Category: Nursing Theory

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

Overview of Nursing Theory in Nursing Practice

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

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

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

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

Case Scenario

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

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

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

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

Application of the Comfort Theory in Resolving the Issue

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

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

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

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

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

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

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

Conclusion

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

References

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

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

Lucero, R. J., Lake, E. T., & Aiken, L. H. (2010). Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing, 19(15-16), 2185–2195.

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

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

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

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

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

References

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

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

Introduction

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

Discussion

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

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

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

Conclusion

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

References

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian journal of caring sciences, 33(3), 540–555.

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

Nursing theory is a demanding and innovative way of forming concepts to have an orderly view of an incident. The middle-range theories offer proposals and ideas, nursing policies, and an increasing theory-based tactic. There are three major types of middle-range concepts: descriptive, explanatory, and predictive theories (Fawcett & Garity, 2009). The descriptive theory is the first and most basic one created through expressive study techniques, which may either be qualitative or quantitative. It helps to identify what is similar in groups, circumstances, occasions, or characters. The explanatory theory is the second type used to define the relationship between ideas (Gray et al., 2017). This concept also demonstrates the degree to which an idea is related to another, and it is formed and verified by linked research which is mostly numerical in presentation. The predictive theory is the third one created and confirmed through investigation (McEwin & Wills, 2019). This concept goes beyond the descriptive and explanatory as it helps to show how variations happen in a phenomenon.

The Hypothesis from the Middle Range Theory

As an example of a practice project, the hypothesis will be taken from the mid-range principle of holistic treatment. The first premise is that there is a connection between the patient’s confidence and quality of life or well-being (Jacelon et al., 2011). Second, there is an association between a client’s spiritual activities and their health during illness. Third, there is a recurrence between the sick person’s emotions about spiritual satisfaction and the value of life in their holistic understanding (Fawcett & Garity, 2009). The central concept is an interdependence between all-inclusive treatment and patient quality of life or welfare. The mid-range concept of medical practice integrates the model as a framework of four interpersonal versus non-relational hypotheses (DeSanto-Madeya & Fawcett, 2009). Therefore, nursing is only concerned with the four non-relational and relational premises of the metaparadigm.

Application of Middle Range Theories in Health Care Delivery Phenomena

Middle range theory enriches nursing ideas by providing tangible organized interpretations of variables that guide the nursing and nursing knowledge development (McEwen & Wills, 2019). The middle range theory provides a focus on research, an objective, and focuses for a study. Through the speculative outlines and guidance to research, the nurses are able to form foundational knowledge. Research is vital to direct evidence-based practice involvements for better patient results. In middle range theory, the features of the proposals are clearly indicated, due to which enhanced decisions can be made for health care patients. The middle range theory offers the nursing students with concepts of specific areas in nursing. Though the ideas are limited, they still help on adding to their knowledge. The theory also contains all the necessary literature reviews and clinical practices and guidelines that should be followed by nurses.

Empiricism on Quantitative Research Methodology

Empirical research is grounded on measured and practical phenomena that develop information from concrete research rather than from a belief. This is why the methods employed in quantitative research are aimed at getting data that is tangible, usually in numerical form (Murrock & Higgins, 2009). Issuing questionnaires, surveying, and observation are some of the methods employed to achieve empiricism under quantitative research. Therefore, as an example, and using the descriptive concept, which is under middle-range theory, research should be conducted to find out what is similar in alcoholics, especially after consuming alcohol. The study should also explain why this behavior occurs more often, its negative effects, and how it can be controlled.

References

DeSanto-Madeya, S., & Fawcett, J. (2009). Toward understanding and measuring adaptation level in the context of the Roy Adaptation Model.Nursing Science Quarterly, 22(4), 355-359. Web.

Fawcett, J., & Garity, J. (2009). Evaluation of middle-range theories. Evaluating research for evidence-based nursing (pp. 73-88). Philadelphia, F. A. Davis.

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Saunders Elsevier.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53-60. Web.

McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.). Wolters Kluwer Health.

Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65(10), 2249–2257. Web.

Introduction

Understanding a theoretical perspective in nursing plays an important role in defining care quality. There are three levels of nursing theories, namely high, middle, and low, and their difference is abstraction application. High-level or grand nursing theories are based on abstract and complex concepts that cannot be tested. Such theorists rely on their experiences to describe an idea without implementing interventions. In contrast, middle-range theories are used in more specific areas and narrow research scope to address a specific phenomenon. Finally, low-range theories focus on interventions for nurses within a particular situation. They create a framework that may be tested to check its impact on nursing practice.

Middle-range theory definition

When a researcher uses a middle-range nursing theory, choosing a particular area and practice is essential. This choice is one of the most comprehensive and effective because it allows for defining the connection between theory and practice. Besides, middle-range theories help limit dimensions and use specific knowledge in developing practical solutions and testing the offered suggestions from multiple perspectives. These approaches are concrete because only a few concepts are applied within the same situation. Instead of using several ideas, problems, or expectations, middle-range theorists organize their thoughts in a clear and informative way.

