In fact, the nursing theory for a nurse is the exact cornerstone of education as for a doctor – a complex of morphological disciplines. Nevertheless, Martha Rogers is the person that laid down and expanded the critical components’ understanding of this theory. Due to her talents, abilities, and efforts, a modern specialist sees science and art in nursing, comprehensively covering a patient’s body, mind, and spiritual sphere. In addition, this sphere supports mental and physical health through training and focuses on maintaining health and helping patients. Rogers’ concept is also aimed at the individual in man following natural phenomena and processes, as well as human development.
Exactly, health and condition are one of the most significant values that a person has. However, due to certain external conditions and circumstances, people may forget to consider such moments. Everyone is equal in their rights and privileges, and it is entirely incorrect to determine the working conditions of nurses and opportunities for patients due to regional or other conditions. Following this, both the government of the state and regional hospital managers should take significant measures to minimize and eliminate such troubles.
Undoubtedly, the work and contribution to the development of nursing by Jean Watson are challenging to underestimate and overestimate. The concepts of the “science of care” developed by this theorist are mainly based on those aspects of nursing that go beyond the usual knowledge and ideas. For example, both philosophical and ethical elements are touched upon here as the foundations of the “cosmic infinite field of universal love” (Turkel et al., 2018). According to the expert, it is love and kindness that are the starting points for creating an energy source of all healing and the realization of care at the highest level.
Moreover, nursing is a significant business, and the work of a professional nurse is extremely valuable. Especially if this specialist thinks broadly and deeply, sees the hidden essence of phenomena, and can analyze from the point of view of global scales and levels. Moreover, there are no borders and intercontinental frameworks in this profession. Especially when a person’s health and life are at stake, as the most important human elements, specific internal and external criteria and indicators do not matter.
One of the most valuable lessons I’ve learned in this nursing theory course is that healthcare professionals can actively develop evidence-based practices wherever they work. According to Hoeck and Delmar (2017), nurses can begin this process by collecting or recording information about their work and using the data to navigate different situations in their work settings. This approach can help nurses save significant amounts of time spent trying to control tiny or mundane variables. Nurses can then complement universal theories and information in nursing with their in-house data to make the best resolutions and conclusions in any given situation within their practice. This strategy is vital in nursing practice because universal theories in nursing cannot be applied comprehensively across the board since nurses do not have control over every factor around them.
Developing evidence-based practices in nursing practice can require a lot of information gathering. In this nursing theory course, I have learned that this process is a constant cycle of gathering and analyzing evidence, synthesizing it into practice recommendations, disseminating the information to other healthcare practitioners, and evaluating its impact on nursing practice. According to Hoeck and Delmar (2017), since evidence-based practice is a resource-intensive activity that takes time and resources to create, implement and evaluate, nurses must find ways to make this process as efficient as possible. Additionally, the scholars state that it is essential that nurses identify and use an appropriate information system to gather the data needed to develop evidence-based practices. In this case, nurses need a tool to facilitate the rapid retrieval of recorded information and new data collection. In the end, I reckon that the purpose of collecting all this information to develop relevant evidence-based practices is to improve patients’ health and well-being, which makes the time spent in research worth every minute.
References
Hoeck, B., & Delmar, C. (2017). Theoretical development in the context of nursing-the hidden epistemology of nursing theory. Nursing Philosophy, 19(1).
It is important to note that nursing theories were essential in shaping modern nursing practices and the delivery of health care. The given critique will primarily focus on Florence Nightingale and Dorothea Orem with their corresponding conceptual frameworks of the environment theory and self-care theory, respectively. Florence Nightingale’s environment theory is among the most influential theoretical notions about the provision of necessary conditions for patient recovery. The five major elements of the conceptual framework include access to light, sanitation, fresh air, cleanliness, and water (Alligood, 2017). The critique of Nightingale can be targeted at the failure to include diet or food as a core aspect of basic patient necessities.
Although she addressed diet in her chapters and writings, her emphasis was not on what is healthy but on what the patient prefers. She wrote that “the patient’s stomach can assimilate or derive nourishment from, and of this, the patient’s stomach is the sole judge. Chemistry cannot tell this. The patient’s stomach must be its chemist” (Oerther & Oerther, 2020, p. 141). Considering the abundance of unhealthy processed foods responsible for many modern metabolic diseases, among other factors, the personal food preference of an individual uneducated in nutrition might not be the best option.
In addition, Dorothea Orem’s self-care theory focuses on enabling a patient’s self-care agency and demand. The core emphasis is put on the ability to faster recovery if a person is given self-care independence (Younas, 2017). The theorist can be critiqued for the poor applicability of the concept in the most deficient situations. Patients are unable to have an agency over their care in cases where they need an enhanced recovery the most.
References
Alligood, M. R. (2017). Nursing theorists and their work – E-book (9th ed.). Elsevier.
Nursing practice can be based on empirical evidence from the past or nursing theories describing an integrated approach to nursing. For this critique, an article by Yip has been selected in which an advanced nurse used practice based on Orem’s general self-care deficit patient care theory (SCDNT) (2021). The author explains the choice of this theory by the fact that previously only certain aspects of this theory were studied, but not its complex application. This fact can be singled out as a research problem.
