human behavior, Plenum, New York, NY.

Deci, E & Ryan, R 2004, Handbook of self-determination research, Univ. of Rochester Press, Rochester, NY.

Diclemente, R., Crosby, R & Kegler, M 2009, Emerging theories in health promotion practice and research, Jossey-Bass, San Francisco, CA.

Johnson, J 2009, Health organizations: theory, behavior, and development, Jones and Bartlett Publishers, Sudbury, MA.

Matson, J 2009, Social behavior and skills in children, Springer, New York, NY.

Mcinerney, D & Van Etten, S 2004, Big theories revisited, Information Age Pub, Greenwich, CT.

Otto, H 2010, Education, welfare and the capabilities approach a European perspective, Budrich Press, Opladen.

Self determination theory.org. 2006, An Approach To Human Motivation and Personality. Self Determination Theory. Web.

Switzky, H 2004, Personality and motivational systems in mental retardation, Elsevier Academic Press, Amsterdam.

There are a lot of English words and vocabularies used differently by people with diverse personalities when speaking, reading or writing, to convey a particular message. It is mind-numbing and unimaginable to think of a world where people, places or objects would be referred to using one word or a limited number of words.

There are however, particular English words that have multiple interpretations and uses. This paper shall look at the various interpretations of the word ‘spirit’, and its uses in the field of nursing.

The word spirit is used in reference to the part of a human being that is associated with the mind, will, and feelings. This description of the word spirit gives us the concept of spirituality, which according to Mauk (2004), can be defined as “the core of a person’s being, involving one’s relationship with God or a higher power”.

An individual’s spiritual health is evaluated based on their internal and external traits, and not on the basis of the factors that may result in their spiritual health. People who are said to be spiritually healthy are observed to have a clear perception of the world that enables them to understand reality, as well as provide them with a coherent belief system. This clear perception is a product of their belief in a higher power or larger reality.

The word spirit is also used to refer to a petroleum distillate that is used as a degreaser, or an industrial cleaning agent (Irvin, 1997). This spirit is also referred to as Stoddard solvent. White spirit, also referred to as mineral spirit, is a clear liquid that is distilled from petroleum.

This spirit is an organic solvent that is used in painting and decorating, as an alternative to turpentine when thinning paints and cleaning paint brushes. Another use for the mineral spirits is in degreasing and cleaning of machinery, due to its low volatility. Mineral spirits can also be used as a lubricant for screws (Irwin, 2007).

Spirits are a familiar ingredient in the manufacture of alcoholic drinks, garnishes and mixers (Arnold, 2005). Lichine (1987), defines spirits as “Unsweetened, distilled, alcoholic beverages that have an alcohol content of at least 20%”. Spirits are made from the distillation of alcohol; a process that involves heating the alcohol until it vaporizes, before it is cooled and condensed.

Sollier (1912), provides us with the fourth interpretation of the word spirit; an intangible being with the ability to influence human events. Occurrences such as voluntary determinations, which are divine, are viewed as supernatural by people who advocate a deterministic view of the world that does not believe in free will (Sollier, 1912).

There is a particular kind of spirit that is used to treat fainting. The aromatic ammonia spirit is used as a respiratory stimulant in syncope, weakness, or threatened faint (McCrory, 2006).

The word spirit can also be used in the field of nursing as a synonym for vivacity. In the profession of nursing, the metaphor, ‘spirited nurse’ can be used to show passion and dedication to helping others. Such a nurse can be said to be highly motivated, and one who seeks to make a difference in their profession.

Reaching out to those in need is as simple as extending a hand. The spirit of nursing, in my practice, is evident beyond clinical application. My involvement symbolizes the caring nature that is carefully interwoven into the methodical details of nursing.

The body reflects the notion of integration of the body and spirit. “Spiritual care can be a natural part of total care, which fits easily into the nursing process of assessment, nursing diagnosis, planning, implementation and evaluation” (Jenkins, Wikoff, Amankwaa, & Trent, 2009).

The term holistic nursing is used to refer to the healing process in entirety. Healing the whole person involves the body, mind and spirit, of both the patient and the care-giver or nurse. It is vital for the nurses, as care-givers, to learn how to take good care of the themselves, in order to improve their effectiveness. Good care looks into physical, emotional and spiritual well being.