Study Results and practical implications

There are many research studies in which middle-range theories can be applied. For example, Barreiro et al. (2020) aimed to examine diagnostic validation of the low self-efficacy concept in health and nursing care by constructing a middle-range theory for diagnosis validation. The results include 18 etiological factors and 16 clinical indicators for diagnosing low self-efficacy in the healthcare sector (Barreiro et al., 2020). Despite the limitation of concept broadness, the contributions and practical implications of the offered approach cannot be ignored.

Conclusion

In conclusion, the middle-range theory is effective for clinical practice in detecting expectations and personal perceptions in patients. Thus, it creates a solid basis for new nursing diagnosis approaches.

Reference

Barreiro, R. G., Lopes, M. V. D. O., & Cavalcante, L. D. P. (2020). Middle-range theory for the nursing diagnosis of low self-efficacy in health. Revista Brasileira de Enfermagem, 73(5).

Nursing Theory

To meet the needs of patients in the diverse contemporary community, one must focus on creating consistent communication between a nurse and a patient based on the latter’s environment and background. Furthermore, patient education must be enhanced to ensure patients’ ability to identify a health concern and use appropriate healthcare services. Therefore, a combination of Florence Nightingale’s theory and Dorothea Orem’s approach is used as the basis for my nursing theory (Cherry & Jacob, 2016; O’Shaughnessy, 2014).

Excellent Nursing Practices

Florence Nightingale’s theory is typically applied in a nursing environment to enhance the process of knowledge acquisition and education among nurses (Cherry & Jacob, 2016). Therefore, the application of the identified theoretical framework implies. In other words, a set of rigid criteria for meeting the needs of patients must be set for nurses to follow. Furthermore, enhancement of communication within a diverse community with the following development of new skills must be regarded as a necessity (Cherry & Jacob, 2016).

Professional Practice Nursing Theory

The environmental theory promoted by Nightingale aligns with my professional practice perfectly since, as an APRN, I will have to both cater to the needs of patients from multicultural backgrounds and manage the work of teams of nurses. Therefore, the issue of cross-cultural communication and multidisciplinary collaboration will have to be addressed. Nightingale’s theory will serve as the platform for building the standards for efficient nurse-patient dialogue and the consistent improvement of nurses’ skills (Awalkhan & Muhammad, 2016).

Contributions of 19^th or 20^th Century Historical Nursing Figures

As stressed above, Florence Nightingale and Dorothea Orem will be viewed as key role models whose examples will be followed closely. Nightingale cemented her image of a leader who contributed to the increase in nurse education levels, whereas Orem’s philosophy helped nurses to encourage independence and awareness among patients.

Difference in Contributions

Orem placed a very powerful emphasis on the necessity to provide patients with independence and enhance their education process. Nightingale, in turn, focused on engaging nurses in the process of lifelong learning (Cherry & Jacob, 2016). Therefore, each helped enhance education, yet the recipients of knowledge and the relevant information were different in each case (Cherry & Jacob, 2016).

Description of Historical Figures

Both Nightingale and Orem helped me shape my mission as a nurse precisely. For instance, Nightingale’s philosophy helped me realize the necessity of acquiring new skills on a regular basis in the ever-changing realm of the global community (Cherry & Jacob, 2016). Orem’s theory, in turn, helped me recognize patients as active agents of the nursing process, who must be encouraged to gain new knowledge as well.

State Board of Nursing versus ANA

To provide proper nursing services, one must also keep in mind that there is a massive difference between the State Board of Nursing (SBN) and ANA. SBN operates within a particular state, whereas ANA works on the nationwide level. Moreover, SBNs deal with licensing, while ANA designs programs aimed at improving nursing (Cherry & Jacob, 2016).

Roles of Organizations

Both types of organizations play huge roles in advancing the quality of nursing. SBNs keep the quality of nursing services consistent by allowing only people that meet the set requirements to get a nursing license. ANA, in turn, sets the bar for the quality of services even higher by identifying contemporary issues in nursing and creating programs for managing the specified concerns (Cherry & Jacob, 2016).

Influence of the State Board of Nursing and ANA

As a result, both ANA and SBNs contribute to the process of unceasing development in nurses. Consequently, members of nursing facilities are enabled to adapt to the ever-changing realm of global nursing and meet the needs of multicultural communities. Thus, a gradual rise in healthcare service efficacy and the number of positive patient outcomes becomes a possibility.

Requirements for Professional License Renewal

As a rule, to retain the right to practice nursing, one must renew one’s license every two years. Although requirements for the process of license renewal may vary depending on state-specific laws and the type of license required, general guidelines include providing specific nursing services. The test does not include financial compensation (Cherry & Jacob, 2016).

