Category: Nursing

Introduction and Problem of Practice

This paper examines the significance of applications of theory in nursing practical situations. Concerned with the care of communities, families and individuals, nursing is an expansive discipline within the health sector, which encompasses collaborative and autonomous care of sick or health people in various settings. The nursing profession involves a range of definitions and specialties that would vary from place to place. However, in whatever specialties involved, the personnel in this profession have always strived to achieve the best results in their demanding discipline. In most cases, nursing profession is known to involve a lot of practical activities rather than theory. However, theoretical application is essential in such situations for it plays a key role in assisting the practitioners in achieving their goals effectively and for thus, it helps in facilitating positive development of the discipline.

The nursing scope of practice is usually surrounded by various issues, some of which could be more delicate to handle and in that case, there is always a need for the practitioners to consider applying the necessary steps that will help to improve the quality of their tasks. This report observes the analysis of clients assessment data as one of the most common practice problems facing many nurses today in their daily interactions with patients and clients. According to Tomey and Alligood (1998), analyzing assessment data is a critical approach in the operations of a nurse within a particular health setting. However, lack of enough skills and knowledge on how to go about this practice can be a major problem since this is among the core interventions which help nurses carry out the appropriate care actions on their patients and clients.

Nursing is a unique profession in the medical sector whose major responsibility revolves around variables affecting people in diverse environments (Barbara and Lynn, 2006). The actions of any nursing professional are initiated to best attain, retain, and uphold optimal clients wellbeing or good health through the intervention of primary, secondary and tertiary prevention of diseases and disorders. Nursing services can be administered from diverse settings which include hospitals, private homes, learning institutions, cruise ships, military facilities and pharmaceutical companies, among others. In most of these settings, nursing practitioners are capable of making necessary assessments, planning, implementation, and evaluation of patient care independently of doctors through the formalities of their discipline. More importantly, nursing professionals also provide significant support to physicians in some critical medical matters (George, 2002). In all these working circumstances within the nursing scope, effective practical situations would be critical in the provision of high quality services in all settings. In order to display professionalism and maturity in their work, nurses must always learn to sustain their practical situations with theoretical approach. Apart from helping them achieve their nursing goals efficiently, this would be a sure way to facilitate the professional maturity in the entire nursing staff.

Literature review

Studies pertaining to effective administration of nursing practices in various health settings have identified a high need for work-based learning programmes and practices that would help nurses accomplish their tasks more efficiently. A good example of these intervention practices can be through the sustainance of normal nursing practices with theory. Theory refers to any set of concepts designed with the objective of providing a systematic view of a particular phenomenon (Whall, 1999). Numerous theories would be based on assumptions and are composed of definitions, models, concepts and propositions (Mobley and Johnson-Russell, 2005). In this regard, nursing theories are sets of concepts, definitions and assumptions that are derived from the models of nursing. In other words, these are organized sets of statements that would be related to the concepts in the expansive discipline of nursing. Nursing theories are important in that, they offer in-depth descriptions and explanations of the nursing phenomenon, thus helping nurses carry out their duties effectively. As it would be observed, the very practice of analyzing assessment data has always proved to be a challenging experience to many people in this profession.

Assessment is the first step of the nursing process which involves the continuous collection, confirmation and communication of a patients data as it would be compared to the norm. In this stage, information concerning the health status of a patient is assembled and assessed to assist health practitioners in making relevant care plan decisions on the patients. This approach is vital in assisting nurses devise the most appropriate care fit for their patients. In order to develop effective care plans on patients, nurses ought to draft informed assessments for the right decision making upon their clients (Potter and Perry, 2005). Being the first stage in the patients problem-solving framework, assessment is vital and for thus, it is likely to influence all the other phases of the process. This simply means that, improper assessment on patients would definitely lead to poor execution of the care plan. This can result to serious medical blunders and it is here where theory comes in to spare nurses the big disappointments of miscalculated actions in their profession.

The above scenario explains the significance of applying theory to practical situations as far as nursing profession is concerned. According to Benjamin and Curtis (1992), nursing theory comes with a wide range of benefits to the health practitioners. First of all, it provides a reliable framework for generating new ideas and knowledge, thus helping nurses to come into terms with some important knowledge gaps in their line of duty. The framework also serves as an informed guide to practical nursing situations. In most cases, these theories would tend to relate directly to the undertaken practices, thus helping nurses achieve their goals and objectives successfully. Nursing theory is also significant in that, it guarantees for diverse patterns of knowledge which could be lacking in practical situations (Reed, 1991). More importantly, apart from the benefit of word definitions, new ideas are likely to develop through nursing theories and this is certain to make a positive outcome in the implementation of nursing practices. Underpinning knowledge is ever present in those environments where nurses are much concerned about the welfare of their patients and clients, to support and sustain their practice circumstances. It is interesting to note that, one of the most common manner by which nursing theory has been organized into practical approaches is in the process of planning and analyzing assessment data (Barker, 2009). This has actually played a significant role in helping nurses to successfully overcome the practice problem in question. Application of nursing theories in the daily operations of a nurse is a clear outline of the essential changes that ought to be embraced for outstanding professional conduct and safe care in the nursing profession.

Application of Middle-Range Theory to Problem

Middle range theory refers to an approach to sociological theorizing which is aimed at integrating theoretical approach and empirical research (Peterson, 2008). The concept was first developed by Robert Merton, undoubtedly one of the most distinguished sociologists in the American history. Robert was born in the year 1910 in Philadelphia. As a young man, he grew up in the midst of cultural and educational centers and this would undoubtedly come to form the basis of his lifestyle that was characterized by a big desire to learn. As a matter of fact, the events surrounding Mertons early life played a significant role in shaping one of the biggest science sociologists in history, out of him; a career he would strongly uphold till the time of his death in February 2003. Merton is recognized for developing notable concepts, some of which have greatly steered modern global developments in sociology. Some of these concepts include; the reference group, unintended consequences, role model, role strain and self-fulfilling prophecy, among others. Merton is also recognized for the development of the middle rage theory; a sociological approach which has found immense use in many sectors of our modern world.

Mertons theory is rather an approach on the construction theory and for thus; it does not necessarily refer to any particular theory. In most cases, the work of Merton can be compared to that of Talcott Parsons; his biggest influence in sociology, even though the two would differ greatly in their assumptions and definition of terms. One outstanding difference between the two sociologists was that, Parsons would tend to emphasize the necessity for social science in establishing a general foundation, while Merton preferred middle-range theories that were limited. As a testable theory bearing limited variables and scope, middle-range theory has continued to enjoy sufficient application in many sectors, including practical nursing. In nursing, middle-range theory is defined as a set of interrelated ideas that are focused on limited dimension of the nursing reality. In the highly reputed discipline of nursing, middle-range theories are incorporated on the basis of offering guidance for the daily tasks rooted to the profession (Alligood, 2002). As it would be observed, the general interest of the concept among nursing faculty has continued to take shape owing to the fact that, it informs research and practice in routine nursing tasks, thus helping nurses make informed care decisions and approaches on their patients and clients.

According to Johnson (1998), middle-range theory forms part of the framework of the nursing discipline. This concept addresses the substantive knowledge and understanding of the sector by emphasizing on various specific phenomena or guidelines related to the nursing process. Owing to its effectiveness, the concept has found constant use in nursing research and practices all over the world. Considering the practice problem identified in part 1 of this paper, this theory can play a significant role by equipping nurses with sufficient theoretical knowledge to sustain their nursing practices, thus helping to bring about the desired results in the nursing care. Incorporation of the theory in the nursing discipline is likely to steer positive outcomes in the sector thus leading to continued development of the discipline (Miranda, 2003). In this regard, this theory proves appropriate in equipping nurses with informed understanding of various practices in their disciplining such as analyzing assessment data among other significant nursing interventions.

Application of Borrowed Theory to Problem

Borrowed theory refers to a theory applied in a particular field, but which has been developed or shaped in another discipline (Villarruel and Bishop, 2001). As observed from various studies, the practice of health care disciplines borrowing theories from one another has become a norm in the contemporary world. Just like any other discipline in the health sector, nursing discipline has continued to rely on theories borrowed from other disciplines and this has raised constant debates and questioning on whether those theories, having been developed in other disciplines would bear adequate explanations of the nursing phenomena (Crosta, 2009). However, the truth of the matter here is that, by applying borrowed theories, nursing would be describing phenomena associated with those disciplines whereby propositions remains in the borrowed theorys context. Based on this understanding, application of borrowed theory in the practice problem mentioned in part one would not be empirically adequate in defining the phenomena in the discipline of nursing. In that case, the idea of a borrowed theory may prove inappropriate in helping nurses deal with the big problem of analyzing assessment data of patients and clients.