According to Murray (2001), the spiritual dimension tries to be in harmony with the universe by going outside a person’s own power. The spiritual dimension also “strives for answers about the infinite, and especially comes into focus or sustaining power, when the person faces emotional stress, physical illness, or death” (Murray, 2001).

It is the role of nurses as caregivers to provide their patients with holistic nursing, since there are numerous positive effects of spirituality on health, well-being and life satisfaction. Spiritual care provides the patients with a sense of serenity and well-being, even in their agony or sorrow due to illness.

This is important in the recovery process of patients, since studies have indicated higher chances of survival for patients who have a sense of meaning (Jenkins, Wikoff, Amankwaa, & Trent, 2009).

According to Roberts (1925), the spirit of nursing is indestructible, as it comprises qualities such as courage, truthfulness, tolerance, courtesy, generosity, benevolence, compassion and sympathy. She compares the spirit of nursing to the tender care a mother gives to her children. This is the spirit that allows nurses to volunteer in societies such as Red Cross, since such people are brave even in the face of discouragement (Roberts, 1925).

References

Arnold, J. P. (2005). Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology. Cleveland, Ohio: Beerbooks.

Irwin, R. (1997). Environmental Contaminants Encyclopedia Mineral Spirits Entry. Fort Collins, Colorado: Natural Park Services, Water Resources Division.

Jenkins, M. L., Wikoff, K., Amankwaa, L. & Trent, B. (2009). Nursing the spirit. Nursing Management , 40(8), 29-36.

Lichine, A. (1987). Alexis Lichine’s New Encyclopedia of Wines and Spirits. New York: Alfred Knopf.

Mauk, K. L. & Schmidt, N. K. (2004). Spiritual Care In Nursing Practice. Philadelphia: Lippincott.

McCrory, P. (2006). Smelling Salts. British Journal of Sports Medicine , 659-660.

Murray, R. B. & Zentner, J. P. (2001). Health Promotion strategies through the life span. Upper Saddle River, NJ: Prentice Hall.

Roberts, M. M. (1925). The Spirit of Nursing. The American Journal of Nursing , 25(9), 734-739.

Sollier, J. (1912). Supernatural Order. New York: Robert Appleton Company.

Introduction. Concept Statement: Human Being in Nursing Theory

Human beings are regarded as open energy fields, possessing unique experiences. They could be placed in broader contexts and, therefore, they differ from the unity of their parts that are impossible to predict based on knowledge of separate parts.

As holistic beings, humans are represented as sentient, dynamic, and multidimensional entities who are capable of creativity, abstract reasoning, self-responsibility, and aesthetic appreciation. Further, human could also be considered unique individualities due to the peculiarities of language, caring, and empathy patterns that a person employs while interacting in a social environment.

From spiritual and moral viewpoints, humans are defined as valued, respected persons who are understood with the right to making choices concerning their health. All these dimensions of concept analysis are considered in various theories, particularly in Johnson’s Behavior System Model and Science of Unitary Human Being.

Describing the Concept within Two Nursing Theories

Johnson’s Behavior System

Metaparadigms

According to Dorothy Johnson, the founder of the behavior system model, human beings should be evaluated from the perspective of two main systems: the behavior system and the biological one. The task of the medicine consists in resorting to the biological system, whereas the main scope of nursing is confined to focusing on the behavioral system (Theoretical Foundation of Nursing, 2011).

At this point, the concept of human being could be regarded as the behavioral model that seeks to make constant adaptations to maintain, regain, or achieve balance to the state that implies the adjustment process.

Philosophies

According to Johnson’s Behavioral System Model, nursing focuses on promoting efficient behavioral functioning of a patient for the purpose of noticing and preventing illness. At this point, the patient is presented as a behavioral system that consists of seven subsystems, including dependency, affiliative, ingestive, sexual, eliminative, achievement, and aggressive (Theoretical Foundation of Nursing, 2011).

There are three functional requirements that imply protection from harmful influence, motivation for growth, and insurance of a nurturing environment. The failure of any of the described systems can lead to disequilibrium. At this point, the main role of nurses lies in assisting the patients in sustaining the balance.