Failure to Maintain License Requirements

In case of a nurse’s inability to maintain a license, further practice is deemed illegal. If a nurse does not file the required documents before the registration expiration date or takes any other steps that lead to a failure to maintain license requirements, a nurse cannot legally practice as an RN or APRN. The failure to maintain license requirements will also lead to a significant lapse in a nurse’s practice, thus, affecting their professional record and impeding their ability to grow as a professional (Minnesota Board of Nursing, n.d.b).

Compact versus Non-Compact State

The mutual recognition model creates opportunities for nurses to practice their licenses across compact states. Nurses are entitled to be licensed by endorsement. In addition, a further education process is mandatory. However, the specified standards are not applicable to non-compact states, where licensing may be restricted to the specified state. However, enhanced Nurse Licensure Compact (NLC) standards are currently becoming increasingly common for both compact and non-compact states (Cherry & Jacob, 2016).

Agencies Functional Differences

There is a significant difference between the functions of regulatory nursing agencies. For example, the U.S. Food and Drug Administration (FDA) serves the purpose of ensuring the quality and safety of food, drinks, and medications consumed by the U.S. population (U.S. Food and Drug Administration, n.d.). The Centers for Medicare and Medicaid Services (CMS), in turn, focus on providing Medicare and Medicaid services by cooperating with state authorities (Centers for Medicare and Medicaid Services, 2015).

CMS also encourages cooperation between patients and therapists. Therefore, while both organizations pursue quality improvement in healthcare, CMS addresses interpersonal relationships between patients and healthcare professionals, as well as explores the tools for improving access to healthcare services, whereas FDA is concerned primarily with the quality of consumed products.

Influence on Professional Practice

Seeing that FDA defines the safety of medications and devices used by nurses when addressing patients’ needs, FDA affects nurses’ professional practice by helping them choose the tools that can be used to attain optimal patient outcomes (U.S. Food and Drug Administration, 2018).

CMS, in turn, increases the access to healthcare insurance for a large number of people that do not have an opportunity to pay for health insurance on their own (Centers for Medicare and Medicaid Services, 2015). Due to the provision of essential data about the quality of food and medications, as well as the promotion of Medicare and Medicaid standards, the specified agencies allow increasing patient safety rates extensively (Cherry & Jacob, 2016).

Nurses’ Role as a Patent Advocate

Because of the necessity to encourage patient education, a nurse plays a huge role in the process of advocating patient’s rights and needs. The quality of nursing services can be advanced significantly by introducing a set of rigid guidelines into the environment of a nursing facility (Cherry & Jacob, 2016). In addition, the process of communicating with patients must be enhanced to ensure that all of their needs are met respectively. As a result, a nurse plays the role of a patient’s advocate in case the latter chooses alternative treatment options. By supporting a patient’s decision and giving them the required information, nurse advocates for patients’ rights (Cherry & Jacob, 2016).

Purposes of the Nurse Practice Act

Allowing establishing quality standards and, thus, measuring the quality of nursing services, the Nurse Practice Act plays a huge role in advancing healthcare and improving patient outcomes. Furthermore, opportunities for detecting and preventing the instances of violating the set nursing standards can be created with the help of the Nurse Practice Act (Cherry & Jacob, 2016). The Nurse Practice Act also defines the scope of a nurse’s personal and professional practice by outlining the practices that can be defined as violations and, therefore, may result in a nurse’s license becoming invalid (Cherry & Jacob, 2016).

Scope of Practice

For an APRN, the scope of practice ranges from ensuring the quality of services provided to patients to encouraging nurse and patient education to addressing the issues associated with nursing management (Cherry & Jacob, 2016). Particularly, the roles that a registered nurse (RN) may perform in Minnesota include assignment of nursing tasks, a delegation of authorities, the introduction of the intervention, monitoring, and supervision of patients (Minnesota Board of Nursing, 2013).

Rules for Effective Delegation

Delegation is traditionally defined as the process of transferring specific authority or functions to another nurse (Cherry & Jacob, 2016). The Minnesota Board of Nursing (MBoN) follows the guidelines for delegation set by the National Council of the State Board of Nursing (NCSBN) (Minnesota Board of Nursing, n.d.a). NCSBN, in turn, states that to delegate responsibilities successfully, a nurse must focus on training and education, ensure two-way communication, and communicate relevant information accordingly (National Council of the State Board of Nursing, 2015).

Application of Nursing Roles

As an APRN, one must play the role of a nurse as a detective by scrutinizing the environment of a particular community and isolating the factors that may pose a threat to patients’ well-being. As a result, subordinates can be instructed about the means of meeting target demographics’ needs. In addition, as a scientist, an APRN must explore the effects that proposed evidence-based techniques have on patients’ well-being. Finally, as a manager of the environment, an APRN must contribute to the enhancement of the communication between nurses and patients, as well as the patient education process, with a close focus on cultural competency enhancement (Western Governors University, 2013).