Conclusion

While significant progress is notable in the development of the nursing discipline, there is still much concern on the interventions that need to be administered in ensuring that effective and high quality nursing care is executed upon patients and clients (McEwen and Wills, 2010). As observed from this report, the application of nursing theories to practice situations proves to be a significant approach towards the overall achievement of nursing goals and missions within various health settings. Nurses are most likely to achieve the best value of their work through informed and guided nursing processes. Part 2 of this paper observes the middle-range theory as a significant intervention to the practice problem identified in part 1. Part 3 observes the idea of borrowed theory in nursing and the relevance this would have on the identified practice problem which proves to be inappropriate. However, the application of the two theories presented in part 2 and 3 is observed to have continued to raise some problems of inconsistency. Talking of middle-range theories, they are firmly sustained with empirical data and this may not be easy to achieve in some cases. On the other hand, borrowed theory is likely to raise issues by connecting theory and research in nursing.

References

Alligood, M. (2002). Nursing Theory: Utilization & Application (3rd ed). Missouri: Elsevier Mosby Publications.

Barbara, M. & Lynn, K. (2009). Holistic Nursing: A Handbook for Practice (5 ed.). New York: Jones & Bartlett Publishers.

Barker, A. (2009). Advanced practice nursing: Essential knowledge for the profession (1st ed.). Boston: Jones and Bartlett.

Benjamin, M. and Curtis, J. (1992). Ethics in nursing. New York: Oxford University Press.

Crosta, M. (2009). What Is Nursing? What Does a Nurse Do? Medical News Today. Web.

George, J. (2002). Nursing Theories: The Base for Professional Nursing Practice.5th ed. New Jersey: Prentice Hall.

Johnson, D. (1998). Symposium on theory development in nursing. Theory in nursing: borrowed and unique. Nursing Research, 17 (3), 206.

McEwen, M. & Wills, E. (2010). Theoretical basis for nursing (3rd ed.). Philadelphia: Lippincott, Williams & Wilkins.

Miranda, D. (2003). Nursing activities score. Critical care medicine, 31 (2), 374.

Mobley, C. & Johnson-Russell, J. (2005). Theory-directed nursing practice. New York: Springer Publishing Company.

Peterson, S. (2008). Middle range theories: application to nursing research. Maryland: Lippincott Williams & Wilkins.

Potter, P. and Perry, A. (2005). Fundamentals of nursing. Missouri: mosby.

Reed, P. (1991). Toward a nursing theory of self-transcendence: Deductive reformulation using developmental theories. Advances in Nursing Science, 17 (4), 56-64.

Tomey, A. & Alligood, M. (1998). Nursing Theorists and Their Work, 4th ed. Boston: Mosby.

Villarruel, A. and Bishop, T. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly, 14 (2), 158.

Whall, A. (1999). Conceptual models of nursing: Analysis and application. New York: Hall Publishers.

The research question may be formulated as follows: What effects does training aimed at improving new nurses cultural competence have on patient satisfaction? The independent variable, in this case, is the training provided to nurses as it will remain unaffected. The focus is on nurses who have little working experience. This is another independent variable. The dependent variable is the patient satisfaction that may (or may not) be affected by some intervention (the training provided to nursing professionals).

The hypotheses can be as follows:

1. The provision of training aimed at improving new nurses cultural competence results in improved patient satisfaction.
2. The provision of training improves new nurses cultural competence.

The hypotheses in question are causal as they focus on causal relationships between the variables (Grove, Burns, & Gray, 2014). In both hypotheses, the effects of the provision of certain training are examined. These effects are the improvement of patient satisfaction and the improvement of nurses cultural competence. These hypotheses are simple as they explore relationships between two variables. In the first case, the relationship between training and patient satisfaction is explored while in the second hypothesis, the focus is on the relationship between training and nurses competence.

Both hypotheses under discussion are directional as the identify a specific direction the research will take (Trice & Bloom, 2015). It is mentioned that the training will improve patient satisfaction and will also have a positive effect on nurses competence, so a positive effect is expected. These are research hypotheses as they identify a specific relationship between the variables. In both cases, it is mentioned that there are certain effects of the training provided to nursing professionals.

References

Grove, S., Burns, N., & Gray, J. (2014). Understanding nursing research. St. Louis, MO: Elsevier Health Sciences.

Trice, L. B., & Bloom, K. C. (2015). Asking the right question. In C. Boswell & S. Cannon (Eds.), Gender identity and gender politics (pp. 215-232). Burlington, MA: Jones & Bartlett Publishers.

The worksheet presented below is targeted as describing two educational frameworks of perennials and positivism. Its analysis will be beneficial for understanding the key principles as well as the way in which both frameworks are used in education and can be used in the nursing curriculum.

To conclude, perennials and positivism are frameworks different not only in their definitions but in the nature of their application. While perennials is a general approach that implies equal treatment for all participants of the educational process, positivism is specifically targeted at promoting logical thinking and sensory experiences when it comes to education.

References

Dible, R. (2010). The philosophy of mysticism: Perennialism and constructivism. Journal of Consciousness Exploration & Research, 1(2), 173-183.

Jent, G. (2003). Perennialism. Torch Trinity Journal, 6, 3-21.

Johnson, B., & Onwuegbuzie, A. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher, 33(7), 14-26.

Mack, L. (2010). The philosophical underpinnings of educational research. Polyglossia, 19, 5-11.

Uzun, U. (2011) What is your educational philosophy? Modern and postmodern approaches to foreign language education. SSLLT, 2(3), 333-348.

Research Problem and Purpose

For Magnan and Norris (2008), the context of plumbing student nurse attitudes in the area of barriers to accommodating patient sexuality and sexual needs is occasioned by the erosion of social mores, the resurgence of teenage pregnancy and abortion rates, and the continued prevalence of sexually transmitted acute and chronic disease. Little is known, they maintain, about how nursing students currently perceive barriers to addressing, among others: a) sexuality issues in the African pandemic that is HIV and the treatment of AIDS patients within America itself; b) the agitation by marginalized homosexuals, cross-dressers and transsexuals for acceptance of their gender choices and roles; and, c) sexual harassment and outright rape of women and children. The authors essentially argue from the platform that nurses should be prepared to address sexuality as an intrinsic component of holistic health care.

Beyond simply social relevance, the research proposed to solve the problem of both nurse and patient being reluctant to engage with each other on assessment of sexuality, taking a sexual history, or offering related counseling. Since nurses have the requisite training, only sheer inhibition on both sides prevents such beneficial practices in a clinical setting.

Review of the Literature

The study at hand goes back a long way to trace the origins of concern with the potentially useful role of nurses in showing empathy for the sexuality-related issues in patients under their care. Magnan and Norris demonstrate that there have been studies about nurses attitudes towards human sexuality issues since the 1970s. Coverage extends only to 2005 and 2006  one that establishes the body of knowledge about accelerated nursing programs, a Potter and Perry book about the fundamentals of nursing, and two more that Magnan had authored with Reynolds concerning precursors to the research covered by this critique  and only because the researchers had submitted the manuscript to the Journal of Nursing Education (JNE) as early as two years before the piece saw light in the pages of the journal.

Employing the heavily-attitudinal Sex Knowledge and Attitudes Test (SKAT), the early investigations were conducted in the hope that patients would benefit more if nurses could acknowledge that conservative attitudes make them prone to &punitive attitudes, careless statements, and inappropriate reactions (Magnan and Norris, 2008, p. 261). Even then, comparisons had already been drawn between nursing students on one hand, and RNs or family planning nurses on the other. Over time, participants evinced swings between liberal and conservative attitudes, presumably reflecting cycles in social mores. When SKAT-based studies were replicated in British settings, one barrier that did emerge was patient reticence about discussing matters of sexuality with nurses. Still, it bears pointing out that the U.K. investigations did not consider it worthwhile to break out the findings for student nurses in the sample.

This inordinate attention to the information gap where student nurses are concerned is explained simply by the fact of submission for publication in the JNE.

In compiling the literature review, the authors consistently focused on readiness for assessing and counseling patients on sexuality matters related to their condition; in effect, this is the criterion variable. On the other hand, the explanatory concepts revolve on liberalism/conservatism, knowledge, sexual myths, and permissiveness with respect to auto-eroticism, heterosexual acts, premarital intercourse and adultery. Finally, the authors evince an interest in sexual health as the critical outcome.

Theoretical Framework

Given the subject matter, it stands to reason perhaps that the authors fall back on no theoretical concepts. Instead, the research is framed by nursing practice becoming more complex for having to empathize with previously-overlooked sexual health issues. In effect, the Magnan and Norris argument for better nursing training and for more tolerant attitudes is based on ideology.

Variables/Hypotheses/Questions/Assumptions

As a descriptive and correlational study, the Magnan and Norris research focused on the independent variable of attitudes of addressing patient sexuality concerns among nursing students. In effect, the research question investigated whether RN attitudes in the clinical setting have their origins in preexisting attitudes earlier in life. This study therefore relies on the construct that attitudes are enduring predispositions hardly altered by education or early on-the-job training.