Additionally, it should be stressed that the theory focuses solely on individual level and, therefore, its basic concept does not cover families, relatives, groups and communities (Theoretical Foundation of Nursing, 2011). The main concept defines how a person’s behavior is represented in terms of psychological development.

Classifying various types of behavior within the proposed seven subsystems allows nurses to work out specific interventions. The quality of case provided by the nurse can be diminished as a result of fractionalized care that does not support a holistic approach to treating an individual.

Conceptual Model

The nursing model is used to measure the patient progress along with the managerial determination of the personnel levels. The importance of the proposed model is applicable to both nurses and their patients and relies on developing new classification systems in which all behavioral components matter for insuring high quality of health care delivery.

There are several underpinnings for applying to Johnson’s Behavioral System Model. First, the theory could be employed in combination with other theories, such as social learning theory (Meleis, 2011). Second, it could also be introduced with regard to various clinical settings, with emphasis placed on bio-psychological, social, and cultural factors (Meleis, 2011). Finally, the model contributes to identifying universal patterns of behavior.

Science of Unitary Human Being

Metaparadigms

Within the theory of unitary human being, an individual is defined as “an irreducible, indivisible, pan-dimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts” (Dossey and Keegan, 2008 p. 534-535). Human being is also identified with the energy field that shapes the core unit of the nonliving and the living.

The field is a holistic concept that underlines the dynamic nature of the energy field. Therefore, the latter is represented as infinite, continuous motion. Additional, the theorist Martha Rogers defines a person as an open system that interacts with the environment and exchange information with it.

Philosophies

Assigning the above-introduced concept to the therapeutic practices, it is purposeful to consider the value of the theory to improving communication. Within this context, Roger’s definition also changes our thinking to consider communication as an exchange of energy fields. Roger’s assumptions seek to entertain the fact that human interaction can be extended beyond spatial and temporal dimensions.

Conceptual Model

The principle of integrality is also embedded into Roger’s holistic model in terms of the nature of communication strategies. At this point, integrality is presented as a continuous environmental and human field process and, therefore, an individual and environment are constantly exchanging their energies. In other words, all behaviors, thoughts, and emotions influence each other, creating social and cultural environment.

There are four concepts introducing Roger’s system: pattern, energy fields, openness, and pan-dimensionality. In addition to these four elements, Rogers introduces the aspects of homeodynamics that focus on “a way of perceiving human beings and their environment in which changes reflect the mutual process of the two” (Bramlett, Gueldner, & Boettcher, 2008, p. 10).

Although, Roger’s model is a relatively abstract system, in which humans are perceived as the sum of energy interacting with the external environment, it still depends on social and cultural backgrounds of these humans, shaping the foundation for nursing professionals.

Applying the Concept to the Nursing Practice

Nursing currently faces challenges of the emergence of new theoretical frameworks, models, and sciences that influence nurses responses to the therapeutic approaches. The modern theoretical frameworks have been classified into different paradigms in terms of philosophical underpinnings. There is a serious controversy about which theory and model is most valid in nursing science (Bramlett et al. 2008).

As soon as the consensus is reached, it is possible to foster progress of theories by relying on the main concept at issue. At this point, science of Unitary Human Beings seems to be the most effective in disclosing the main aspects of nursing practice (Bramlett et al. 2008).

Specifically, the science deviates significantly from the traditionally accepted concepts due to viewing humans as holistic, integral beings whose social, emotional, and cultural dimensions are closely intertwined.

Unlike Johnson’s behavioral system model, which relies primarily on behavioral system of a person, Rogerian principle of treating an individual can be carried out in a broader context. In particular, it is important for a nurse to understand the environment in which a patient interacts and socializes with other people (Bramlett et al. 2008).

Perceiving a person in a continuous dynamics contributes greatly to the analysis of person’s psychological and emotional wellbeing. Therefore, Johnson’s model is too concise and context-independent and, therefore, it prevents nurses from understanding the patient’s background (Bramlett et al. 2008). Besides, relying solely on a patient’s behavior does not allow nurses to understand the nature of those behavioral patterns.

Comparing to One Model and Best Nursing Practices

The model could be applied both in learning psychological nature of patients, as well as in exploring how environmental factors influence human behavior. In this respect, Bramlett et al. (2008) states, “subject in an environment of high frequency sounds would demonstrate greater increases in vividness and creativity of imagery than would subjects in a low-frequency sound environment” (p. 16).