ANA code of Ethics Provisions

As an APRN, one must also focus on meeting the requirements for accountability and the code of ethics. For instance, it is necessary to respect patients’ dignity, which is stated in Provision 1. The specified step implies addressing their culture-specific needs, providing them with empathy, and recognizing their human rights, which is Provision 2, according to the ANA Code. The necessity to be committed to a patient, whether the latter is represented by an individual or a community, should also be listed among the key objectives (Cherry & Jacob, 2016).

Analysis of Provisions

Respect for patients’ dignity, which is Provision 1, affects the nursing practice directly by improving the communication process between a nurse and a patient. As a result, the needs of the latter are identified faster and more efficiently, leading to a rise in a nurse’s ability to meet target demographics’ needs. Commitment to patients and communities, which is Provision 2, leads to the development of the ability to adopt a patient-centered approach, thus, engaging in multicultural dialogue and developing a better understanding of patients’ needs. As a result, the quality of the nursing practice improves since a nurse learns to identify patients’ needs successfully (Cherry & Jacob, 2016).

Clinical Practice Error

Provision 1 will help reduce the threat of a clinical practice error by making a nurse respect patients’ dignity and, thus, recognize their needs as essential and strive to meet them accordingly. Provision 2 will allow humanizing patients and encouraging nurses to recognize their role as patients’ advocates by reinforcing the code of ethics, thus, leading to better control of nursing services quality and, consequently, a drop in the chances of a clinical practice error (Cherry & Jacob, 2016).

Application of ANA Provisions

The recognition of patients’ rights (Provision 1) will help make nurses develop empathy toward their target demographics and accept ethical standards based on meeting patients’ needs, thus, managing patients’ personal data more carefully. Combined with the commitment to patients and communities, which is Provision 2, it will help design a framework for managing patients’ personal data more carefully, which will help prevent the instances of negligence causing medication errors and errors in diagnosing health issues (Cherry & Jacob, 2016). Provision 2, in turn, will also allow for a multicultural approach based on recognizing patients’ diversity.

Leadership Qualities or Traits

The significance of leadership can hardly be overrated for an APRN in a healthcare setting. An APRN must deploy team-building skills to provide the basis for multidisciplinary cooperation. In addition, the ability to plan and organize will help get the priorities straight. The capability to implement change will allow adjusting to the ever-changing environment of global healthcare. Finally, the propensity toward learning will promote the active knowledge and skills acquisition among nurses (Cherry & Jacob, 2016).

Demonstration of Nursing Leadership Qualities or Traits

Like a detective, a nurse must use learning strategies to study the specifics of target communities and health-related factors, thus, gaining essential information about patients’ characteristics that will help at the bedside by building an intercultural dialogue and addressing possible instances of misunderstanding. As an explorer, a nurse will also need to focus on the means of adjusting to changes in the target environment, including both technological and cultural aspects of change to enhance interdisciplinary cooperation.

The specified step will also include the enhancement of education among nurses and patients alike, which is crucial in an interdisciplinary setting (i.e., in a team of nurses). Finally, as a manager, a nurse must organize the work of a team efficiently, avoiding the instances of workplace burnouts and keeping motivation levels high, thus, leading to better management of team tasks (Cherry & Jacob, 2016). The identified change helps improve the quality and speed of transferring information at the bedside, as well as within an interdisciplinary team.

Work Environment

To attain the goals listed above, an APRN must create an appropriate workplace environment. The use of a transformational leadership style will have to be considered. For instance, the focus on education and quality improvement can be kept by empowering nurses to engage in lifelong learning and professional development. Thus, nurses will develop leadership qualities that will help them manage their responsibilities more efficiently. Identification of changes will be managed by imparting meaning to work and encouraging nurses to be passionate about their job. Finally, changes in mission and vision will allow adjusting to changes efficiently and make decisions based on appropriate ethical and professional standards (Cherry & Jacob, 2016).

Conclusion

The contemporary nursing environment demands that nurses engage in the process of unceasing self-education, as well as maintain the connection with target communities. Therefore, the active use of the theories promoted by Florence Nightingale and Dorothea Orem must be viewed as a necessity. The specified approaches help upgrade the quality of nursing on a regular basis, as well as enhance patient education and promote knowledge acquisition among nurses.

References

Awalkhan, A. & Muhammad, D. (2016). Application of Nightingale nursing theory to the care of patient with colostomy. European Journal of Clinical and Biomedical Sciences, 2(6), 97-101.

Centers for Medicare and Medicaid Services. (2015). Center for program integrity. Web.

Cherry, B., & Jacob, S. (2016). Contemporary nursing: Issues, trends, and management (7th ed.). St. Louis, MO: Mosby Elsevier.

Minnesota Board of Nursing. (n.d.a). National guidelines for nursing delegation. Web.