Besides age, the explanatory and independent variables consist of gender and educational level. The null and alternative hypotheses are not specifically stated. Suffice it to imply that reticence about addressing sexuality concerns of patients is greater among female, younger, and lower-level nursing students

The dependent variable itself is operationalized in the attitudes measured by the Sexuality Attitudes and Beliefs Survey (SABS) study instrument developed by Reynolds and Magnan (2005) shortly before the study subject of this critique. SABS measures attitudes pertaining to personal comfort, confidence, meeting patient expectations, and making time to address patient sexuality concerns (pp. 256-8) in nursing practice and covers not at all the permissiveness operationalized in heterosexual practice and behavior that SKATdid.

Methodology and Research Design

This is a quantitative-type study, employing a convenience sample of 341 students in one school setting. As such it can be argued that the findings are representative solely of that school though other researchers may certainly test reliability by replicating the findings in other schools and settings.

Respondents ranged from sophomores in a baccalaureate nursing program to a 52-year-old in the accelerated, second-degree program. It is not known whether the total sample covered all nursing students in the university or whether there had been an effort to systematically sample from among all available classes (SABS was administered in-classroom). Participation was voluntary to the extent that any student could opt to return the questionnaire unaccomplished or (in the case of seniors) not respond at all to the online invitation. Given the unknown about this having been census or systematic sampling, it is impossible to judge the type of sampling done.

The aforementioned absence of theory, the admitted descriptive study approach and the obvious procedure of moving from single observations to generalization and theory are all hallmarks of inductive logic.

Ethical considerations were addressed by asking students to return accomplished (or not) questionnaires in envelopes provided for the purpose, by having the professor handling the particular class leave the room during test administration, and by routing the online responses of seniors to a secure Web site.

As to reliability, the authors report simply an acceptable calculated internal consistency reliability of 0.74 (Cronbachs ±). One aspect of internal validity was addressed by incorporating a shortened form of the Marlowe-Crowne Social Desirability Scale in order to test for bias towards socially acceptable responses. Findings were marginal, suggesting that study participants were inhibited by both the natural desire to present an acceptable front and by apprehension that responses might impact their course standing.

Data Analysis

Data analysis included simple counting up of scores on SABS (with higher scores of up to 61 indicating greater attitudinal barriers to engaging with patient sexuality), correlation with the Marlowe-Crowne social desirability scores (not statistically significant and therefore ostensibly honest responses), and statistical analysis for differences across participant subgroups. Presentation of data was done exclusively in the form of a cross-tabulation between agreement-disagreement on the 12 SABS items and academic levels: sophomore, junior, senior baccalaureate and senior/second degree.

Owing to the nature of the data (the cumulated SABS scores are effectively an ordinal scale) and item-by-item recoding in the second stage into the categorical form agree/disagree, Magnan and Norris employed the MannWhitneyWilcoxon (MWW) rank-sum and the Kruskal-Wallis tests as nonparametric equivalents for the t test and ANOVA, respectively. Like the t test, MWW examines whether two sub-samples (e.g. by educational level) come from the same population. For its part, Kruskal-Wallis tests for differences of medians since the distribution of answers (to both SABS and the social desirability scale) was very likely to be skewed instead of exhibiting something akin to a normal curve.

By way of example, the authors report that a greater proportion of sophomores made time to assess sexual health concerns of patients than did juniors and seniors in the traditional baccalaureate program. As well, seniors were more likely to disagree about patients having expectations of their nurses for engaging with sexuality matters.

Summary/Conclusions, Implications & Recommendations

The principal strength of this study is that findings make intuitive sense. Those who had had formal classes in human sexuality in nursing school naturally felt more competent and on surer ground. Hence, they could address sexual health care with fewer barriers. On the other hand, barriers are greater for male students presumably for being more inhibited about attaining empathy, risking accusations of undue intimacy with female patients, and (as elsewhere in real life) avoiding intimations of homosexuality in male-male encounters.

A second strength of the study is that having taken a course on human sexuality makes a difference. This explains why the research was submitted for publication to the JNE in the first place.

The absence of information about sampling design prevents the casual reader from judging whether the findings can be projected to other centers of nursing education. As an RN with a PhD and a handful of published works, Mr. Magnan may even be faulted for lack of objectivity. He does not, for instance, ponder the truth of sophomore nurses claiming to give more time for sexuality assessments when they have no ward duty yet.

References

Magnan, M. & Norris, D. (2008). Nursing students perceptions of barriers to addressing patient sexuality concerns. Journal of Nursing Education, 47(6), 260-8.

Reynolds, K.E. & Magnan, M.A. (2005). Nursing attitudes and beliefs toward human sexuality: Collaborative research promoting evidence-based practice. Clinical Nurse Specialist, 19: 255-259.

Introduction

The content of nursing has changed over the centuries as the demands of society, and the conditions of life have varied. Nowadays, nursing care models define the essence of relationships between a nurse and a patient. Any model focuses on a patient and his or her health problems.

The nursing care model observed in practice refers to Nightingales model that distinguishes between caring for sick and caring for healthy people. In particular, health care delivery services performed at the local hospital by nurses were different from healthy and sick patients. If the core role in caring for healthy patients was given to education and prevention strategies, then sick people were treated with the aim of improving their standard of living. As a result, such an approach provided within half a year proved to be rather effective for patients health outcomes.

Nursing Care Model Identification

In her article, Magpantay-Monroe (2015) discusses the concept of emotional intelligence in relation to Nightingales nursing care model. In order to detect any connections between the above notions, the scholar analyzes writings and pictures of Florence Nightingale. The author comes to the conclusion that Nightingale expressed a firm conviction that nursing as a profession differs from medical practice and requires a special form of medical knowledge.

It is also stated that the application of this model contributes to leadership, motivation, and integration of nurses that, in turn, are likely to develop emotional intelligence prospects. Magpantay-Monroe (2015) claims that compassion with which she wrote her letters is great and inspirational. Therefore, the study findings maintain the model implication by the fact that it may be used as the prototype to prepare emotionally intelligent nurses.

Another research by Selanders and Crane (2012) focuses on the role of Nightingales model in nursing advocacy. This theoretical study aims at providing a safe health care environment through the consideration of nursing leadership strategies. The authors state that Nightingale distinguished the simple domestic service from nursing care for the first time. Furthermore, the authors focus on the modern environment and argue that the 21st-century requirements remain complicated and multifaceted in spite of technology development.

The leadership development model and the egalitarian value system serve as the measurement tools to evaluate the mentioned concepts. The importance of this study refers to the fact that it proves the relevance of Nightingales model to the modern nursing metaparadigm. In particular, nurses may apply it to advocate for patients rights effectively in terms of health and the environment. In other words, the research findings contribute to the implementation of this nursing care model in modern advocacy.

The purpose of the article by Englebright, Aldrich, and Taylor (2014) is to implement an electronic health record (EHR) system based on Hendersons nursing care model. The authors begin with the identification of the theory and participants of the study. The first eight principles are focused on physiological needs, and others  on the needs for security along with social, psychological, and spiritual needs. These principles form the basis for the definition of nursing that can be specified as follows: the role of a nurse is to help a patient or a healthy person in carrying out activities that promote his or her health or recovery.

Each of Hendersons needs can vary depending on the situation. The nursing assessment of a patients condition determines the most important of the listed needs with the goal of developing a systematic nursing care plan. After that, the authors apply the Clinical Care Classification (CCC) system to conduct the study. They conclude that nine basic needs are to be included in EHR system, the use of which will help to accurately document and communicate medical information.

Ahtisham and Jacoline (2015) aim at the elaboration of implication strategies in the care setting. They state that Henderson suggests a new, scrupulously adjusted definition of nursing, which is used until nowadays. The nurses mission is to help a person, either sick or healthy, to perform actions related to the maintenance of his or her health. At the same time, they point out that Henderson constantly stressed that a nurse is expected to help a patient to become independent as soon as possible.

The assessment of the quality and results of care is carried out when the fundamental needs for which nursing intervention has been applied are met. To test the applicability of the nursing model, Ahtisham and Jacoline (2015) create a case study based on Pakistani environment. They come to the conclusion that this model is useful to be applied in practice as it is likely to benefit patients by enhancing their health and to promote staff satisfaction.

Implementation of Current Nursing Care Model and Recommendations

Nightingales model can be applied in practice to implement emotional intelligence, thus creating the appropriate patient-centered approach. The ability to understand the needs and expectations of patients in a timely manner is of great importance for nurses (Kamau, Rotich, Cheruiyot, & NgEno, 2015). This will promote comfortable and trustful relationships between a nurse and a patient.

As a result, a nurse would receive a complete understanding of a patient and have the opportunity to apply relevant nursing theories and instruments. Consequently, a patient would receive high-quality health care delivery and enhanced health outcomes. The strategies proposed by Nightingale show that special knowledge and skills are required to advocate for patients rights (McCrae, 2012). For example, respect for their personality, freedom of expression, and confidentiality can be noted.

To implement Hendersons nursing care model, it is essential to make sure that a highly qualified nurse have sufficient knowledge and skills to plan, implement, and evaluate the results of care, meeting the needs of an individual patient. At the same time, special emphasis should be placed on the uniqueness of the contribution of nursing care to the recovery of a patients health. The nursing interventions are to be aimed at achieving a patients independence to meet his or her basic needs and improve health indicators (McCrae, 2012).

