Theory Application Paper
Theoretical Foundations for Nursing
Nursing practices continue to evolve over the years. Specific basic standards of practices remain the same. As a state surveyor, I have observed various healthcare providers implement the Needs Theory. In this paper, I will be concentrating on the needs nursing theory and notions that comprise the patient and caregiver(s), environment, and health outcomes. When caring for patients, healthcare professionals should assess every aspect of the patient’s needs including family/caregivers, psychosocial, spiritial, and environmental requirements to promote optimal outcomes.
When observing patient care, I often have to verify that healthcare staff is meeting the patient’s needs as well as following the facilities policy and procedures, and state & federal laws. According to (Petiprin, 2016) “The Nursing Need Theory was developed by Virginia Henderson and was derived from her practice and education. Henderson’s goal was not to develop a theory of nursing, but rather to define the unique focus of nursing practice. The theory emphasizes the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the patient and how nursing can assist in meeting those needs.”
According to ***, (****) “Theories that focus on very broad, abstract concepts (e.g., caring) can be applicable to a very wide range of situations; these theories are sometimes labeled as “grand” theories. When the concepts tend to be descriptive of more specific situations, they can be labeled as “middle-range” theories.” I choose Grand Theory because I often observe patient care, and as a surveyor, I have to verify that healthcare staff is following state and federal regulations, as well as their facility’s policies and procedures.
Each healthcare organization will have policies and procedures outlined for their team to follow, as well as, state and federal regulations. For example, the guidelines for patient care in Endstage Renal Disease setting will be different from patient care in the hospice setting. Both areas have patients’ with terminal illnesses, yet, the Endstage Renal Disease organizations have patients that should be referred to various transplant organizations to prolong life. On the other hand, hospice patients are expected to have a life span of 6 months or less. When comparing some of the Endstage Renal Disease patients to the hospice patients, the continuum of health varies from top level wellness to actively dying patients. Although there are other nursing theories, the Grand theory applies more to my area of practice because I survey a variety of healthcare services.
According to McEwen & Wills (2014), “Theory description has six elements: purpose, concepts, definitions, relationships, structure, and assumptions.” The nurse should be able to help their patients holistically during all phases of care. Patients are often overwhelmed with the new diagnosis of Endstage Renal Disease. The patients and family members sometimes have an unspoken fear of the prognosis of Endstage Renal Disease. The nurse should be able to apply his/her vast range of knowledge to help the patient and their family members to be able to understand the disease process. The nurse should be ready to assist the patient and family with the drastic change in life style. The patients will interact with the nursing staff more than he/she will be communicating with the physician. Consequently, it is essential for the nurse to master his/her role in abetting the patient’s in their transitioning period on dialysis. An educated nurse can inform the patient and family members that a diagnosis of Endstage Renal Disease is not a definitive death sentence. There are treatment options such as In-center hemodialysis, home hemodialysis, home peritoneal dialysis, and transplant options. Today’s dialysis patients are living longer due to the years of tracking and trending data and making adjustments for patient care.
The nurse should also be able to help their patients and family holistically during all phases of death and dying. The hospice patient may similarly be overwhelmed with their new terminal illness diagnosis. The nurse should be capable of supporting the patient as well as the family in the dying process. Sometimes the patient reaches the acceptance stage of dying, and their family or friends are struggling with accepting the thought of loosing their loved one. The nurse should be able to recognize if he/she need to assist family members or friends who are facing ineffective coping skills. In this instance, if the nurse is applying his/her observational and theoretical skills the patient’s family member or friend could a get the support he/she need.
According to The Four Metaparadigm … (as cited in Branch, Haley, Hiner, & Holzwart, 2016). “Florence Nightingale was a nurse who dedicated most of her life to helping others in the 1800’s. She essentially laid down the foundation for the modern nursing metaparadigm of the environment in supporting patient health in the medical field… Although Nightingale’s theory was built on environment, she specifically focused on the environment for the person or patient. Without the person, you would have no need for an environment, medically speaking. Nightingale’s environmental theory can be viewed as a systems model that focuses on the client in the center, surrounded by aspects of the environment all in balance.”