The study aimed to find out the global understanding of the philosophy of this theory and how the theory is applied to patient management in practice. The literature review of this article confirms the positive impact of selected aspects of SCDNT on patients with migraines and multiple sclerosis (Yip, 2021). In addition, these experiments create a theoretical foundation for this study to obtain practical recommendations based on positive dynamics. Using the example of an asthma patient and a nurse using SCDNT, questions are raised about using the strengths of this theory, monitoring patient compliance with all prescriptions, and presenting the patient as a representative of the wider family and society.
The nursing framework is reflected in the nurse’s many years of experience dealing with similar conditions. The variables were taken as indicators of the four primary operations of this approach: diagnosis, prescription, treatment, or regulation, and case management (Yip, 2021). In addition, the patient had to monitor his health indicators with particular devices, such as a peak flow meter, and administer the dosing of the inhaler.
The account also includes the social aspects of the case, for example, the patient’s dependence on his own family, which is not described in detail in Orem’s original theory (Yip, 2021). Consequently, the relevance and validity of this study are supported by a review of the literature, which has proven the usefulness of this approach in the management of patients with chronic lifestyle-related diseases. Efficiency is achieved by an integrated approach, partly expanding this theory. The nurse showed more responsibility, was able to find an approach to the patient that began to look after herself better – the issue was resolved.
The legal and ethical issue of this study is not addressed directly in the article. The involvement of the patient’s wife paid off. Preliminary and subsequent negotiations made it possible to arrange the use of the patient’s wife’s time and energy in advance. As representatives of the same family, their mutual concern is not discussing rights and obligations since this is their own business, and they are not strangers to each other. The nurse’s competence can be noted in the fact that she found the necessary lever of pressure on the patient through his social dependence, which is fully justified by the results of treatment. The cultural aspect of the study also lies in the complex consideration of each case from the point of view of the sociology and psychology of the patient.
The sample patient with asthma was initially unable to answer the essential questions of self-esteem and recognition of the disease. Nurse procedures aimed to transfer relevant knowledge and skills of health control to the patient, while dialogues developed the patient’s own management decisions (Yip, 2021). Finally, the involvement of a wife allowed for the creation of a coordinated care system. The results showed that the patient successfully applied the acquired skills and improved his health indicators.
For nursing practice, these research results bear a confirming nature of the positive influence of this theory. In addition, this case reveals one of the needs of patients, which is not spelled out in the original text of Orem. Given the growing concern about the increase in chronic disease, this kind of humanistic, holistic care will implications for future practice. Such research allows students to take a fresh look at practice, allowing them to consider the social aspects that improve the positive results of the theory.
Reference
Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing, 7. Web.
At least once in life, every person experiences existential vulnerability caused by the loss of meaning or a life-threatening event. In this regard, the self-transcendence framework is one of the most effective approaches to dealing with such conditions. It is especially of great importance for medical workers, including nursing practitioners, who may encounter people who experience vulnerability every day. As such, under the paradigm of holistic healthcare, medical personnel should strive to ensure the physical well-being and provide psychological comfort. For this reason, the current essay intends to review the self-transcendence theory and show how it may be applied in advanced nursing practice by describing and analyzing a hypothetical patient vulnerability situation.
Theory Review
The idea of self-transcendence as a structured theoretical view first appeared in the middle of the 20th century. Victor Frankl – the first major thinker in this sphere – argued that true happiness might be achieved when a person’s locus of attention is directed outside of oneself towards the outside world (Worth & Smith, 2021). The latter, in this case, may include other people or the surrounding environment. In order to achieve that, Frankl asserts that an individual should construct a meaning that would transcend oneself.
As for the realm of healthcare, the most prominent framework was proposed by Reed, who postulates that human development occurs as a result of experiences that make a person reevaluate one’s life. The author notes that as individuals become older, they enhance their emotional and psychological maturity, which helps them to develop a broader view of the world and, consequently, achieve self-transcendence (McCarthy et al., 2017). However, some events earlier in life that make people aware of their vulnerability and mortality may sometimes lead to an increased self-transcendence earlier in life (Fiske, 2019). The latter, in turn, is associated with the construction of meaningful systems that help cope with difficulties and problems and achieve greater well-being.
Vulnerable Situation and Self-Transcendence Promotion Plan
Liza, a 47-year-old single woman, has recently been diagnosed with inoperable breast cancer. This news has led to deep depression, eventually resulting in heart problems due to constant stress. As a result, one day ago, Liza was brought to the emergency room after she fainted on the street. She was diagnosed with the 2nd-degree AV block and later transferred to a non-intensive care unit as her children could not be with her at home. However, today after arriving at work, I found that Liza refuses the treatment because she does not see its purpose, as she will be dead soon.
In order to address this problem, a self-transcendence promotion plan was developed. Firstly, I will discuss with Liza and explain the importance of overcoming depression and intending to find a new meaning in life. Regardless of the patient’s reaction, she will be offered to use certain techniques to promote intrapersonal and temporal transcendence techniques. Then, when Liza becomes more accepting of her disease, she will be suggested to share her problems with other sick people and listen to their stories.