In his model, the authors emphasize the obligatory participation of a patient in identifying and resolving his or her health problems. When examining a patient, a nurse should discuss the conditions for providing nursing care as only in a state of high dependence of a patient, such as a comma or a state of complete prostration, a nurse has justified motives for making a decision. In this regard, the role of a nurse represented by Henderson on both sides. On the one hand, a nurse is an independent specialist of the healthcare system as she or he performs those functions that a patient needs in order to feel comfortable. On the other hand, a nurse is an assistant of a doctor, performing his or her prescriptions.

For example, if a patient refuses to eat the hospital food, then his or her need for food is not satisfied. In collaboration with a patient, a nurse should determine the possible causes of this problem (poor appetite, fastidiousness, and so on) and set realistic goals to address the problem. In case a patient is disturbed by sleep, a nurse should establish the causes of this problem (uncomfortable bed, stuffiness, etc.) and then specify the goals of nursing care and intervention. To resolve such problems, a nurse is expected to identify several short-term goals. With this in mind, in case of a patient who refuses food, one should plan a conversation with relatives, a patient, and staff of the food unit. In case of a patient with sleeping problems, relaxation exercises or timely aeration should be planned. The goals set should be realistic and measurable, so that either success or failure of nursing intervention can be assessed.

Conclusion

In conclusion, it should be pointed out that this assignment helped in learning nursing care models, including theoretical aspects and practical steps. I understood the two fundamental models in detail that is likely to allow me implementing them in practice, thus improving health care delivery quality and meeting patients requirements. In particular, according to Florence Nightingales model, a nurse should provide different care to those who are sick and those who are healthy, considering their specific needs. The model by Virginia Henderson identifies the key needs of a patient that should be satisfied in terms of the comprehensive approach, taking into account both physical and psychological well-being.

References

Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice: Virginias Henderson need theory. International Journal of Caring Sciences, 8(2), 443-450.

Englebright, J., Aldrich, K., & Taylor, C. R. (2014). Defining and incorporating basic nursing care actions into the electronic health record. Journal of Nursing Scholarship, 46(1), 50-57.

Kamau, S. M., Rotich, R. J., Cheruiyot, B. C., & NgEno, L. C. (2015). Applying Florence Nightingales model of nursing and the environment on multiple drug resistant tuberculosis infected patients in the Kenyan setting. Open Access Library Journal, 2(8), 1-10.

Magpantay-Monroe, E. (2015). Exploring the emotional intelligence of Florence Nightingale. Asia-Pacific Journal of Oncology Nursing, 2(2), 107-111.

McCrae, N. (2012). Whither Nursing Models? The value of nursing theory in the context of evidencebased practice and multidisciplinary health care. Journal of Advanced Nursing, 68(1), 222-229.

Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. The Online Journal of Issues in Nursing, 17(1), 1-6.

Nursing Theory: Name of Theorist and Background

Nurse Practitioners (NPs) can borrow numerous concepts and elements from nursing theories to improve the health outcomes of their clients. It is appropriate for healthcare workers to be aware of some of the grand and mid-range nursing theories. I believe that I can use different nursing theories to come up with an effective healthcare delivery model. One of the theories that are appropriate for my practice setting is Madeleine Leiningers Transcultural Nursing Theory (McFarland & Wehbe-Alamah, 2014). This theory is meaningful because it can guide me to deliver evidence-based care to more clients from diverse backgrounds.

Madeleine Leininger is admired by many professionals in nursing because of her contributions to the field. The transcultural concept in nursing gained much attention because of the works of Leininger. The theorists background is believed to have impacted the development of this nursing model. Born on 13^th July 1925, Leininger pursued her dreams tirelessly to transform the health outcomes of many people. She pursued her diploma in nursing from St. Anthonys Hospital School of Nursing (McFarland & Wehbe-Alamah, 2014, p. 27). She later obtained her bachelors degree from Creighton University (McFarland & Wehbe-Alamah, 2014). She earned a Master of Science in Nursing from the Catholic University of America (McFarland & Wehbe-Alamah, 2014). She later earned a PhD in the year 1966 (McFarland & Wehbe-Alamah, 2014). The idea to come up with the Transcultural Nursing Theory emerged at the time she was studying social and cultural anthropology for her PhD (McFarland & Wehbe-Alamah, 2014). The knowledge gained from the study encouraged her to analyze the issue of cultural differences in healthcare practice from a critical perspective. She also took up a wide range of lecturing and teaching jobs. These practices equipped her with new concepts that led to the development of the Transcultural Nursing Theory.

Leiningers theory is believed to have evolved systematically based on her ideas and studies. This knowledge can be obtained from the books written by the theorist. The book Culture Care Diversity and Universality published in 1991 explored the importance of diversity in medical practice. In this text, the author acknowledged the fact that differences occur in nursing because people come from diverse backgrounds. The synthesized theory was published in another book titled Transcultural Nursing. The book came up with a powerful model that focused on the best nursing practices that are appropriate whenever dealing with patients from diverse backgrounds. These works led to the refinement of the Transcultural Nursing Theory in 2002.

Leiningers nursing model addressed various concerns or problems that had been ignored for decades. Before the 1990s, many nurses were not aware of the unique role of culture in healthcare practice. Most of the practitioners during the time were unable to offer quality care depending on the unique needs of their patients from diverse populations. During that time, the demographics of the United States were changing significantly. That being the case, the theory emerged as a powerful model for understanding and addressing the diversity experienced in nursing (McFarland & Wehbe-Alamah, 2014). The theory appreciated the fact that patients possessed diverse spiritual needs, cultural values, and religious beliefs. The most appropriate nursing philosophy should put these aspects into consideration.

Theory Description

The theorist uses deductive reasoning to come up with the model. This kind of approach begins with a general understanding or rule. This understanding is then developed further to come up with the theoretical framework. From the very beginning, Madeleine Leininger acknowledges that every person belongs to a given culture. That being the case, a persons culture influences his or her behaviors, health outcomes, healing processes, and communication channels. The deductive approach is taken further to acknowledge the fact that healthcare workers should be ready to study the unique aspects and cultural attributes of their respective patients (Axford, 2015). This information is used to develop the transcultural model for effective nursing practice. The deductive approach, therefore, empowered Leininger to come up with the theory.

Several concepts have been used by the scholar to develop the theory. The first outstanding concept is that cultural competence is something meaningful in nursing. The theorist goes further to indicate that cultural knowledge is vital whenever delivering patient care. The other concept revolves around the ideas of wellbeing and illness. According to the theorist, wellness and illness are influenced by a patients social and cultural attributes. The other powerful concept is that culture will influence all the major spheres of human life (Axford, 2015, p. 6). Culture is also described as a powerful force that guides or dictates human behaviors. Nurses, therefore, should be aware of these attributes to offer effective and quality support to their clients (Viadas, 2015). This analysis reveals that the concepts have been defined operationally. This is the case because the notions are guided by the informed understanding and knowledge of the author. The description of concepts is also guided by the key definitions of the theory such as religion, culture, cultural competence, wellbeing, and intercultural communication. This is a clear indication that the use of terms and concepts in the theory is consistent.

The concepts described above have been defined explicitly. This is the case because Leininger uses direct descriptions depending on the meaning of the key definitions in the concepts. For example, the aspect of transcultural nursing borrows a lot from culture, inclusiveness, and cultural competence (Prosen, 2015). The author indicates clearly that culture is something that will always dictate human behaviors and health outcomes. This is an explicit idea that cannot be refuted. The theorist goes further to explain how and why nurses should be aware of a populations culture to be able to deliver evidence-based care (Viadas, 2015). Human beings use their cultural values and ideas to reshape their behaviors. This definition makes it easier for the theorist to come up with unique definitions that can be taken seriously by nurses who want to apply the model in their health practices (Axford, 2015). Some of these definitions include trans-cultural practice, cultural awareness, cultural risks, acculturation, diversity, and ethnicity (Axford, 2015, p. 7).

Leiningers theory of nursing has several propositions that can be used by practitioners who want to maximize their patients outcomes. To develop the propositions, the theorist relies on the outlined concepts and key terms. The first proposition is that nurses should be on the frontline to study the cultural aspects of the patient and deliver evidence-based care (Larson, 2014). The second proposition is that nurses should develop powerful plans that can meet the changing needs of the patients. Nurses should go further to design unique care delivery philosophies depending on the aspects of the targeted cultural groups. These propositions borrow the ideas outlined in the presented concepts (Viadas, 2015). That being the case, the concepts and propositions of the theory can guide nurses to understand and appreciate the values, cultural aspects, and beliefs of the targeted patients. This strategy will result in the development of a powerful health promotion model. Nurses and practitioners who fail to embrace these attributes will find it hard to meet the changing health needs of diverse populations.