Minnesota Board of Nursing. (n.d.b). Renewal of Advanced Practice Registered Nurse (APRN) license. Web.

Minnesota Board of Nursing. (2013). Nurse Practice Act – Minnesota statute section 148.171. Web.

National Council of the State Board of Nursing. (2015). Delegation. Web.

O’Shaughnessy, M. (2014). Application of Dorothea Orem’s theory of self-care to the elderly patient on peritoneal dialysis. Nephrology Nursing Journal, 41(5), 495-498.

U.S. Food and Drug Administration. (n.d.). What we do. Web.

U.S. Food and Drug Administration. (2018). FDA’s role in regulating medical devices. Web.

Western Governors University. (2013). Conceptual model, nursing programs: Journey to well-being. Web.

Application of the Theory

Faye Abdellah’s theory is that nursing should be patient-centered. This is accomplished by directing the nurse’s abilities toward the desire and knowledge to help people overcome their illnesses. The theory finds its application in nursing education by developing nurses’ skills in understanding, decision making, and seeing social connections (Gonzalo, 2021). The potential applications of this theory are justified by nurses’ sensitivity to and ability to identify patients’ hidden problems. In addition, the availability of resources from the community and health care providers will ease the nurse’s burden. On the part of the nurse, it is also essential to find a personalized approach to the patient and accept all sides of the patient while respecting culture and individuality (Gonzalo, 2021). Overall, applying Faye Abdellah’s theory in practice is influenced by the personal qualities the nurse wants to bring to professional practice.

The Relationship between Theory and Practice

Faye Abdellah’s theory connects the nurse’s desire to help the patient and her actions. In practice, this can be expressed through an evidence-based approach. Younas and Quennell (2019) note that using an evidence-based approach in practice based on nursing theory allows for a favorable outcome. In addition, there is no evidence that nursing practice has a negative effect or is useless. Li et al. (2019) note that many nurses are also optimistic about using an evidence-based approach and want to combine it with the principles of the theory. The development of evidence-based practice is built on understanding the principles of the relationship between action and effect and creating a body of knowledge. At the same time, Yancey (2018) notes that an evidence-based approach based on nursing theory will be successful if institutions maintain a focus on the value of nurses. Thus, views such as Faye Abdellah’s will be successful in integrating evidence if participants in transformations recognize the status of nurses as professionals.

References

Gonzalo, A. (2021). Faye Abdellah: 21 nursing problems theory. Nurselabs.

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review.Medicine, 98(39).

Yancey, N. R. (2018). Evidence-based practice in nursing for teaching-learning: But is it really nursing?Nursing Science Quarterly, 32(1), 25-38.

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory-guided practice: an integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555.

There is a statement that it is better to have one nursing theory rather than a variety of options to guide education, research, and practice. On the one hand, this approach has a reason and can be supported as an opportunity to facilitate a learning process. On the other hand, it is hard to agree with this idea because alternatives and differences make nursing unique and effective. Regarding differences between patients and healthcare workers, one nursing theory is not enough to identify all care methods and introduce the effective nursing practice.

Modern nursing education is diverse and complex by its nature. Students have to identify and understand various concepts, learn much new information, and find practical applications to the offered theoretical perspectives (Salifu, Gross, Salifu, & Ninnoni, 2019). Educators, in their turn, must use the most effective techniques to explain the material and make sure all aspects remain clear and helpful. Therefore, when one nursing theory is applied to the whole education process, it seems to be easy to understand the essence of nursing and follow clear instructions and guidelines.

At the same time, nursing is a field with several systems and concepts to be taken into consideration. Even the simplest nursing theory consists of three major concepts – person, environment, and health – which in their turn have some sub-concepts (Black, 2017). In clinical practice, each family and patient have specific demands, needs, and expectations. Some hospitals are provided with all the necessary equipment and human resources, and some facilities still experience certain shortages. Therefore, it is difficult or even impossible to choose one theory and be sure it is effective for nursing practice globally.

Many attitudes towards nursing theories and their extensive presence in education exist. Despite the intentions to facilitate a learning process and decrease the number of concepts and regulations in nursing, one theory to guide education, practice, and research will never be enough. Even if a single theory is finally chosen, its opponents develop critiques and reasons for improvement because some aspects of nursing work are missing or misunderstood regarding the already gained experience and knowledge.

References

Black, B. (2017). Professional nursing: Concepts & challenges (8th ed.). St. Louis, MO: Elsevier.

Salifu, D. A., Gross, J., Salifu, M. A., & Ninnoni, J. P. (2019). Experiences and perceptions of the theory‐practice gap in nursing in a resource‐constrained setting: A qualitative descriptive study. Nursing Open, 6(1), 72-83. doi:10.1002/nop2.188

Several differences exist between a nursing theory and a nursing conceptual model. A nursing theory refers to statements that attempt to explain the relationship between two or more ideas. Nursing theories are critical for the development of the nursing practice since nurses apply nursing theories in their everyday activities as they address the healthcare challenges faced by patients (Carla et al., 2020). A nursing conceptual model, on the other hand, refers to an image of a phenomenon. A conceptual model attempts to identify specific ways of thinking about how a theory works or fits together (Carla et al., 2020). Hence, a conceptual model attempts to expound more on the theory by providing a vivid picture of the explained relationships.