As for promoting intrapersonal awareness, Liza will be asked to contemplate her experience through techniques such as prayer, meditation, and journaling. Additionally, the patient will be instructed to analyze how her past experiences meaningfully related to the current disease and what she expects in the future to promote temporal self-transcendence (Reed, 2021). For a similar purpose, it is planned to conduct a one-on-one interview with the patient, where she can share the key events in her life, biggest challenges, and beliefs (Reischer et al., 2021). Finally, Liza will be suggested to join one of the breast cancer support groups to promote interpersonal self-transcendence.
Conclusion
Overall, the current essay reviewed the self-transcendence theory and showed its importance in the work of healthcare professionals, including advanced practice nurses. In this regard, it was shown that successfully finding meaning in the outside world is highly related to a person’s levels of happiness. Moreover, self-transcendence allows people who encounter life-threatening difficulties to overcome them by constructing new meanings effectively. In addition, the hypothetical case of Liza, who was diagnosed with breast cancer, was discussed. To address her depression and refusal of treatment, such techniques as journaling, prayer, meditation, personal interview, and group therapy were proposed.
Nursing is a scholarly discipline that is founded on theory and the skill of caring. However, the theory-practice divide has become the profession’s most difficult obstacle, lowering the quality of the service in both education and clinical practice (Irajpour et al., 2018). The theory-practice gap develops when practitioners fail to combine subject knowledge with clinical setting practice. As medical standards of care improve, there may appear to be a gap between what is recognized as recommended practice and practical reality (Irajpour et al., 2018). In general, the gaps between theory and application of scientific activity can be bridged by conducting action compatible with the procedural rules inherent in the conceptual framework driving the activity on the issue.
In the assigned case study, the issue of the theory-practice gap is present. Namely, the nurse in the situation under discussion was instilling saline into the endotracheal tube of the patient after an operation related to coronary artery bypass. It can be assumed that she had done this activity to loosen the secretions. As a matter of fact, during suctioning, nurses encounter thick, sticky discharge. There are numerous methods for diluting this discharge, one of which is to instill normal saline into the airway (Chai et al., 2022). However, research suggests that the use of various tracheal suctioning solutions correlates with the prevalence of pneumonia in ventilator patients (Chai et al., 2022). Although normal saline is commonly used in tracheostomy, multiple studies have revealed conflicting results on whether or not to utilize it. One study found that using normal saline before suction did not produce significant hemodynamic changes. Nevertheless, it increased the quantity of ventilator-associated pneumonia (Chai et al., 2022). Therefore, the nurse has used a widely-applied medical method, relying on her experience, although academic knowledge disputes it.
As a result of the theory-practice gap, graduated and even experienced nurses would undergo transition shock. It leads them to decide that their training was useless and that sticking to established routines is preferable (Irajpour et al., 2018). The experienced discrepancy causes nurses’ incapacity and lowers the nursing care they provide. A lack of rules, nurses’ emphasis on conventional hospital care, and routine-based behavior would prevent nursing students from using their theoretical concepts in the emergency room. Thus, one fundamental difficulty encountered is the routine-oriented approach to giving nursing care, which should be substituted with judgments based on their academic knowledge and abilities.
In the particular case study mentioned earlier, the theory-practice gap demonstrated by the nurse has several implications for nursing practice and patient care. First of all, the confidence of the nurse concerning her clinical activity might influence the practice of newly-admitted practitioners. Namely, the nurse might try to guide others in the process of diluting the discharge during suctioning with saline instilling. Although the new health care providers might be aware of the hazardous effect of such a practice, the claimed expertise of the nurse might reassure them. Hence, a system of inappropriate nursing practices would be exchanged in the facility, further affecting the clinical expertise. As for patient care, it could be observed that the customer experience discomfort because of the procedure, which reduces the positivity of the patient experience. Moreover, the practice is useless and might cause morbidity in the nearest future. Thus, the patient is at risk of ineffective care, which leads to readmissions.
The positive patient outcomes in this scenario could be created through the interaction of theory, research, and practice. To transcend the gap between theory and practice, it appears that a strong desire to change and active engagement from professors and clinical nurses is required. According to the findings of a study, developing an appropriate atmosphere for nurses and nursing instructors encourages mutual learning (Shoghi et al., 2019). Moreover, using a common shared practical language as a way of clinical guidelines may assist in closing this gap (Shoghi et al., 2019). Furthermore, critical thinking is essential to use as expertise and experience to recognize patients’ needs and to guide clinical judgments and activities that result in favorable patient outcomes. In turn, clinical decision-making balances the established best practice, awareness of the present situation and surroundings, and patient understanding (Ludin, 2018). Thus, the practice is guided by the theory and medical research while evaluated through the lens of clinical decision-making.