Evaluation

Leininger presents both explicit and implicit beliefs in the theory. The assumptions and beliefs are defined clearly to inform nursing practice (Prosen, 2015). The first assumption is that nurses should focus on the cultural values, beliefs, and notions of their respective clients. The second one is that nursing should be implemented as a transcultural practice that is capable of addressing the needs of diverse populations (Larson, 2014). Another belief is that nurses should acknowledge that individuals from diverse backgrounds require different care models. These beliefs are founded on the premise that global cultures have similar health needs but practices. This is the case because cultures are characterized by different languages, cultural values, religious beliefs, and care delivery models (Viadas, 2015). When these assumptions are embraced, Leininger believes strongly that nurses can find it easier to address the changing needs of their patients.

Madeleine Leiningers theory does not describe the four meta-paradigms of nursing. However, the unique elements described in the theory echo the meta-paradigms of nursing. To begin with, health is considered as the ultimate goal that should be targeted by nurses who provide culturally competent care (Larson, 2014). The second meta-paradigm is the patient or human being. This concept is supported by some of the concepts of the theory such as cultural groups, personal beliefs, and families. The ultimate goal of nursing should, therefore, be to deliver quality care that is congruent with the needs of individuals depending on their cultural backgrounds. The other aspect is the environment. The theory describes this meta-paradigm using different elements such as social structures, cultural practices, and diversity (Axford, 2015). The author of the theory believes strongly that cultural practices constitute the environment and eventually dictates the health outcomes of every patient. The fourth meta-paradigm is nursing. Leiningers theory describes nursing as a powerful practice that focuses on the cultural attributes and perspectives of targeted clients. These elements can, therefore, guide nurses to apply the theory by the four meta-paradigms of nursing.

Leiningers Transcultural Nursing Theory is a powerful model that is supported by explicit concepts and definitions. The major terms used to develop the theory have been defined and analyzed professionally. The concepts are described clearly and accurately. By so doing, the theorist managed to come up with powerful propositions that make the theory applicable in different healthcare settings (Viadas, 2015). The author goes further to describe how propositions can be applied in a wide range of healthcare settings. For instance, the theory can guide nurses to analyze the cultural attributes of their clients, embrace traditional healing procedures, support the use of multidisciplinary teams, and collaborate with underserved populations (Betancourt, 2015). The elements have been defined clearly. These aspects, therefore, show clearly that the aspects of the theory are presented consistently. Nurses can, therefore, embrace these elements, propositions, and attributes to come up with a powerful healthcare delivery philosophy.

Application

Nurses can benefit significantly from Leiningers theory. This is the case because the theory outlines several concepts, ideas, and propositions that can be used to design a powerful nursing philosophy. NPS is always expected to become leaders who can promote sustainable practices and eventually support the wellbeing of their patients. Within the past century, human beings have been migrating from one region to another. Consequently, cultural diversity has become a reality in every part of the world (Betancourt, 2015). These cultural groups will always need quality medical care and support. That being the case, nurses should be ready to meet the needs of their patients from diverse backgrounds. The Transcultural Nursing Theory is therefore a powerful framework that guides nurses to implement appropriate processes that can maximize patient outcomes.

The theory is guided by powerful concepts and propositions that are applicable in different healthcare settings. For instance, cultural competence is a powerful concept that can be embraced in every institution. Caregivers who possess this concept will be able to analyze the religious values, cultural attributes, and social behaviors of their respective clients. This knowledge will make it easier for nurses to develop powerful models that can deliver quality support to more patients (Larson, 2014). This theory is a powerful model that can guide and inform nursing actions. The knowledge can empower nurses to develop evidence-based practices and strategies that can support the emerging needs of their clients. The theory is appropriate for NPs, physicians, psychiatrists, clinicians, and family nurse practitioners (FNPs). The propositions can, therefore, be embraced to develop evidence-based practices depending on the unique needs of the targeted patients. When more nurses become proficient providers of culturally competent care, it will be easier to transform the field and maximize the outcomes of every underserved population.

As a Nurse Practitioner (NP), I strongly believe that Leiningers theory of transcultural nursing will support my career goals. To begin with, the theory guides me to begin by acknowledging the fact that the cultural affiliation and social practices of a given population will influence its health outcomes. With this understanding, I can go further to identify the unique behaviors and risk factors that are associated with various diseases. This knowledge will make it easier for me to develop a powerful philosophy that can influence the health outcomes of my patients (Betancourt, 2015). The concept of lifelong learning appears to emerge from this theory. This is the case because nurses should seek new ideas in an attempt to improve their models. I will, therefore, use the model to analyze the cultural needs and attributes of my clients. The knowledge gained from this theory can be expanded further to develop new concepts in nursing. For instance, the theory can encourage me to embrace the power of teamwork to deliver culturally competent care to targeted patients. The theory supports the use of evidence-based approaches depending on the emerging concepts and needs of the targeted patients (Larson, 2014). I will also embrace the power of multidisciplinary teams to ensure more patients from diverse backgrounds receive quality nursing support. These aspects will inform my practice as an NP.

References

Axford, R. (2015). Nursing education and practice: What cultural competency can teach us. Scientific Cooperations Medical Workshops, 1(1), 1-10. Web.

Betancourt, D. (2015). Madeleine Leininger and the Transcultural Theory of nursing. The Downtown Review, 2(1), 1-7. Web.

Larson, M. (2014). Cultural immersion and compassionate care in a study abroad course: The Greek connection. Journal of Compassionate Health Care, 1(8), 1-13. Web.

McFarland, M., & Wehbe-Alamah, H. (2014). Leiningers culture care diversity and universality. Burlington, MA: Jones & Bartlett Learning.

Prosen, M. (2015). Introducing trans-cultural nursing education: Implementation of Transcultural Nursing in the postgraduate nursing curriculum. Procedia  Social and Behavioral Sciences, 174(12), 149-155. Web.

Viadas, C. (2015). Historic perspectives from anthropology: Reflections proposed to Transcultural Nursing. Investigación y Educación en Enfermería, 33(2), 374-379. Web.

The tuition reimbursement occurs when the employer pays for employee education expenses after he/she passes the classes. This practice used to be beneficial both for medical institutions and individuals as it increases the overall level of societys healthcare, hospital performance, and reputation. In their turn, medical professionals use this employment-based benefit as a chance to improve their knowledge, skills, and activity. According to Eslamian et al. (2015), medical staff should regularly update their knowledge via continuing education (CE) programs that are primary components of professionalism and competency. Advanced education helps the latter build their experiences without incurring additional costs or dedicating their whole time to education. The nursing salary research report revealed that most CE healthcare professionals plan to attend classes to increase their salaries (Jakucs, 2018). Instead, 50% of nurse respondents point at receiving certificates and education as their primary goal. Moreover, the majority of nurses highly value employers who offer CE programs that encourage the former to become long-term employees. This paper will further focus on tuition reimbursements importance and justification in the healthcare industry.

The Cost of Reimbursement Programs versus Return on Hospital Investment

The majority of hospitals offer reimbursement programs despite their relatively high costs. Reimbursement, in contrast to scholarships and grants, does not cover tuition costs upfront. It is often accompanied by a signed commitment of the employee to continue working at the same workplace for a couple of years if he/she plans to secure the reimbursement. Moreover, healthcare institutions incorporate other restrictions to their programs, including the maximum amount of tuition reimbursed according to educational outcomes (grades received). For instance, 100% cost recovery will be granted to those who received A, while those who got B will receive 75%. Approximately $2,600 were granted on average to 40% of nurses for educational purposes in 2018 (Jakucs, 2018). The benefits for nurses are quite clear, including improving skills, knowledge, salary, and career prospects.

Hospitals also enjoy a set of crucial advantages stemming from CE reimbursement. Return on investment (ROI) compares the initiatives costs to its outcomes (cost reduction or profit). Reimbursement is considered as a hospitals investment, and it proved to be financially beneficial if appropriately designed. Many different studies found that it increases job satisfaction, competence, and confidence (Opperman, 2016). It usually leads to decreased turnover and significantly raised retention due to special contracts, employee satisfaction, and higher loyalty. The ROI indicators proved that tuition refund practice is an excellent investment, as cost savings are often higher than initially incurred money (Opperman, 2016). Further study also highlighted that additional education is financially beneficial in decreasing length of stay, surgical site infections, preventing pressure injuries, and improving staff confidence (Opperman, 2018). In other words, tuition reimbursement may positively affect a hospitals promotion, retention, recruitment, productivity, and performance.

The Return on Investment for a Nurse Going to School

The programs offered by hospitals encourage staff to pursue additional education that improves their ultimate performance. Busy nurses have a chance to attend special courses and advance their academic achievements. Finances and time are two main obstacles working health professionals face in CE (Taylor, 2015). It offers greater professional opportunities for them, including home-based, outpatient, and acute care. The bachelor and higher programs are usually focused on policy, finance, leadership, teamwork, communication skills, and other subjects related to their obligations. Thus, CE contributes to better-implementing healthcare reforms and retaining more professional staff in the long-term. Moreover, such programs help enhance financial support, healthcare culture and align individual goals with institutions ones.