Jean Watson’s theory of human caring is one of the main theories in nursing. Watson asserts that even though caring exists in every society or community, in many cases most of them do not transmit a caring attitude from one generation to another (Carla et al., 2020). As a result, caring is transmitted from one generation to the next by the nursing profession as a way of coping with its environment.

Therefore, Watson’s theory asserts that caring consists of ten curative factors. These aspects consist of the formation of humanistic value systems, instilling faith and hope, creating sensitivity to others and self, nurturing a helping trust relationship, and encouraging the expression of feelings (Carla et al., 2020). Other factors include utilizing problem-solving for decision making, encouraging teaching-learning, creating a supportive environment, helping in the gratification of human needs and permitting existential-phenomenological forces (Carla et al., 2020). For example, a 76-year-old man is scheduled for an operation after developing complications on his leg. The man lives in a nursing home because other members of his family live in other states. The nurse starts caring for him immediately after going through the report from the previous nurse.

Thus, from the above analysis, the first three creative factors from Watson’s theory should be applied. Foremost, there must be the formation of humanistic-altruistic value systems. The nurse should not be task-oriented and realize that she is dealing with a human being with precious life. The nurse should instill hope in the patient by assuring him that everything will be fine. It is also essential to be sensitive to the man’s plight and offer him the emotional and physical support required.

Reference

Carla, B. E., Maria Emília, L. L., Maria Miriam Lima da Nóbrega, Ferreira de Vasconcelos, M., & Ana Claúdia, G. V. (2020). An analysis of Jean Watson’s theory according to chinn and Kramer’s model. Revista De Enfermagem Referência, 5(4). Web.

Abstract

Peplau’s theory of interpersonal communication is one of the most influential works in nursing practice and can be traced to many modern theories and healthcare policies. Being initially devised for application in psychiatric nursing practice, it has since found implementation in many fields of healthcare, including nursing practice, education, administration, and research thanks to its scalability, flexibility, and comprehensibility. Despite several limitations, it has a potential for reshaping APRN practice in general and is expected to improve outcomes in specific aspects such as medication prescription, preparation, and administration.

Introduction of Theorist and Theory

Hildegard Peplau was born in Reading, Pennsylvania in 1909, in the family of German descent (Snowden, Donnell, & Duffy, 2014). By the time she was able to pursue a nursing career, the nursing profession was primarily restricted to simple supportive tasks and did not emphasize communication. In 1931, Peplau graduated in the Pottstown Pennsylvania School of Nursing. From then on, her primary interest was in the psychology of interpersonal communication. In 1943 she earned a bachelor’s degree in interpersonal psychology at Bennington College followed by a master’s and a doctoral degree from Columbia University in New York in 1947 (Snowden et al., 2014). Roughly in this period she first looked to extend the nursing practice to the communication domain. The main idea behind her early work was that nurses could be of greater help to patients if their tasks go beyond simple cleaning and laundry duties. Another notable contribution to the shaping of her theory was her involvement in the transformation of the American mental health system following the introduction of the National Mental Health Act of 1946.

Her seminal work, Interpersonal relations in nursing, which laid out the foundations of her theory, was published in 1952. Importantly, despite bearing a resemblance to the conceptual framework, it is referred to as a theory since it is testable (Peterson & Bredow, 2013). It is also important to note that while it has a wide scope of application, it is recognized as a middle-range theory by most scholars and was initially defined as such by Peplau herself, describing it as “a partial theory for the practice of nursing as an interpersonal concept” (Peterson & Bredow, 2013, p. 139).

Support Theory

Peplau’s theory is based on several psychological and social concepts, most prominently those by Neal Elger Miller and Abraham Maslow. The one which plays a central role and is used as support theory is Harry Stack Sullivan’s interpersonal theory of personality. Its notions form a basis for Peplau’s work since the latter relies heavily on the interaction with peers. Sullivan’s basic premise is that human personality develops based on the interaction with the surrounding individuals. In other words, personality requires a social environment to be shaped.

Peplau utilizes this principle to shift the attention of nursing practitioners from mechanistic and utilitarian tasks to communication as a central tool for improving patient’s health. The core thesis of nursing as an interpersonal process built around the interaction between two or more individuals is also based on the social nature of human relations. Finally, while not explicitly stated in Peplau’s works, her interpersonal theory is defined by many scholars as psychodynamic as it requires the reflective analysis and understanding of behavior for successful implementation (Peterson & Bredow, 2013). The concept of behavior as a means for achieving the desired needs and avoiding anxiety is also borrowed from Sullivan’s theory.