Finally, a plan for closing the gap in the pertinent situation could be made in accordance with the mentioned approaches. First of all, the clinic should invest in fostering an inquisitive attitude in nurses. For example, the facility might begin to use the PICOT framework to ask clinical questions. As for the particular nurse, it is necessary to find the best evidence by reading abstracts or entire publications to establish the quality of evidence about the effect of saline for suctioning. Examining the evidence critically and combining evidence with clinical competence as well as patient preferences and values would be an essential step. Based on the evidence, one should evaluate the effects of practice decisions or modifications. Finally, it is necessary to communicate the findings about saline instillation to the nurse that was using this method, as well as to inform their colleagues. Thus, the application of inappropriate methods would be reduced, closing the gap between theory and practice and improving quality care.
Nursing theory is a branch of knowledge about nursing activities based on algorithms of nursing activities. Theoretical aspects of nursing consider the health care system and the role of the nurse in it, the concept of public health and criteria for its assessment; demographics, communication, training, legal standards of nursing activities. The nursing philosophy is guided by the principles of mercy, respect for human rights, life and dignity. The proper formation of the nurse-patient relationship is based on the principles of the nursing philosophy. In the research, I would like to study the ways of changing the quality and wellbeing of new alumni enrolled attendants’ training. The theory that thoroughly studies the strategies of developing attendant’s training was offered by doctor Patricia Bennet. It is devoted to describing a model of skill acquisition in nursing. The theory, presented in Patricia Bennett’s best-known book, presents the different competencies as well as the challenges faced by nurses who have recently graduated. The theory also covers the differences between regular nurses and those who work in some specialty.
Dr. Bennett argues that with the right resources, it is possible to move to the next level of practice. So she has studied these methods and made them visible to the world, so that anyone who wants to work or work in nursing can apply them and become a professional. In her theory, Bennett identified modalities of experience. A beginner is a person with knowledge but no previous experience encountering situations.
An advanced beginner is someone who has gained minimal experience in practice and can face real situations in an acceptable manner. A competent professional, through experience gained and imitated by others, is able to consciously plan how he will encounter various situations and apply them in practice. He is also able to prioritize, recognizing which situations are more urgent than others. An effective person is able to understand situations intuitively, even though he knows little about them. He is a confident professional and relates to patients and their families.
The expert is in complete control of the situations he encounters, being able to identify the problem and find a solution effectively without wasting time searching for alternatives (Butts & Rich, 2021). As part of her theory, Patricia Bennett also identified areas that every nurse should know perfectly and have in mind for her professional development in nursing. She suggested: diagnosing the patient, conducting and monitoring interventions, maintaining continuity and safety as a health care practice. In addition on her list, the doctor included: teaching and training function, effective contingency management, the role of patient care, competency-based organization, and nursing contributions.
Patricia Benner’s theory has undergone a change in the organization of nursing work competencies. This change continues to this day because nurses are classified according to the grades she explained and assigned to their jobs according to their experience and acquisition of skills and competencies. Thus, the experience they gain will change the perception, and that perception will be more experiential, which is always more reliable than the abstract knowledge that a newly educated novice might have. The model presented in Patricia Benner’s theory provided the impetus for the creation of clinical advancement pathways, orientation programs for newly graduated nurses, and workshops in which to develop clinical knowledge. Hence, the model presented in the theory will become a good theoretical basis of discovering the ways of changing the quality and wellbeing in the new alumni enrolled attendants’ training.
References
Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.
This course focuses on the beginners of nursing care of customers to encourage healthy transition for persons showing occurrences of chronic illness in a well-defined practice setting. It offers an overview of human needs, how to use nursing as a systematic method to address those requirements and nurse’s responsibility in aiding persons in achieving optimal health outcomes. Basic time management ideas are emphasized, and the continuous ability to think critically, clinical judgment, and skills (Kitson, 2018). This course allows nursing students to get the skills they have to meet customers’ demands throughout their lives.
The students in this course will learn the conceptions and theories primary to the art and science in nursing. On the other hand, the students will get an orientation to the perceptions of customers’ requirements, security, communications teaching or learning, critical thinking, ethical-legal, cultural diversity, nursing history, and the program’s philosophy of nursing (Feo et al., 2018). Nurse to patient relationship will also be emphasized to enable the learners to enhance their communication skills and care giving capabilities.
In this course, students will learn about infection control, safety, and necessary measures to keep clients safe from harm. This course also covers the psychomotor nursing knowledge. The program includes skills for ensuring microbiological, physical, and mental safety and skills for treatment modalities. It offers an orientation to the healthcare industry, in terms of teamwork and delivery systems as well. The participants will learn about the function of healthcare practitioners and the variety of healthcare organizations, and the degree of treatment they give.
Gap Analysis
Current state
Desired state
Identified gap
Cause of the gap
Methods used to identify
Students are not able to properly implement all the knowledge they acquire in practice.
Students are well-taught to implement their theoretical education in practice.
The gap is defined by the difference between students not being able to implement theoretical knowledge in practice in the current state. Though, they should be able to do so in the desired state.
The lack of practice-based processes and practice professionals engaged in evaluations in education is the reason for the existing gap.
