Nursing Process, Health Promotion, and Health as Expanding Consciousness Theories - Essay Example

NURS 4343 NURSING THEORY AND RESEARCH COMPARISON OF NURSE THEORISTS Comparison of "Nursing Process Theory", "Health Promotional Theory" and "Healthas Expanding Consciousness Theory" Introduction As far as nursing is concerned, practice should lead to theory, theory should lead to research, and research should lead back to practice. In other words, new theory generated from practice will lead to new studies, which will lead to new knowledge for practice, and new knowledge would present with new facts, encouraging development of theories to explain these facts. Unfortunately, much of the research in nursing has been descriptive and poorly linked to theory, and studies continue to be undertaken without cognizance of any theoretical alliance. Research is a tool of science and its function is enquiry. The product of science is theory and these theories go to make up the working parts of our body of knowledge for practice. To date, most of the research in nursing has been of the theory-testing variety with little concern for where and how theories were developed. Theoretical progress in a discipline is measured to a great extent by the number and the quality of the theories developed by its scholars. From that point of view in nursing, the most useful measure of research outcome is the growth in sound theory on which to base nursing care and education (LoBiondo-Wood. & Harber, 2006). Grand and Mid-Range Theories Nursing theories may be classified by their levels of abstraction along a continuum from grand theories to practice theories. As alluded to above, grand theories are broad and abstract and do not easily lend themselves to application or testing. In contrast, narrow-range theories are very precise and restricted in their focus. It is evident that for a theory to be usefully generalized to other nursing situations, it needs to be abstract. However, this means that it is difficult to operationalize the concepts within a theory. Being abstract means, there are no measurable indicators, and this it becomes very difficult to test the concepts and propositions through systematic and rigorous research. Mid-range theories go some way towards solving this problem. They are moderately abstract and inclusive but are composed of concepts and propositions which are measurable. Therefore, midrange theories, at their best, balance the need for precision with the need to be sufficiently abstract. Mid-range theories are more focused than grand theories. They have fewer concepts and variables within their structure, are presented in a more testable form, have a more limited scope and have a stronger relationship with research and practice. Mid-range theories provide nurses easy applicability in practice and enough abstract ideas to be scientifically interesting (Tomey & Alligood, 2006). Comparison In this assignment, three nursing theories will be compared. These are "Nursing Process Theory", "Health Promotional Theory" and "Health as Expanding Consciousness Theory." Background of the Theorists Ida Jean Orlando was born in 1926 in New York. Her nursing education began at New York Medical College School of Nursing where she received a diploma in nursing. In 1951, she received a Bachelor of Science degree in public health nursing from St. John's University in Brooklyn, New York, and in 1954, she completed a master's degree in nursing from Columbia University. Orlando's early nursing practice experience included obstetrics, medicine, and emergency room nursing. Her first book, The Dynamic Nurse-Patient Relationship: Function, Process and Principles (1961), was based on her research and blended nursing practice, psychiatric-mental health nursing, and nursing education (Tomey & Alligood, 2006). Dr. Jean Watson has earned undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and holds a doctorate in educational psychology and counseling. Dr. Watson's published works on the philosophy and theory of human caring and the art and science of nursing are used by clinical nurses and academic programs throughout the world. Her caring philosophy is used to guide new models of caring and healing practices in diverse settings and in several different countries. Dr. Watson's book, Postmodern Nursing and Beyond, reflects her most recent work on caring theory and nursing healing practices (Tomey & Alligood, 2006). Health as Expanding Consciousness is a theory by Margaret Newman. Margaret Newman entered nursing school at the University of Tennessee in 1959. After graduating from Baylor University, Newman went home to Memphis to work and care for her mother, who had amyotrophic lateral sclerosis. Caring for her mother was transformative for Margaret Newman. This experience provided her with two profound realizations: that simply having a disease does not make one unhealthy, and that time, movement, and space are in some way interrelated with health, which can be manifested by increased connectedness and quality of relationships. In the midst of this terminal disease, both mother and daughter experienced a greater sense of connectedness and increased insight into the meaning of their experience and into the meaning of health. Newman's theory is a composite of her early influences and life and practice experiences (Tomey & Alligood, 2006). How the Theory Defines Orlando's theory reflects her belief that nursing practice should be based on the needs of the patient. Hence, communication with the patient would be important to understanding the needs, so effective nursing care can be provided. The theory focuses on the patient and his or her needs and the communicative interface between the nurse and the patient. To Orlando, nursing is unique in addressing patients' "immediate" situational needs through communicative and interactive processes so that patients will be relieved of distress or gain greater sense of adequacy or well-being. Orlando conceptualized nursing practice as an interactive process focused on the patient's needs and/or responses to the environment. She defined nursing as a deliberative interaction process that is learned and includes the patients' needs, the nurse's reactions, and the nursing interventions to assist the patient. Therefore, person is the central focus of this theory, where the total individuals and all his needs are to remain the major drives for nursing. Health thus is a concept in this theory that may be defined as expressions of the needs through patient behaviors. Patients experience distress when they cannot cope with their needs. Therefore, the nurse must take the initiative in helping the patient express the meaning of behavior to ascertain distress. The basis for nursing action is determined by the distress experienced by the patient (Tomey & Alligood, 2006). Understanding the meaning of the patient's behavior is influenced by the nurse's perceptions, thoughts, and feelings requiring deliberative responses. Direct and indirect observations of patient behavior can be used to determine its meaning, and thus provide knowledge about the patient in planning nursing care. Orlando's theory addresses all but environment, and the concept of health is implicit in the theory. The domain of environment includes the physical, social, and symbolic environment of the patient and is an essential concept for holistic nursing practice (Tomey & Alligood, 2006). The nurse's moral commitment, intentionality, and caritas consciousness is