Components of the Nursing theory

Major Concepts and Metaparadigm Definitions

Despite its complexity, Peplau’s theory relies on four concepts that are perceived as universal in the metaparadigm of nursing.

Nursing

As was already mentioned above, the main focus of Peplau’s theory is on the relations between a nurse and a patient. Thus, nursing can be defined as a therapeutic interaction between someone who experiences health problems and needs help (patient) and someone who possesses relevant knowledge and has access to resources that can assist the patient in reaching this goal (nurse). In the broad sense, nursing is on par with other common social processes and must acknowledge and cooperate with them to raise the chances of achieving good health (D’Antonio, Beeber, Sills, & Naegle, 2014). It can clearly be seen that technical and resource-supplying procedures are not prioritized by this definition – instead, they are assigned a secondary role.

Persons

Two persons are central to the theory – a nurse and a client, i.e. a patient. A nurse is defined as a person with definable expertise, e.g. the ability to identify the problems of patients, allocate relevant skills for solving them, and demonstrate the capacity to form with the patient the kind of relationship which would be the most beneficial for reaching the desired outcome. The nurse must also possess values and commitment consistent with achieving patient’s well-being. A patient is a person who is entitled to universal human rights such as privacy, confidentiality, respect, and ethical care and is in need of health care. Additionally, the patient may or may not actively participate in a relationship with the nurse.

Health

In Peplau’s theory, health is a process of moving towards the state of productive and constructive living. She identifies two main aspects of health – biological, which is determined by physiological principles of human functioning, and social, which is defines emotional and psychological well-being of individuals.

Environment

This concept is mostly restricted to therapeutic environment and is broken down into two categories. The structured environment, such as a hospital or a ward, is traditionally associated with technicalities of healthcare. The unstructured component, i.e. an interconnected system which includes patients, staff, and visitors, is often poorly managed or overlooked but conveys significant importance for the patient outcomes. A properly maintained environment results in an atmosphere which facilitates recovery.

Philosophical Underpinnings

Due to the relative complexity and diversity of the interpersonal relations theory, it is not possible to conclusively assign it to a specific philosophical foundation. Nevertheless, it aligns well with the existential phenomenology (Butts, Bandhauer, & Rich, 2013). According to this view, nursing acquires an interpretive character since the task of observing the patient requires involvement with the existential situations of the latter. The identification of patients’ problems can be viewed as meaning-seeking activities resulting from nurse-patient relationship aimed at achieving a mutually satisfying result.

Goals of Nursing

As can be seen from the definitions, the main goal of nursing is the creation of the environment which promotes the attainment of positive health by the patient. This is achieved primarily by establishing appropriate communication channels and assuring the participation of the patient in achieving the desired results. Other important components of the environment formation, and, by extension, minor nursing goals, are mutual education and constant development directed at achieving personal and community well-being.

Theory and Nursing Process

Peplau suggests breaking down the process into four phases. It is important to understand that the chronological order of the phases is not necessarily exact, as most of the time the phases are overlapping and integrating into each other.

Phase of orientation

After identifying the patient’s problem, the nurse is expected to deliver the informational resources relevant for its solution (resource person), encourage the patient to communicate the issues associated with the problem (counselor), help the patient reenact prior relations to locate and address existing issues (surrogate), and provide the specific technical and clinical information which is most likely unavailable to the patient at this phase (technical expert). Notably, the latter is positioned at the end of the list because it is mostly a secondary role.

Phase of identification

At this phase, the patients often make a choice of further behavior model. Ideally, they decide to interact with the nurse in active pursuit of attainment of positive outcome. Two major difficulties at this stage are reluctance to facilitate a collaboration because of the previous negative experience and the false interpretation of participation which leads to excessive dependence. At this stage, the nurse largely plays the role of a leader.

Phase of exploitation

This phase includes most of the clinical and nursing interventions. Depending on the chosen role, the patient may display varying level of involvement. Nevertheless, one of the nurse’s goals at this phase must be towards decreasing the patient’s dependence and promoting empowerment.

Phase of resolution

This phase is initiated once all of the predetermined initial goals (i.e. the problem which triggered the visit) are fulfilled. By this time patient should determine a new set of goals aimed at maintenance and improvement rather than addressing a specific issue. During the resolution, the patient should become proficient enough to stop feeling dependent on the nurse, so the relation is terminated as unnecessary. Both sides of the relation are expected to enrich their knowledge and resource base as a result of this relation.

Aside from the primary roles of surrogate, leader, resource person, and counselor, Peplau isolates the role of a stranger, which sees limited use during the orientation phase, and teacher, which can be observed throughout the process and is gradually substituted with one of a leader.

Current Applications of Theory in Nursing

Despite being initially devised for application in psychiatric nursing practice, Peplau’s theory has since found implementation in many fields of healthcare, including administration and research.