Literature review of articles mentioning the gap. (Shoghi et al., 2019)
Duration and Contents
The course “Fundamental Principles of Nursing Care Theory” takes one entire semester, with an admission requirement of three credits. This course focuses on the beginners of nursing care of customers to encourage healthy transition for patients with chronic illness in the well-defined practice setting. The course is typically taught in nursing colleges or universities for an undergraduate diploma in nursing. The theory instructions methods are conducted through:
Lectures and discussions
Through demos
Video or giving hand-outs or in the form of YouTube assignments.
On the other hand, examinations and assignments are evaluated in the following manner, where student class attendance is treated as part of an exam:
Quiz or Unit exam constitutes 20%
Student attendance is 10% (whether online or on-campus)
Class assignments 10%
Midterm exam 25%
Main examination 35%
Before sitting the unit exam, all assignments must be completed (with NO EXEMPTIONS whatsoever). Absentee on the exam day without a previous professor or management’s consent will result in a ZERO. A Skills Lab is included in this program.
THE GRADING POLICY FOR GENERAL EDUCATION AND THE SCIENCES is as follows, with a pass mark for the course set at 75%. The nursing courses typically need a minimum of 78% for a pass, while the LAB and Clinical are generally graded as P for a Pass and F for a Fail.
The students are required to attain a minimum of 78% in the nursing core class in their final examinations, irrespective of the quizzes to be considered to have passed in their studies. Any other grading that is below 78% in the core courses is, on the other hand, thought failures where they will be prevented from proceeding to the next level. This will instil hard work, commitment, and responsibility to the student to manage their time well.
Repeating of Courses
A student who receives a “D” or “F” in a subject may repeat it at the School of Nursing. A student who drops out of a class will be able to retake the course up to two times. Credit will be awarded for the previous effort, even though it will be noted that the grade was a repetition, which will be shown by an “R” next to the final grade. A student will be required to withdraw from the school after the second chance of repetition or third attempt. They can then be allowed to choose to resubmit to other short program after a full academic year (Wiggins & McTighe, 2005). A student in the Associate of Science in Nursing Program, for instance, who failed a class on their third try can reapply to the Practical Nursing Program. I suppose a student in the Practical Nursing Program failed a particular course on their third trial, they may reapply to the Nursing Assistant Program. They may apply to get back to their former program, supposing they are successful in a particular program.
Ideas
The three big ideas:
Learning objective 1: Knowledge – At the entry-level of training, students must apply their understanding derived from professional nursing to the provision of evidence-based nursing care.
Learning objective 2: Technological Aptitude – At the enrolment level of expertise, students will be able to use technologies to access information needed for discovering patterns, helping to promote quality enhancements, preserving safeness that can provide patient care, and work collaboratively with inter-professional team members, while continuing to progress their nursing careers.
Learning objective 3: Lifelong learning – Through engaging in scientific inquiry, research, and new knowledge development, students will continue to progress their education to offer high-quality care.
For each of the above three students learning objectives, they should be able to comprehend the following from the “three big ideas”:
Learning objective 1: The students will have explored and understood the importance of evidence-based practice in providing good nursing care.
Learning objective 2: Demonstrate familiarity with computer programs used in client evaluation, care, and documenting. Demonstrate understanding of the criteria required for safe and effective documentation that complies with legal and ethical obligations.
Learning objective 3: Determine the varied functions of nurses in diverse health environments and the responsibilities of other healthcare professions. Address the necessary nursing concepts, professional attitudes, personal attributes, and professional behaviours for exemplary interpersonal inter-relationships involving caregivers, patients, households, and co-workers.
The main objectives essential questions:
Learning objective 1 – What knowledge will you have acquired by the end of the nursing course?
Learning objective 2- Having been an expert in technological nursing, how best do you maintain patients’ confidential information?
Learning objective 3 –After the current course, you are undertaking, what will be your next class in nursing to maintain lifelong learning?
The skills and knowledge acquired from each objective:
Learning objective 1:
Knowledge: The knowledge of the fundamental principles of nursing care theory.
Skills: The ability to implement knowledge in the evidence-based nursing care.
Learning objective 2:
Knowledge: Technology is a critical factor in the nursing industry.
Skills: Critical thinking in the nursing career.
Learning objective 3:
Knowledge: Professional nursing necessitates continuous learning to keep the nurse updated on the global changes in the industry.
Skills: Problem solving abilities in the career.
References
Wiggins, G. & McTighe, J. (2005). Understanding by Design. ASCD.
Shoghi, M., Sajadi, M., Oskuie, F., Dehnad, A., & Borimnejad, L. (2019). Strategies for bridging the theory-practice gap from the perspective of nursing experts. Heliyon, 5(9), e02503.
Feo, R., Kitson, A., & Conroy, T. (2018). How fundamental aspects of nursing care are defined in the literature: A scoping review. Journal of Clinical Nursing, 27(11-12), 2189-2229.
The modeling and role-modeling (MRM) theory provides a broad theoretical perspective on nursing care and suggests that nurses should employ individual approaches to patients by recognizing their needs and addressing those needs effectively (“Modeling and role-modeling theory,” 2015). Also, the theory addresses the concepts of leadership and suggests that successful nurse leaders should build trust in their followers and comply with a number of principles that promote the professional development of the followers.