While testing the integrality principle, specific emphasis is placed on the connected between different harmonic environment and passiveness of patients confined to bed.

At this point, understanding restfulness “will be lower…for confined subjects who experience varied harmonic auditory input than for those who experience quiet ambience” (Bramlett et al., 2008, p. 16). Therefore, the Science of Unitary Human Beings can serve as a solid framework for managing information and highlighting the development of new pattern displays.

Conclusion

The emergence of innovative methodologies increases the importance of Rogerian model of perceiving human beings, as well as expand philosophical analysis approving the use of various paradigms. Specifically, the theory allows the theorists and nurses to grasp broader sense of the community and its role in treating individuals.

Additionally, the Science of Unitary Human beings creates a consistent framework for regarding human being as holistic entities. The theory also ensures therapeutic value of the framework in terms of holistic communication patterns worked out specifically to deal with nursing practice.

References

Bramlett, M. H., Gueldner, S. H., & Boettcher, J. H. (2008). Reflections on the Science of Unitary Human Beings in Terms of Kuhn’s Requirement for Explanatory Power. Visions: The Journal of Rogerian Nursing Science, 15(2), 7-22.

Dossey, B. & Keegan, L. (2008). Holistic Nursing: A Handbook for Practice. US: Jones & Bartlett Learning.

Meleis, A. I. (2011). Theoretical Nursing: Development and Progress. US: Lippincott Williams & Wilkins.

Theoretical Foundation of Nursing (2011). Dorothy Johnson. The Behavioral System Model. Web.

Introduction

The reflection on the practicum experience is an essential element when it comes to assessing patients and providing health care services. The application of nursing theories to the process of a patient’s examination and treatment allows for ensuring high quality care. This journal entry defines the theory of Dorothea Orem, determines the achievement of goals set initially, and explains the use of seven domains of practice in the context of personal nursing practice.

Defining the Nursing Theory by Orem

Dorothea Orem’s theory of self-care was used to guide the practice. It was selected due to its focus on enhancing care quality and assisting patients in becoming more self-reliant (Alligood, 2018). At the same time, Smith and Parker (2015) claim that the mentioned theory implies that nursing should provide the link between patients and care professionals, which is expected to promote self-care behaviors in the former. Orem’s theory emphasizes that a socio-cultural context needs to be taken into account while helping patients, which can be regarded as great contribution to practicing multicultural care provision (Smith & Parker, 2015; Younas, 2017). The identified theory was proved to be effective as it allowed for understanding that a patient’s self-care should be promoted by nurses, and its accomplishment means that the goals of care are reached.

Goals, Objectives, and Timeline

All goals and objectives set in the initial journal entry were achieved. In particular, it may be noted that appropriate management and clinical process were established in terms of management of patients’ health status, a professional role of a nurse, and negotiation of healthcare delivery systems. More to the point, proper communication was provided to patients to meet such domains of practice as nursing-practitioner-patient relationship and ensuring health care quality. As stated by Ambrose, Lin, and Chun (2013), cultural competence is a significant skill that prepares nurse practitioners to meet the needs of patients with diverse backgrounds. It should be stressed that precise attention to patients’ cultural background was based on implementing the domains of cultural competence as well as a teaching-coaching function. The latter was perfectly aligned with Orem’s concept of self-care necessity. Thus, all seven domains were considered while developing and achieving personal practice goals and objectives.

While examining patients and considering their health concerns, evidence-based solutions were applied. Based on the recent literature, only relevant ideas and concepts were introduced to practice. With the aim of supporting nursing knowledge, valuable concepts of Orem’s self-care theory were regarded as the main theoretical underpinnings. This theory was beneficial to understand that self-care helps patients in their daily activities to maintain health and the overall well-being. The patients’ motivation to obtain knowledge and skills necessary for self-care seem to be increased with the use of Orem’s theory. Speaking of the timeframe, it is important to state that it was met. All the activities offered by the course were completed on time.