It is not enough to conduct employee satisfaction research to assess the outcomes of continuing education financed by the hospital. It may require the application of cost analysis, ROI, benefit-cost ratio, and cost-effectiveness analysis approaches (Opperman, 2018). The managers performance following the passed courses should be tracked and compared to previous results before his/her enrollment. The difference in performance and other stuff opinions may give an essential insight into the programs effectiveness and improvement of hospital management.

The Argument and Position Concerning Cost of Education and Benefit to the Hospital

To my mind, tuition reimbursement is a practical investment that yields positive outcomes for hospitals, their employees, and the community. Although medical institutions often cut spending on CE in times of financial hardship, I believe that this practice should be further maintained at least partially. Otherwise, the hospital will put retention, job satisfaction, and quality of service in danger. The returns on well-designed hospital investment are capable of compensating for expenditure on education.

Nevertheless, during a recession, it is important to limit education investment instead of its total elimination. The hospital management should rather focus on short-term cost reduction methods regarding medical expenses and find ways to increase revenue. The amount of tuition that can be reimbursed should be moderately cut. According to Taylor (2016), every dollar spent on education may generate at least 1.3 dollars of cost savings by talent management and retention. The tuition reimbursement (close to the national average) will help retain most healthcare professionals. Moreover, it is expected to bring long-run benefits regarding performance and cost savings.

To conclude this part, investment in CE is beneficial both for institutions and nurses. The latter are encouraged to enhance their skills and knowledge positively contribute to the organizations performance. The higher quality of management and provided services enhance the hospitals reputation in the eyes of patients. What is more, this approach improves communication, teamwork, offers learning access, and financially supports talented people who have not enough money for further education.

Recommendation to the CFO in Fiscal Terms

I am convinced that the hospital will lose a range of benefits by stopping the tuition reimbursement program. Hence, I recommend limiting the expenditures on CE to the regional level. Moreover, management should pay attention to spend less on short-term workers and identify those who have a higher potential to benefit the organization (assessment of past performance). To do that, the former should establish requirements such as special contracts (setting legal obligations between parties), type of degrees, and grade attained. It will help to use wisely organizations resources both for the benefit of employees and the hospital. I recommend the CFO regularly assess the information collected regarding CEs results and apply advanced technologies to monitor educational progress. Such monitoring will help to identify the best candidates to be the organizations leaders. This method will foster the hospitals top management decision-making process (if they should or should not invest).

To conclude, nursing tuition reimbursement is essential for every medical setting that strives to improve its service quality. In order to maximize benefits in the long-run, this approach should be integrated by the hospital. The CFO will benefit more from cutting some medical expenditures instead of eliminating CE costs. Although nursing tuition reimbursement should be limited and monitored, I recommend preserving this approach even during the recession.

References

Eslamian, J., Moeini, M., & Soleimani, M. (2015). Challenges in nursing continuing education: A qualitative study. Iranian journal of nursing and midwifery research, 20(3), 378.

Jakucs, C. (2018). Tuition reimbursement could be key to attract and retain fresh RN talent. Nurse.com.

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S. (2018). Measuring return on investment for professional development activities: 2018 updates. Journal for Nurses in Professional Development, 34(6), 303-312.

Opperman, C., Liebig, D., Bowling, J., Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for nurses in professional development, 32(4), 176-184.

Taylor, B. (2015). Flexible programs, tuition breaks help nurses pursue bachelors degrees.

Concept of Excellence as it Relates to Nursing Education

The concept of excellence in nursing education refers to the practice of ensuring that nurses who graduate with diplomas, associate degrees, baccalaureate, masters degree or doctoral degrees not only have the theoretical knowledge but also practical experience to handle patients (Wittmann-Price, 2008). The concept has gained popularity in the recent past due to the growing partnership between learning institutions and healthcare facilities in various parts of the world. It seeks to ensure that the graduates are competent enough to handle patients in various contexts. The following figure shows fundamental elements of excellence in nursing education.

As shown in the above figure, a nurse can only be considered competent enough to handle patients if he/she has the capacity to the tasks identified in the figure above. They must be able to watch over the patients, assess them, and recognize any complications that may need the attention of a doctor. The graduate must have proper clinical reasoning and decision-making skills. According to Nee (2013), such nurses should have skills in patient engagement before they can start working in healthcare facilities. The concept emphasizes on nursing diagnosis. As Montagu (2010) says, nurses should be able to identify any new complications in their patients as soon as possible. There are also other cases where nursing intervention may be necessary. This is specifically so when the patient develops complications at a time when the doctor is out of reach. All these factors will culminate into nursing outcomes.

How Changes in Nursing Education Relate to Changes in Other Health Professions Education

According to Montagu (2010), nursing education has undergone a number of changes in the recent past. Nurses are no longer mere assistants to the doctors in a healthcare setting. They have become an integral part of the medical staff that can go beyond offering care services. This means that they can do some tasks that were previously considered exclusively for medical doctors. This has been reflected in the nursing curriculum in nursing colleges. Nursing education now seeks to empower nurses to be professionals who are dynamic and multi-skilled.

Changes in nursing education have contributed to changes in other health professions education. Other healthcare experts now have to learn how to work with more skilled nurses who understand human anatomy better than they did in the previous years. For example, it has become necessary for the doctors to find ways through which they can work effectively with modern nurses. As Wittmann-Price (2008) says, doctors must now consider nurses as partners other than assistants who are there to receive instructions. This has forced medical schools to reevaluate their curriculum in order to find a new position of nurses in the medical centers. To ensure that there is harmony and efficiency in hospitals and other medical centers, educators are trying to come up with a new curriculum that will place nurses as partners who can participate in critical decision-making processes. Nurses now have the capacity to operate some of the complex medical equipment that was previously operated by medical doctors. This means that they are taking some of the roles of doctors. To ensure that there is harmony in this new role definition, other health experts must go through a new system of education.

Meaning of Partnership as it Relates to Nursing Education

The concept of partnership in nursing education refers to the relationship that exists between the nurses, their patients, friends, and relatives of the patients. According to Moyer and Wittmann-Price (2008), it is individualized care where nurses make a concerted effort to develop personal relationships with the patient in order to improve the quality of care.

Concept of partnership and how it is mutually beneficial to nurse educators

The concept of partnership is beneficial to nurse educators in the current society where the public has a lot of expectations from the nurses. According to the research by Lee and Tilbury (2008), nurses have been working under very stressful environments making them less efficient. In many instances, they are forced to work with patients who do not want to corporate with them. This makes it difficult to monitor their conditions and determines if they are making any progress. Partnership in nursing is mutually beneficial to the nurses and their patients. A nurse will find it easy to communicate with his/her patient. Through this communication, the nurse may easily know the progress the patient is making and any issue that could be hindering their recovery rates. On the other hand, the patients get to benefit from this partnership because they can easily explain issues that are affecting them within the hospital. As Saleh (2006) says, in this strategy, a patient is made a partner in the caregiving process instead of being dormant. They can give suggestions about the kind of care they want and how they feel about a given medication. This partnership not only benefits the nurses but also doctors who may want specific information from the patient.

References

Laiho, A. (2010). Academisation of nursing education in the Nordic Countries. Higher Education, 60(6), 641-656.

Lee, J. & Tilbury, D. (2008). Changing Environments: The Challenge for Environmental Education in China. Nursing Education Journal, 83(3), 227-236.

Montagu, C. (2010). Civil Society and the Voluntary Sector in Saudi Arabia. Middle East Journal, 64(1), 67-83.

Moyer, B. & Wittmann-Price, R. A. (2008). Nursing education: Foundations for practice excellence. Philadelphia: F.A. Davis.

Nee, P. (2013). The Key Facts on Medicare: Everything You Need to Know About Medicare. Boston: Medical Center.

Saleh, A. (2006). Development of Higher Education in Saudi Arabia. Higher Education, 15(2), 17-23.

Introduction

The nursing profession has been seen to be directed by diagnostic related groupings, measures of patient acuity, quality statements, and measures of the quality. The profession further has to deal with issues of staffing, cost effectiveness, educational advancement, retention, recruitment, image, professionalism and autonomy (Parker and National League for Nursing, 1990, p.1). Much about nursing practice is done with a lot of emphasis on management and economics to the neglect of the nursing of patients and clients. Using any theory in nursing, suggestion has been made that professionals in the field need to think, question, discuss, study, explore, task risk and through these they will be able to realize the caring and commitment that should be in accordance with nursing principles. In addition, nursing theory presents the practitioners of the nursing field with opportunity to ask various and relevant questions and as a result they become to conceptualize the nursing field more accurately. Therefore, this research work will look at nursing theory and how the nursing theory can provide guidance in many nursing practice situations.

Metaparadigms in nursing

Johnson defines metaparadigm as a concept that is very general and one that functions to give definition to the entire world of thought (Johnson, 2010). Jacqueline Fawcett (1984; cited in Johnson, 2010), in her famous work, Analysis and Evaluation of Conceptual Models of Nursing developed four main metaparadigms of nursing and which have come to serve in guiding the larger theoretical universe of the nursing profession (Johnson, 2010). The four metaparadigms are; person, health, environment and nursing.