A unit supervisor in Facility A has been chosen to address the issues of leadership, modeling, and role-modeling. To analyze her leadership characteristics, it is necessary to describe the facility, assess strong and deficient leadership features, examine the change she has brought to the facility, explore the ways in which she contributes to the professional development of her followers, and evaluate her from the perspective of MRM concepts and applications.
Clinical Setting and Role of the Nurse Leader
Setting Description
The clinical setting that will be addressed is Facility A, an in-patient and transitional facility that provides health care services to people with mental illness. The facility’s location is characterized by favorable climatic conditions. The hospital is divided into seven units for different patients; normally, approximately one hundred people can be accepted, and services are provided round-the-clock. A major division of patients is into two groups: those incapable of functioning in the society safely due to their mental health problems and those who were prosecuted but claimed not guilty due to mental illness; the care that the latter group receives qualifies as preparation for competency.
Health care services are designed as an individual treatment aimed at attaining and maintaining mental stability in patients and developing skills in them that are necessary to function properly in a group home setting. The medical components are present in most treatment cases; however, interactions with patients are recognized as the most important part of care delivery, and some types of interactions are part of nursing work. Additional services include assistance with activities of daily living (ADL), lab coordination, and medication administration.
The working hours are divided into three shifts: early, late, and overnight. The number and qualifications of employees present in the workplace during different shifts are different. During the early shift, there are the hospital administrator, the nursing administrator, a medical provider, a psychiatric provider, the unit supervisor, a pharmacist, a social worker, a psychologist, dental clinic staff, a phlebotomist, RN/LPN,HST/CNA, the maintenance crew, a nutritionist, house-keeping staff, rehab staff, and security officers.
During the late shift, units in the facility are overseen by the administrative officer of the day (AOD); one RN acts as the charge nurse in each unit, and RN/LPN provides nursing care such as medication delivery and communicating with patients concerning their needs and treatment plans. CAN/HST meets with patients, too, to assist in the latter’s ADL and to promote engagement in group activities.
The nutritionist serves dinner and snacks to units, and there is a front desk secretary who receives phone calls and communicates with visitors. During the overnight shifts, each unit only has three employees headed by the AOD; two security officers and the front desk secretary are present in their workplaces, too. Out of the three employees in each unit, two are LPN, and one is HST. The staffing plan may display variations in case there is a need for special observation; these situations mostly occur in the intensive care area. During the late and overnight shifts, no physicians are present in the hospital; however, on-call doctors and pharmacists are available.
The experience of working in the facility has demonstrated that proper leadership practices are crucial for the success of providing high-quality nursing care. Nurses work in teams and cooperate with other members of the staff, which is why it is necessary that their work is appropriately coordinated by someone who can accept the responsibility for the team and assume leading functions.
However, it is also important that, apart from officially holding an administrative position and performing supervisory functions listed in their job description, leaders display characteristics that allow other members of the nursing team to follow him or her, respect his or her decisions, trust the leader, and be willing to collaborate in the context of leadership. In other words, besides complying with the duties of a supervisor, a leader should also display certain informal influence on followers and gain their willingness to follow. Good leaders facilitate the development of their followers and nurture them. For me, such a leader is my unit supervisor Angela. Her position in the hospital is both a formal and informal leadership position.
Role and Responsibilities of the Nurse Leader
Angela reports to the hospital administrator, and her role generally is to oversee the work of nurses in her unit, compose teams, and provide proper staffing. Angela’s duties and responsibilities primarily include ensuring that the nurses are well-familiarized with all current nursing policies and procedures and ensuring that there is a sufficient number of nurses who are properly trained according to the annual schedule and whose contribution to the overall quality of care in the hospital is adequate.
Also, she cooperates with other leaders, including managers, physicians, and administrators, in order to improve the facility’s overall decision-making. Monitoring and evaluating the nurses’ work, including the provision of feedback to nurses and the composition of reports for the administration on the quality of care and patient satisfaction, are among Angela’s responsibilities, too. Further, she is responsible for improving the workflow of nursing care, for which purpose she may engage in collaboration with other departments, such as the laboratory or the pharmacy.
An important element of Angela’s role is that she participates in the hiring process at different stages of it; particularly, she attends job interviews and provides coaching to new employees to facilitate their professional development and adaptation to the facility.
Leadership Characteristics
Observed Characteristics
Before starting to work in my current unit, I worked in a different one, and upon the transition, the contrast was impressive; I had a chance to actually observe good leadership practices in my new unit supervisor, Angela. Two leadership characteristics can be particularly noted. First of all, Angela empowers her staff, i.e., she affirms and promotes strength in nurses working in her teams. This is especially manifested in the way she encourages and praises positive behaviors; whatever a nurse in our unit does right, Angela will not fail to notice it and provide positive feedback. My experience shows that this practice is highly motivating.