Conclusion

In conclusion, Dorothea Orem’s theory was utilized as the basis for nursing practice. Its key implications guided through the course and allowed for focusing on communication with patients, provision of high-quality services, and paying attention to their cultural peculiarities. In other words, Orem’s theory was considered as the focal underpinning of the practice, which was supplemented with the implementation of seven domains related to nursing competence. Thus, all the goals, objectives, and learning activities were accomplished in a timely manner.

References

Alligood, M. R. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier Health Sciences.

Ambrose, A. J. H., Lin, S. Y., & Chun, M. B. (2013). Cultural competency training requirements in graduate medical education. Journal of Graduate Medical Education, 5(2), 227-231. Web.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: FA Davis.

Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23. Web.

Introduction

Nursing theories provide useful information concerning the definitions of nursing and the practice itself, principles that form the foundation for nursing, and also the goals and functions of nursing. Theories can be constructed to make a conceptual model which assists nurses in the assessment, planning, and implementation of patient care by providing a framework for which the nurses work in.

It is this framework that provides uniformity in the nursing profession. It does this by systemizing the nurses’ actions by guiding them on what to ask, observe, focus, and so on. These theories also provide an outline for the development of new information concerning the profession and the validation of the current information.

Theories in the nursing profession help to:

• Describe existing elements in a discipline
• Explain the relationship between two properties or components and the functioning of the profession
• Predict how components of a phenomenon related to each other
• Describe the nursing therapeutics and the result of interventions

Nursing theories are in four levels. These are:-

• The metatheory which is very abstract and difficult to test
• The grand theory consists of a conceptual framework that defines the practice
• Middle range theory is a moderate abstract with limited variables
• The practice theory outlines the nursing practice.

Theories come in four types. These are needs, interaction, outcome, and humanistic.

Various major nursing theorists have come up with theories to streamline the nursing profession. The first theorist who defined the role of nurses was Florence Nightingale who developed her theory during the Crimean War period.

In 1959 Ray MA developed the theory of bureaucratic caring for the nursing practice. Her theory intends to explain caring decisions in terms of politics, economy, technology, and law. It also explains caring in terms of ethics and spirituality. This theory will focus more broadly on the management and caring views. The application of this theory will lead to a transformation of the health care organization.

Watson J and Ray M.A say that

Caring science encompasses a humanitarian, human science orientation to the human caring process, phenomena, and experiences.

Tranpessmal caring acknowledges the unity of life and connections that move in centric circles of caring from individuals to others.

Nurses need to provide quality health care within a framework of human caring with the economic resources available. Ray M.A (1995) says that the right model used should be comprised of ‘bottom line’ solutions and human caring solutions. Looking for only one particular solution is bound to affect the health of the caregivers and the clients. It can also affect the well-being of health care organizations.

In the event of an illness especially a major one, people tend to turn to spirituality for healing and to ease their pain. At this time spirituality plays a very major role in the provision of inner strength to help the sufferer to bear with the discomfort they are experiencing.

It is through spirituality that patients can acquire a new attitude towards life and health. This attitude helps them to appreciate life through love and faith. It is mostly through suffering that one develops a desire for spirituality.

Ray (1994) recommends the use of love in caring for a patient. The incorporation of love in the giving of care creates a suitable environment for the physical and emotional healing of an ill person. This inclusion of spirituality in health care can transform nursing care and provide a way of producing optimal patient outcomes. A nurse caring for a patient provides her touch and presence. This creates a spiritual connection between two people. Spiritualism is required in the nursing practice for directing and fulfillment. It entails hope, trust, knowledge, and comparison. Nurturing and the intimacy included in caring express the values of spirituality. Nurses must constantly use love and kindness in the delivery of their services.

Ethics in the provision of care focuses on the ability of the nurse to make important ethical decisions. According to Ray, ‘reasoned moral choices’ enable us to choose how, when, where, what, and who we care for. Caregivers must employ a code of ethics in their profession.

This can be achieved by employing loving relationships. Love gives reason to care. This love should be unusual and non-judgmental. To embrace this love is to embrace the belief in a higher power.

This code of ethics should include moral judgments on how the caregiver ought to treat the patients.

Nurses enface many ethical dilemmas in their practice and often need the advice to make good decisions that involve patient care.

There is a delicate relationship that exists between nursing and ethics. This means that the quality of nursing where ethics are not applied is usually substantial.