Person

In nursing the metaparadigm of person is the patient who is subjective and unique not objective, predictable and calculating. The patient at the same time is considered to have distinct human needs which are biophysical, psychophysical, psychosocial and interpersonal (Johnson, 2010). More so, the patient needs to be valued, respected, nurtured, understood and assisted. The person at the same time functions as a whole whereby there is no division among the mind, body and spirit and they are influenced by external environment.

Environment

Environment is seen as a persons significant others and the physical surroundings together with other settings in which nursing takes place. Environment is vital to the holistic healing that include; mental, physical, social, emotional, spiritual, developmental, protective and supportive environments which become conducive to a patients health and wellbeing. Furthermore, environment affects both patients and nurses within a caring-healing interaction. In most cases environment ranges from the patients home to the clinical agencies and to society as a whole (Johnson, 2010).

Health

Health can be viewed in holistic terms as the unity that connects physical, social, mental and spiritual self where all parts work interdependently. Health also is influenced by patients unique life experiences and in wholeness; health may include patients physical, social, aesthetic and moral realms and not only behaviors or physiology (Johnson, 2010).

Nursing

The metaparadigm concept nursing is seen as the actions that are taken by the nurses on behalf of the patient and at the same time the goals or outcomes of nursing actions. Johnson observes that, it is an intensely ethical and emotional paradigm that goes to the root of nursing as a profession with its own set of rewards (Johnson, 2010). At the same time nursing actions can be regarded to involve a thorough process of assessment, labeling, planning, intervention and evaluation (Songkham et al., 2006).

Cultural Care Theory

In mid-1950s, Madeleine Leininger was working as a child mental health clinical specialist when she discovered cultural differences among children. Caring for the children became a challenge especially considering the fact that the children were from different cultures and their behavior expectations and needs were totally different. To adequately offer help to these children, Madeleine discovered that she had inadequate education concerning cultural factors and to her observation, nursing field lacked adequate education to address the cultural factors influencing caring for children of different cultural backgrounds (Parker, 1993, p.108). Madeleine Leininger (1991) observed that nurses are living in a new age of human care services where they are greatly challenged to know, understand and provide effective care to people of diverse cultures in the world. As a result, Leininger (1991) suggested that nurses need to increase their knowledge and skills as they interact and work with patients from largely unknown cultures (cited in Parker, 1993, p.108). It is during this 21st century that Leininger (1991) noted that nurses need to be prepare to face the great challenges that are associated to intense multiculturalism as patients expects, demand, and protect their human rights derived from their cultural values, beliefs and practices (Parker, 1993). She developed her Culture Care Theory in mid-1950s and her belief was that all theories and practices should include culture with care in nursing.

The Theorys metaparadigms

Person

The theory postulates that the idea of person should be understood within the culture since person is dependent to culture and this is evident mostly in non-Western countries. In this society a person belongs to family, community, institution and these agencies have a powerful role to influence the individual. Hence linear understanding of culture differentiating the meaning of person has the tendency to limit explanation in nursing.

Environment

The theory appreciates the concept of environment to nursing and uses the context features found in environment that are dictated by culture where each feature found in the environment is given different meaning and implication by different cultures.

Health

The theory postulates that health of an individual is a totality of cultural lifeways with respect to material and non-material cultural care phenomena. At the same time, the health of an individual is influenced by individuals religion, kinship, political interests, economic views, educational experiences in accordance the individuals culture.

Nursing

According to this culture care theory, nursing should be carried out within broad and holistic perspective with understanding on the part of the care giver that it is necessary to develop culturally congruent care that is derived from the specific culture the nurse is working in.

Level and scope of the theory

Upon its inception the theory has led to intense multiculturalism where different approaches and moral obligations to work with patients from different cultures have been suggested and adopted. Leininger writing about the theory in 1978 and 1990, noted that Culture Care and Diversity Universality theory is one of the major and relevant comprehensive theories in nursing that focuses on discovering human care modalities in different cultures in the world and that the theory has the potential to generate knowledge, insights and practices about many different or similar cultures in the world (Parker, 1993). At the same time the theory has been at forefront in providing the broadest and most holistic perspective to study human caring over time and in different places of the world where the main aim has been to develop culturally congruent care. Leininger also note that Culture Care Theory is much interested in the totality of cultural lifeways with respect to material and non-material culture care phenomena but it is the care derived from the religion, kinship, political interests, economic views, educational experiences that the theory has tried to address (Parker, 1993). Further the scope of Culture Care theory has presented nurses with an opportunity to discover differences and similarities about human care, health, healing, and well being of many of the unknown and known cultures in the world.

Assumptions of the theory

Assumptions of Culture Care theory were formulated within the context and deep commitment that nursing is caring and culture has an impact on care (Parker, 1993). Theoretical assumptions of the theory were derived partly from utilizing ethnonursing and ethnographic qualitative research methods about human care. Leininger postulated that theories were basically available to describe, explain, interpret and provide prediction about phenomena under a particular study.

Basically, Leininger formulated assumptions of this theory that included:

1. care is the essence of nursing and a distinct, dominant, central and unifying focus;
2. care is essential for well-being, health, healing, growth, survival and for facing handicaps or death;
3. culture care is the broadest holistic means to know, explain, interpret and predict nursing care phenomena and in the process guide nursing care practices;
4. nursing is a transcultural humanistic and scientific care discipline and profession, the central purpose of which is to serve human beings in the world;
5. culture care concepts, meanings, expressions, patterns, processes and structural forms of care are different from and similar to all cultures of the world;
6. every human culture has generic care knowledge and practices and usually professional care knowledge and practices which vary transculturally;
7. cultural care values, beliefs, and practices are influenced by and tend to be joined in the world view, language, religion, kinship, political, educational, economic, technological, ethnohistorical and environmental context of a particular culture;
8. beneficial, healthy, and satisfying culturally based nursing care contributes to the well-being of individuals, families, groups, and communities within their environmental context;
9. culturally congruent nursing care can only occur when culture care values, expressions or patterns are known and used appropriately and meaningfully by the nurse with individuals or groups;
10. culture care differences and similarities between professional care givers and patients with generic needs exist in human cultures worldwide;
11. clients who show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns need nursing care that is culturally- based; and
12. qualitative paradigm with naturalistic inquiry modes provides essential means to discover human care transculturally (Parker, 1993).

Analysis of the theory

Looking at the tradition of nursing field it becomes evident that nursing instruction, practice and research were before the creation of the theory heavily based upon medical diseases, pathologies, symptoms and the treatment of the disease, but this changed in a big way with the focus of human care as major phenomenon of nursing. Using the theory, Leininger worked in New Guinea in early 1960s and found that prevention of illness in this country was based on protective care. Cultural taboos, world views, environmental consideration and many social structure elements of kinship rules, spiritual beliefs and philosophy of life and culture values were seen to be more powerful means to prevent illness and remain well through caring expressions and patterns (Parker, 1993). During the same time, Leininger indicate that in two villages she worked in there were no psychoses, but at best mild expression of depression, sexual problems and intergenerational concerns were dealt with in an effective way through what she called, culturally-based caring model (Parker, 1993) and the results were effective.

Evaluation of the theory

Many research studies have found out that culture manifest diversity than universality and as such an understanding of peoples culture is of great importance. Culture Care theory has been applied in many societies around the world, for instance in order to achieve culture congruent care, most nursing actions need to be planned in three modes: culture care safeguarding, culture care accommodation and culture care reorganization. In applying this theory nurses have been content with the fact that caring is common to all cultures and the process of becoming familiar of ones culture is of great importance in order to provide the best nursing care.

Conclusion

Nursing in 21st century is becoming more in acquiring wealth knowledge of care and hence it will become critical especially in teaching and guiding the nursing practice as whole. Culture specific and culture congruent are new terms that are related to culture care theory and which are providing help to nurses and enabling them realize that all cultures can be served with this ideas in mind. In essence, culture care theory has contributed to the discovery of knowledge concerning culture care diversity and universalities and the knowledge in turn has been used to guide, improve, and provide new kinds of nursing care.

References

Johnson, W. J. (2010). Four Basic Metaparadigm Concepts in Nursing. Web.

Parker, M. E. (1993). Patterns of nursing theories in practice. NY, Jones & Bartlett Learning. Web.

Parker, M. E. and National League for Nursing. (1990). Nursing theories in practice. NY, Jones & Bartlett Learning. Web.

Songkham, W. et al. (2006). Occupational Health and Safety Programs for Health Care Workers: An application of an Occupational Health Nursing Model. Occupational Health Nurses Society, Vol. 82, No. 4. Thailand, Chiang Mai University. Web.

Introduction

Today, there are many nursing theories that can be applied to clinical practice to solve a nursing or healthcare problem, improve the current state of affairs, and address the needs of clients and employees. High-quality nursing care is the goal that has to be achieved, and if the application of a nursing theory is the way to enhance the health of people, it has to be discussed thoroughly.