In this regard, the attitude my unit supervisor has toward negative behaviors, mistakes, and poor performance is also remarkable. Rather than weaknesses, she regards them as opportunities for growth, and instead of reprimanding, she educates. In this, I see Angela’s deep understanding of the difference between evaluation and feedback. Evaluation is summative, i.e., it is scoring a person’s performance based on certain criteria and standards, while feedback is formative, i.e., it explains how the performance can be improved and what should be modified in attitudes and practices.
Part of Angela’s work is evaluation; however, she never fails to provide feedback as well because she cares about her staff and wants our work to be better. According to Grossman and Valiga (2016), these characteristics contribute to building an environment that promotes effective work in a facility. When one of the nurses informed a physician on a patient’s complaint that the patient had shared confidentially, Angela talked to her and discussed the principle of autonomy in nursing ethics. It showed how the unit supervisor promoted education instead of penalizing.
The other important leadership characteristic that Angela displays is her ability to affirm values. It means ensuring that the values, beliefs, and vision of the members of nursing teams are properly recognized and integrated into the process of providing care (Grossman & Valiga, 2016). This ability of a leader to accumulate the ethical principles of the nursing teams and to transform them into practices and procedures is important for designing individual care that meets the needs of patients (“Modeling and role-modeling theory,” 2015).
Angela pays much attention to ensuring that the nurses on her teams share the conceptual understanding of our work; for this, she holds regular conversations with nurses and discusses current issues and their connection to the overall theoretical framework of nursing care we provide. For example, many patients complain about the work of the nurses because they (patients) think that nurses stole from them or scheme against them behind their backs; I have repeatedly heard Angela explain to her nurses how these paranoid beliefs of the patients should be addressed, and how open communication with patients can help.
In analyzing a leader, one should also pay attention to those characteristics that need improvement (Grossman & Valiga, 2016). After working for some time with Angela, I can say I have detected several deficient characteristics she has in terms of leadership. First of all, Angela’s practices are largely evidence-based and come from her own experience, and this is a good thing for a nurse leader (“Modeling and role-modeling theory,” 2015); however, I have noticed that she tends to be more open with those nurses that already have extensive experience themselves.
With new employees, Angela is rather detached; she talks to them in a professional and formal manner. I think the quality of training and the professional development in the facility could benefit from Angela’s more open attitude toward new employees; if she could be more straightforward with them, the new nurses would master the necessary processes faster. With one of the new nurses, Angela was very formal for a long time; she could tell us, the experienced nurses, what she thought was wrong with the new nurse’s performance, but she avoided telling it directly to her. I think Angela should be more genuine with her new employees.
Another deficient characteristic is that Angela avoids conflicts and rarely argues with other leaders, including managers and physicians. When a patient was complaining about the quality of medical care, a nurse told Angela about this, but Angela was reluctant to bring up this case in front of the doctor that provided medical care to the patient. I think she did it for the sake of better cooperation between doctors and nurses; however, I think she should have been more active.
According to Grossman and Valiga (2016), one of the functions of a nurse leader is to be engaged in patient advocacy. A nurse leader should not be afraid of confronting a doctor because both nurses and physicians pursue addressing the needs of patients in a better way; if a nurse thinks that those needs are not addressed properly, he or she should convey this message to other health care providers involved in treating a particular patient.
Change
One of the important characteristics of a leader is “the desire to become more and more of what one is capable of being” (Erickson & Swain, 1988, p. 3). To accomplish this, one should be involved in changing and improving the practices of his or her own and his or her followers. I think that Angela perfectly understands the need for change, and she demonstrated it in one particular change that she brought to the facility. She introduced a new electronic health records (EHR) system, and this was a strategic change because it implied long-term benefits for the facility.
The importance of the new EHR system consisted in the fact the nurses’ work could become much easier, faster, and more efficient because the processes of collecting and retrieving information became automated. Moreover, the new system reduced the risk of mistakes made by nurses in keeping patients’ records. Also, the automation of the records system contributed to building closer relationships between nurses and patients, and this proximity is pivotal in ensuring that patients’ needs are properly recognized and met (“Modeling and role-modeling theory,” 2015).
Angela demonstrated excellent leadership characteristics in the process of adopting the new system. She realized that the system would not add to the efficiency of nurses’ work unless nurses understood what the system could do, learned to use its functions fully, and committed to using the system in their practice. Angela repeatedly gathered her nurses to explain these things to us, and her arguments aimed at persuading us to use the system were reasonable and convincing.
Followership Characteristics
An important aspect of leaders’ work is developing their followers (Grossman & Valiga, 2016). A leader is not a leader without anyone to lead; that is why, when evaluating leadership characteristics, one should pay special attention to what practices and attitudes the leader’s followers adopt that contribute to positive outcomes. Grossman and Valiga (2016) note that good followership is harder than good leadership in a way because followership involves fewer rewards. This is why a leader should cultivate effective followers.
Angela is successful in this regard, and the particular characteristic that she demonstrates is the ability to effectively communicate with her followers that she wants to be a good leader. During our regular meetings, Angela repeatedly stressed that she wanted to be a unit supervisor as long as she knew that she did her job properly, that her nurses trusted her, and that she was a good fit for the position.