Ethics in caring involve applying principles theories and ethical practice issues. It also involves moral reasoning. A nurse should be able to think and make decisions independently and understand why a particular stance was chosen. They need to keep in mind that the life of the patient is in their hands and consequently the decision they make is very important to the health of the patient.

Dr. Madiline Leininger’s transcultural nursing theory

This theory is based on humanistic discipline and defines caring within the context of culture. Dr. Leininger argues that competent care in the cultural aspect can only be achieved when cultural care values are understood. To augment the provision of quality health care, transcultural nurses are encouraged to be conversant with two or more cultures. Knowledge of various cultures will involve learning the beliefs of values and practices of a particular culture.

Leininger holds that since the quality of life is culturally constituted and patterned a transcultural nursing perspective should be adapted to aid the advancement of the practice and profession.

She discovered that culturally based care factors influenced the human expressions related to health, illness or wellbeing, death, and disability.

According to Leininger, Transcultural nursing goes beyond local regional, and national views to that of worldwide nursing on the global view of nursing.

The need for transcultural nursing theory and practice in all areas of health care became more evident with the changing demographics of countries worldwide.

The development of Dr. Leininger’s theory has led to the discovery of similarities and differences in clients from different cultures. This theory helps nurses to accommodate, maintain or repattern the cultural views and practices of the patient. This leads to the provision of high-quality health care that embraces diverse cultures. Misdiagnoses, poor treatment, staff frustration, and harmful care are some of the issues that arise from ignorance about the patient’s culture.

Leininger has presented the sunrise model with different dimensions of her transcultural theory. It depicts different dimensions of the theory which are closely related. Among the dimensions depicted in this model are political and legal factors, economic factors, and technological factors. Leininger states that these dimensions influence the care patterns and practices which are responsible for the holistic well being.

References

Ray MA. The theory of bureaucratic caring for nursing practice in the organizational culture. Nursing admin quarterly 1989 Volume 13 (2):31-42.

Watson J and Ray MA (1988) The Ethics of care and the Ethics of cure. New dimensions of human caring theory Nursing Science Quarterly.

Ray MA The Edge of chaos: Caring and the Bottom line Nursing Management 1995 Volume 26(9); 48-55.

Raholm MB (2007) Wearing the fabric of spirituality as experienced by patients who have undergone a coronary Bypass surgery. Journal of holistic nursing Volume 20(1) 31-47.

The nursing theory that I utilized during my practice experience was the Theory of Culture Care Diversity and Universality. Introduced by Leininger, this approach was developed for nurses who work in a diverse environment (McFarland & Wehbe-Alamah, 2017). The Culture Care Theory focuses on the uniqueness of each human being and the importance of culture in people’s lives. For example, it recognizes that patients’ mental well-being is detrimental to their physical health, and the nurses’ duty is to address both aspects with care and attention. Nurses should practice culture care, basing their decisions not only on their medical knowledge but also on individuals needs of each patient. Each person has the right to have religious, ethical, and health-related beliefs and they must be respected by others.

Nurses participate both in curing and caring as one process cannot be effective without another. As I worked with many older patients from different backgrounds, I was challenged with their varying levels of knowledge and understanding of medical procedures (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). I also encountered many views on healthcare in general, and my goals were to address each situation with the patient’s opinion in mind. The Culture Care Theory influenced the goals that I formulated for my practice. I aimed to achieve seven objectives, each of them aligned with the seven domains of practice. Thus, I implemented specialized clinical knowledge, guided patients in their recovery, consulted and collaborated with other professionals, used EBP information, employed my leadership skills, and developed ethical solutions for arising issues. As can be seen, these activities are congruent with the seven practice domains and are centered around holistic and collaborative care (Reimanis, 2015). In the end, I believe that I was able to accomplish all objectives and meet the timeline that I have set for myself.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

McFarland, M. R., & Wehbe-Alamah, H. B. (2017). Theory of Culture Care Diversity and Universality. In M. R. Alligood (Ed.), Nursing theorists and their work, (pp. 339-358). Burlington, MA: Jones & Bartlett Learning.

Reimanis, C. L. (2015). The advance practice exam: Understanding the 7 domains of advanced practice nursing. Journal of Wound, Ostomy, and Continence Nursing, 42(3), 287-289.