Nursing

In the modern world, such factors as globalization, intercultural education, international relations, and migration promote cultural diversity considerably. In such fields as health care and nursing, the role of cultural diversity and care cannot be neglected (Alligood, 2014). Leiningers theory of transcultural nursing care is a well-known professional approach that is used by many American healthcare workers, as well as the nurses from different parts of the world, to make sure that they provide a diverse population with appropriate care regarding their cultural beliefs and values.

General Statements

In nursing practice, many problems occur when patients have to follow care plans but fail to comprehend all details of medications and activities due to poor knowledge of the language, strong cultural beliefs, and the inability to admit that some prescriptions remain to be unclear. Leiningers theory is the opportunity for patients and nursing to find out common themes for discussion and the clarification of the points that cannot be identified during the first meeting (Russell, Brunero, & Lamont, 2014).

Summary

The selected theory of transcultural nursing has to be applied to the situations when patients with various cultural backgrounds have to follow such general rules as keeping a diet, avoid fats, and increase physical exercises. The recognition of cultural diversity is integral because various communities have different standards regarding fats or physical exercises. Clarifications and examples should be given to avoid misunderstandings and complications during treatment.

Description of Issue

Issue Introduction

Healthcare policy is about developing healthcare plans, treatments, and care around patients and reorganizing decisions regarding current patients needs and demands (Klecun, 2016). Nurses have to take responsibility for how patients understand their diagnoses and treatments and if patients and their families comprehend the importance of medications or other prescriptions that should be followed. For example, there is a situation when an African-American woman is asked to watch her diet, reduce the amount of fats, and increase the number of physical experiences.

No certain numbers and standards are given. The result of such dialogue is not always positive because African-Americans is the ethnicity with a specific attitude to food and the place of fat products in their lives. The reduction of fat products could mean for such patients eating not 10 but 5 hamburgers per day, and the effects of such diets can be harmful to patients whose task is to control their hypertension. At the same time, it is wrong to believe that all African-American patients like fat food. This is what Leiningers theory of transcultural nursing is all about.

Importance of the Issue

The nursing profession should care about the issue under consideration because it is the responsibility of a nurse to clarify the details of treatment and explain the standards that are appropriate regarding the offered diagnosis. Physicians or other doctors should identify a health problem and find out the best and most effective solution. The way of how patients comprehend the instructions depends on nurses abilities to communicate, explain, and recognize the differences that may challenge treatment. Therefore, cultural differences should not prevent understanding of medical terms, treatments, diagnoses, or care plans.

Literature Review

In clinical settings, medical staff, as well as students, is engaged in various aspects of cultural competence development and the cases of cultural diversity that exists between patients, nurses, and other employees (Cai, Kunaviktikul, Klunkin, Sripusanapan, & Avant, 2017; Jeffreys, 2015). The global migration of people challenges nurses considerably because of the necessity to deliver health care to various patients whose cultural backgrounds and beliefs are not easy to comprehend and accept (Douglas et al., 2014). Due to constant changes and the inability to predict the outcomes, the topic of cultural diversity in nursing care is frequently discussed in nursing, medical, and management literature. Researchers and academic writers evaluate the worth of cultural diversity (Russell et al., 2014), learn how to implement cultural competence (Douglas et al., 2015), and investigate various aspects of nursing care (Klecun, 2016).

Stakeholders

The scope of the chosen issue is impressive indeed. It may influence a single patient or a whole family, one nurse or the whole medical staff, one physician or the whole hospital. Cultural communication is a complex issue, and stakeholders may vary regarding the situation. There may also be a wide range of opinions, attitudes, and beliefs within the same cultural group, and nurses task is not to clarify the reasons for why people choose different positions but make sure that cultural background is not a barrier to health improvement.

According to Leiningers theory, nursing is a science where it is not enough to develop traditional nurse-patient relations. The development has to be organized beyond these traditions and include communication with a patient, their families, communities, and even total cultures to avoid misunderstandings or wrong interpretations of information.

Application of a Nursing Theory to an Issue

Theory

The value of Leiningers theory is the possibility to redefine nursing care regarding a deep cultural perception of the world where people have to move, change their locations and minds, and be adapted to new needs and behaviors (Alligood, 2014). There is a sunrise model with the help of which nurses identify their main steps and have to consider technological, religious, philosophical, social, cultural, political, economic, and educational factors to promote a positive outcome of health care. There are many factors for consideration, and the model helps to find out a starting point and move slowly till the last piece of information about a patient and their cultural background is gathered. Only in case all factors are defined, supportive and facilitative care is offered.

Strategy Introduction

In hospitals, it is important to choose a strategy with the help of which empathy and professional communication can be developed between a healthcare provider and a patient (Douglas et al., 2014). The requirement to be followed is the connection of the strategy with Leiningers theory of transcultural care. It is suggested to rely on a dialogue where a nurse can ask direct questions, and a patient can give clear answers. This strategy is based on fearlessness and competence of nurses to gather information. A nurse should understand that the task is to talk to a patient or their family and evaluate the details that can have an impact on further treatment or stay in a hospital. It is expected to give close attention to patients inability to understand what factors can actually matter and what factors may be omitted during assessment and evaluation.

Strategy Use

This strategy can be used by nurses in different situations. It is possible to start a dialogue when a patient arrives at the hospital and asks for help for the first time. In this case, a nurse can ask a patient if there are any family members to be informed, and if there are the details to be familiar with in case of emergency. If a patient cannot talk at the moment of hospital arrival, it is necessary to find other ways to contact their family and gather the necessary information. According to Leiningers theory and the sunrise model, seven main factors should be identified. As soon as a patient is identified as a representative of another than a hospitals commonly established culture, the identification of the factors (technology, religion, education, economy, politics, society, and culture) should occur to clarify if some methods of treatment may contradict the cultural preferences and values of a patient (Alligood, 2014).

Strategy Implementation

The implementation of the strategy is the way of how nurses understand the importance of recognition of patients cultural needs. It should result in the possibility to bring cultural education to all nursing students. Nurses should learn how to recognize cultural diversities and promote congruent care. It is expected that nurses start respecting all patients and their families and comprehend why one but not another decision is made. Such strategic implementation can lead to a number of positive results, including the improvement of communication skills, enlarged knowledge, compassion, and competence. These qualities are important for nurses. If nurses can use these skills, they can provide patients with guarantees. However, studying nursing and healthcare, it is clear that sometimes, patients may not ask for guarantees but for chances to rely on.

Future Research

Future research can be directed to the number of cultural diversities in different states. In the United States, patients from different parts of the world may address to hospitals for help. Their cultural background varies considerably, and nurses should be prepared for this diversity. The same strategy and a quantitative research method can be used to identify the representatives of which cultures may address to hospitals.

Conclusion

In general, the consideration of nursing practice in terms of the Leiningers theory context may help students and researchers develop the required portion of analytical and critical thinking skills. Todays multicultural societies expect that nurses can identify and meet their cultural needs in a short period of time. Unfortunately, not all hospitals hire nurses with deep cultural background knowledge. The application of such theories of Leiningers transcultural care theory is the solution that can be offered.

The future of healthcare and nursing depends on how well nurses can identify and understand patients cultural perceptions and values. Leiningers transcultural nursing is used to outline the concepts with the help of which effective patient care can be offered. The model and application of this theory show why it is necessary to involve families and communities in taking care of a patient. Nurses cannot know everything for sure.

Self-Reflection

It is not an easy task to apply a nursing theory to a certain issue. However, such issue as a cultural diversity of patient is frequent, and many nurses have already faced it many times. Therefore, it is not difficult to gather as many cases as possible and comprehend the scope of the problem. Multicultural education has been already offered to the students of different schools around the whole world. Multiculturalism in education and nursing is the challenge not all nurses are ready for. Leiningers theory is a helpful tool the application of which promotes the improvement of health and nursing care and the establishment of new standards that facilitate communication between patients and nurses.

References

Alligood, M.R. (2014). Nursing theorists and their work. St. Louis, MO: Elsevier Health Sciences.

Cai, D., Kunaviktikul, W., Klunkin, A., Sripusanapan, A., & Avant, P.K. (2017). Developing a cultural competence inventory for nurses in China. International Nursing Review, 64(2), 205-214.

Douglas, M.K., Rosenkoetter, M., Pacquiao, D.F., Callister, L.C., Hattar-Pollara, M., Lauderdale, J.,& Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.

Jeffreys, M.R. (2015). Teaching cultural competence in nursing and health care (3^rd ed.). New York, NY: Springer.

Klecun, E. (2016). Transforming healthcare: Policy discourses of IT and patient-centered care. European Journal of Information Systems, 25(1), 64-76.

Russell, R., Brunero, S., & Lamont, S. (2014). Reflecting on transcultural care; culture care theory and mental health nursing. Austin Journal of Nursing & Health Care, 1(2), 4-7.