A particular practice that demonstrates Angela’s efforts in building followership is her practice of regularly requesting feedback. Just like she praises any positive behaviors in her nurses and educates them about negative behaviors, she expects the members of her nursing teams to tell her what they think she does right and what they think she does wrong. This practice is not automated, and we do not fill in any questionnaires in this regard, but we feel absolutely free to share our opinions, including opinions on Angela’s work, during our regular meetings with the unit supervisor.
Modeling and Role-Modeling Concepts
One of the key concepts of the MRM theory is nurturance, which is defined as the striving for “know[ing], understand[ing] and valu[ing] client’s model of the world” (Erickson & Swain, 1988, p. 2). Angela has been fully displaying this characteristic; moreover, she promotes nurturance in her nurses. What Angela constantly stresses is that a patient’s understanding of his or her treatment and the patient’s vision of the world should be understood by the nurse in order to properly identify the patient’s needs and address them.
Another thing that Angela recognizes is that “nurse is a facilitator, not an effector” (Erickson & Swain, 1988, p. 2); therefore, she encourages her nurses to act softly and promote the patient’s own strengths through interaction instead of imposing anything on patients. Finally, Angela promotes the concept of unconditional acceptance, which is an important part of the MRM theory, too. To the nurses in her unit, Angela repeatedly recommended that, if they could not accept their patients as unique and worthwhile, they should not provide care to them.
However, the cases of refusing to provide care are rare due to Angela’s efforts in explaining every nurse in her unit why patients should be unconditionally accepted. All three concepts are important in nursing leadership in general because, without them, the promotion of high-quality care is impossible; a nurse leader who does not practice nurturance, facilitation, and unconditional acceptance cannot ensure effective followership.
Modeling and Role-Modeling Application
It is noteworthy that the MRM theory is a grand theory, i.e., it mostly describes abstract concepts and reflects on the philosophical understanding of nursing. However, the theory has applications. As it has been demonstrated, my unit supervisor complies with the theory, and after working with her for some time, I can say that her approaches result in actual benefits for the facility and for patient satisfaction. First of all, her practice of constantly providing feedback to her nurses and receiving feedback from them both improves the quality of care provided by the nurses and increases the level of their trust and appreciation for their leader.
I believe that Angela fully understands the nursing goal of helping people achieve holistic health; this goal is essential in the MRM theory (“Modeling and role-modeling theory,” 2015). Moreover, my unit supervisor is committed to promoting these values among her nurses, and she is a great educator who manages to convey these concepts effectively to everyone who works in her unit. That is what makes her a good leader.
Conclusion
Upon assessing Angela’s strong and deficient leadership characteristics, examining the changes she has brought to the facility, exploring the ways she develops followership, and applying the perspective of MRM concepts and applications, it was shown that the unit supervisor is an effective leader. She manages to encourage her staff to perform better and successfully develops in them the understanding of the key concepts of high-quality nursing care. It can be concluded that the MRM framework is helpful in assessing one’s leadership characteristics because it provides certain criteria for evaluating how effective one’s leadership practices are.
References
Erickson, H. C, & Swain, M. A. P. (1988). Modeling and role-modeling: A theory and paradigm for professionals: Philosophical assumptions.
Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing (5th ed.). Philadelphia, PA: F. A. Davis.
Modeling and role-modeling theory: An introduction. (2015). Web.
This artifact is an essay discussing the theory of nursing care needs and comparing it to the approach of self-care in modern times. The essay presents Henderson’s theory, which emphasizes meeting the patient’s basic needs to aid in recovery, and argues that it is more effective than the theory of self-care, which assumes that patients can take care of themselves without much assistance (Pinheiro et al., 2016).
Discussion
In modern nursing care, the idea of meeting the patient’s basic needs, as presented by Henderson’s theory, is more effective in aiding patient recovery than the theory of self-care. This fact assumes patients can care for themselves without much assistance due to the limitations of patients’ physical abilities and medical knowledge. This artifact was chosen due to the importance of understanding nursing theories and their impact on patient care. From this artifact, I learned about the importance of nursing care and the various theories that have been developed to improve patient outcomes. I also gained insight into the challenges faced by nurses in ensuring that patients’ needs are met and how different approaches can impact patient recovery. While this written work specifically pertains to nursing care theories, the ability to analyze and compare different approaches to problem-solving critically is a valuable skill in many fields, including engineering, which aligns with my future goals. This artifact represents a piece of the journey at SPCC by showcasing the critical thinking skills and research abilities of the writer. The writer demonstrates an understanding of the topic and presents a clear argument supported by evidence. It also reflects the educational values of SPCC, such as critical thinking, effective communication, and problem-solving.
Conclusion
In conclusion, this artifact provides valuable insights into the theory of nursing care needs and self-care and their impact on patient recovery. The essay highlights the importance of meeting patients’ needs during treatment and the challenges faced by nurses in fulfilling this task. The artifact represents a piece of the journey at SPCC by demonstrating the educational values of critical thinking, effective communication, and problem-solving.