Practice

Nursing practice remains an area where the influence of Peplau’s theory is featured most prominently. If, for example, a patient is restricted to bed because of the pelvic traction, the nurse starts with informing him of the reasons for restriction (resource person). She then describes possible benefits of self-care and provides the patient with the information on the exercises which would contribute to improvement (teacher). The identification phase can be facilitated by providing additional information on prevention of complications and explaining the role of patient initiative. During the exploitation phase, the nurse provides the necessary activities, such as massage of upper and lower extremities, and oversees the activities executed by the patient, such as breathing exercises and passive exercises aimed at maintaining muscle tone and strength. When the patient is able to move on his own, the resolution phase commences, during which he should be able to understand the importance of basic recovery exercises and utilize them in future with little to no help from a medical professional.

Education

While the theory is not applicable to education in its entirety, its inherent principles are useful for organizing the education of patients. Specifically, when explaining the procedure of a certain exercise, the nurse must detail the reasons behind its usefulness and, hopefully, dispel common misconceptions which are known to result in adverse results (the roles of a teacher and resource person). At the same time, the educational programs must contain sufficient material to convince the patients in the benefits of active participation (leader role). Finally, the educational sessions must facilitate trust and incorporate the possibility for patients to come forward with their concerns and seek consultation from nurses (counselor role).

Administration

A similar principle can be utilized in administrative practices. The priority of communication in managerial nursing practices is expected to boost loyalty and commitment of the staff. Similarly, articulating the benefits of suggested administrative intervention is known to improve cooperation of employees and raise satisfaction rate (Brunetto, Farr-Wharton, & Shacklock, 2012). It is important to note that such approach is not directly implied by the original theory and should thus be exercised with caution.

Research

Among the less evident applications of Peplau’s theory is its use to maximize participation in research by increasing retention rates. Currently, the retention and recruitment of participants are among the biggest concerns in clinical research field. While the introduction of incentives is expected to increase the number of participants, a growing body of evidence shows that relations between the personnel and participants of the study plays a crucial role in successful sampling (Penckofer, Byrn, Mumby, & Ferrans, 2011). An article by Penckofer et al. (2011) offers a framework for utilizing Peplau’s theory to improve participation by establishing better communication and facilitate understanding. While this is a tempting concept, such approach requires additional adjustment. The suggested framework is thus recommended for discussion.

Applicability to APRN

As was noted above, nursing practice presents the best opportunities for applying Peplau’s theory. In particular, the scalability of the theory allows using its principles in many areas of APRN practices, such as medication prescription, preparation, and administration. According to the current understanding, a sufficient share of medication errors can be prevented by participation of patients in healthcare process and providing them with relevant knowledge (Keers, Williams, Cooke, & Ashcroft, 2013).

Both aspects are central to the discussed theory, making it appropriate for implementation. It is important to acknowledge that Peplau’s is not a practice theory and, therefore, does not include tools for predicting and measuring outcomes. Nevertheless, the growing body of research confirms the relation between the educational events along with patient-empowering environment and a decrease in preventable medication errors (Keers et al., 2013). Thus, it is possible to assume that strengthening the presence of teacher and leader roles while minimizing that of technical expert will likely result in better patient outcomes. Such approach would also require greater emphasis on identification phase.

Critique of the Theory

The theory in question is consistent, testable, and displays scientific integrity. Admittedly, it is fairly complex but can be presented in comprehendible terms to improve understanding. Admittedly, such simplification sometimes leads to misinterpretation and, on some occasions, incorrect usage (such as reaching false attainment followed by overdependence on a nurse), and several notions usually require in-depth explanation, such as the role of surrogate (often reported as obscure) (Peterson & Bredow, 2013). After overcoming such minor barriers, the theory is applicable to the majority of healthcare fields and is scalable to the degree where it can be used as a grand theory or a practice one. The limitations of the theory include the absence of assessment tools and weak emphasis on evidence-based practice, both of which can be averted by minor modifications. Overall, the theory remains among the most influential works in nursing practice and is traceable in most modern theories, guidelines, and healthcare policies.

References

Brunetto, Y., Farr-Wharton, R., & Shacklock, K. (2012). Communication, training, well-being, and commitment across nurse generations. Nursing Outlook, 60(1), 7-15.

Butts, J. B., Bandhauer, D., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Burlington, MA: Jones & Bartlett Publishers.

D’Antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Safety, 36(11), 1045-1067.

Penckofer, S., Byrn, M., Mumby, P., & Ferrans, C. E. (2011). Improving subject recruitment, retention, and participation in research through Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 24(2), 146-151.

Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: Application to nursing research. New York, NY: Lippincott Williams & Wilkins.

Snowden, A., Donnell, A., & Duffy, T. (2014). Pioneering theories in nursing. London, England: Andrews UK Limited.