According to McEwen & Wills (2014), “The theory’s “origins” refers to the historical evolution of the model/theory, the author’s motivation, philosophical assumptions about nursing, the author’s inclusion of works of nursing and non-nursing scholars, and the worldview reflected by the model.” Nursing theory has and always will be relevant to the nursing profession. If we did not have a method, how could we analyze when we should change our standards of practices? According to McEwen & Wills (2014), the unique emphasis refers to unparalleled views of the metaparadigm ideas, different issues in nurse–patient situations or interactions, and differences in modes of nursing interventions. Patient care must be individualized to meet his/her needs. Nurses should consider the overall patient environment when caring for the patient which include family and friends.
Nursing has evolved over the years because nursing scholars joined forces to validate their tested body of data. Today we see positive outcomes from nurses applying theory when taking care of their patients. Patients and family members tend to be apprehensive when they recognize the nurse cannot link theory with skills. The newly diagnosed Endstage Renal Disease patients will have questions about their diet, fluid intake, vascular access, dialysis treatment process, etc.; Colley (2003) states that “Consequently, nurses must be able to appreciate different types of theory to critique them and to contribute to the continued development of nursing.” One way that I utilize nursing theory is when I report observations of deficient nursing practices to healthcare administrators and discuss an acceptable plan of correction. This dialog will allow the facility to recognize what changes need to be made and educate their nursing staff on ways to improve patient care. I think most healthcare professionals want to provide optimal care for their patients but find themselves caught up in productivity instead of valuing quality outcomes. All healthcare facilities should get back to the basics of incorporating theory with skills daily to strengthen the development of the overall nursing community.
According to McEwen & Wills (2014), “theory evaluation requires judgments to be made about a theory’s significance based on how it satisfies certain criteria (Fawcett & DeSanto-Madeya, 2013). The process of theory evaluation includes review of previously published critiques, research reports, and reports of practical application of the theory. During the process of theory evaluation, the criteria to be examined are the explication of the origins of the theory, the comprehensiveness of the content, its logical congruence, how well it can lead to generation of new theory, and its legitimacy. The legitimacy is determined by reviewing the theory’s social utility, social congruence, and social significance. The final step in theory evaluation is to examine the theory’s contribution to the discipline of nursing.”
Grand Theory significance allows the nurse to use a broad range scope of practice when caring for dialysis patients and their families. There are dialysis patients at various age ranges from children to the elderly. When the nurse is knowledgeable, he/she can apply theory with skills that promote a positive outcome for the patient and family members. The nurse is capable of relieving some of the patient’s stress factors when he/she can confidently answer questions and assist patients with their barriers. The patients tend to build a rapport with staff that demonstrates consistant ability to perform their job and can clarify any concerns they may have about their treatments. When the patient is happy with their care, data has shown that the outcomes are conducive to all parties envolved.
According to Thompson, (2017) “Phenomenon of Person: nurses provide nursing care to Persons. The Person is the one receiving the nursing care. But importantly, Person is defined according to the recipient of nursing care (the patient or client) and may include the patient’s family and friends and the community. The nurse needs to consider how the patient defines family when planning care…” When I survey healthcare facilities, I often observe different scenarios where the nursing practice have to conform to an environment of the active nonphysical environment. Nursing care change when the patients’ health status change. The nurse must always remember to consider the patient’s environment which includes family and friends to promote optimal outcomes. Environmental factors remain a significant part of providing holistic care for the patient and family members.
Petiprin, A. (2016). Need Theory. Retrieved June 19, 2018, from http://www.nursing-theory.org/theories-and-models/henderson-need-theory.php
Branch, C., Haley, D., Hiner, C., Holzwart, T. (2016). Four Nursing Metaparadigms: Retrieved from https://scholarworks.iu.edu/journals/index.php/iusburj/article/download/…/28143/
Chinn, P. L., & Kramer, M. K. (2015). Knowledge Development in Nursing (9 ed.). St. Louis, Missouri: Mosby.
Colley, S. (2003). Nursing theory: its important to practice. Nursing Standard. 17, 46, 33-37. Retrieved from Date of Acceptance: May 9, 2003
McEwen, M. (2014). Theoretical Basis for Nursing (4 ed.). [Wolters Kluwer Health]. 100-102. Retrieved from VitalBook file
Thompson, C. (2017). Nursing Education Experts: What is the Nursing Metaparadigms? Retrieved from https://nursingeducationexpert.com/metaparadigm/