to protect, enhance, promote, and potentiate human dignity, wholeness, and healing, wherein a person creates or co- creates his or her own meaning for existence, healing, wholeness, and living and dying. The nurse seeks to recognize, accurately detect, and connect with the inner condition of spirit of another through genuine presence and being centered in the caring moment; actions, words, behaviors, cognition, body language, feelings, intuition, thought, senses, the energy field, and so on, all contribute to transpersonal caring connection. Therefore health could be defined as a state that arises from biological, physiological, spiritual, psychological spheres, and environment exists both internally and externally, where the nurse is also a transpersonal counterpart of this environment. This work, in both its original and evolving forms, seeks to develop caring as an ontological and theoretical-philosophical-ethical framework for the profession and discipline of nursing and to clarify its mature relationship and distinct intersection with other health sciences (Tomey & Alligood, 2006). A caring occasion occurs whenever the nurse and another come together with their unique life histories and phenomenal fields in a human-to-human transaction. The coming together in a given moment becomes a focal point in space and time. It becomes transcendent, whereby experience and perception take place, but the actual caring occasion has a greater field of its own, in a given moment. This feeling of transpersonal connection in both can be extended to health promotion that can extend in all previously mentioned spheres of health (Tomey & Alligood, 2006). If nursing is to fulfill its social commitment to promote the betterment of the human condition, it must be ready to respond to the ever-increasing complexity of the way people relate to each other and to the environment. By the proposition, nursing is a science that would assist a person to recognize the power that is within them for movement toward a higher level of consciousness. Nursing should go beyond combating diseases, accompanying their patients in the process of discovering meaning and wholeness in their lives. Nurses can create a mutual partnership with their patients to reflect on the evolving pattern of their life. The insights gained in this process lead to an awakening and transformation to a higher level of consciousness. The disruption brought about by the presence of disease, illness, and traumatic or stressful events creates an opportunity for transformation to a higher, expanded level of consciousness. This disrupted state presents a choice point for the person either to continue going on as before, even though the old rules are not working, or to shift into a new way of being (Tomey & Alligood, 2006). The Health as an Expanding consciousness perspective sees disease as an explication of the underlying implicit pattern of the person, family, or community. Disease can be part of the process of expanding consciousness. Health would encompass conditions known as disease as well as states where disease is not present, since when it manifests itself, it can be considered a manifestation of the underlying pattern of the person which manifests itself as disease was present prior to the structural and functional changes of disease (Tomey & Alligood, 2006). Type of Research Studies Any approach constructed to describe, analyse and evaluate nursing theories must be systematic and rigorous. All have their limitations, because invariably some sort of judgement is called for. This can be due to the inherent biases of the developer or the user of the scheme. Considering that most nursing theories are abstract, it is not surprising that a structured list of criteria is often inadequate to judge their worth. Many nursing theories have their roots in an interpretative philosophy; it seems contradictory to evaluate these theories using rigid empiricist principles and rules. Without theory, nursing knowledge would be a mass of data, statistics and observations with no coherence or understanding. Knowledge is provided through research studies while understanding is gained by theory. It is a reciprocal relationship; while knowledge can increase in nursing for a time without understanding, understanding is not possible without new knowledge being developed. Therefore many research studies have been undertaken to test these theories or to generate new theories out of these (LoBiondo-Wood. & Harber, 2006). Nursing Process Theory On Nursing Process Theory, most of the research is qualitative with reviews and analysis of the theoretical concepts about this theory. Apart from its use in nursing practice, it has been widely used in nursing research. The reason is, Orlando used research based approach to develop deliberative nursing process theory through field methodology. This theory has been widely used as a framework for numerous studies in a variety of settings. The areas of studies encompassed nursing theories, practice, education, and administration. Both qualitative and quantitative approaches have been employed. This has been applied in theory analysis, analysis of patient outcomes including pain, postoperative recovery, blood pressure and pulse rates, vomiting, and levels of distress. Additional areas that have been researched are spousal grieving, breastfeeding, and cancer. Potter and coworkers (2005) designed a study to determine the implementation of safety agreements that can make a difference in the rate of patient self-harm incidents and in nurses' feelings more comfortable interacting with patients at risk for self-harm (Potter, Vitale-Nolen, and Dawson, 2005). Bezanson et al. (2002) proposed a theoretical research for an outpatient surgery center of acute care hospital based in the community. It was found that implementation of nursing process approach could provide opportunities to improve nursing practice, increase patient satisfaction, and enhance staff satisfaction with nurse patient interactions (Bezanson, Strickland, Kinney, and Weintraub, 2002). Unfortunately, there has been little research supporting Watson theory. The reason may be that the framework of this theory is abstract, and thus it is difficult to design techniques to generate useful findings. However, it is widely believed that traditional research methods are inadequate for knowledge development about human caring. It has been suggested that qualitative-naturalistic-phenomenological methods and descriptive phenomenological approaches should be used. However, it is to be regarded that the concept of health promotion which is originally a derivative of this theory has been widely researched in different contexts, and research has been found to be effective in designing nursing strategies that can be widely applicable in almost all areas of nursing. Most of the epidemiological experimental research to design preventive care has health promotion as a part. Endo and colleagues (2004) used Newman's theory to study with health and disease pattern recognition as a caring partnership between nurses health is seen in an evolving and families of ovarian cancer in Japan (Endo, 2004). Neill (2005) has conducted a study on seven women from suburban Adelaide in Australia, who were aged 44 to 78 and had lived with multiple sclerosis or rheumatoid arthritis for 5 to 38 years. The author explored this theory through narratives of these subjects and concluded that health is a continuous process of expanding consciousness (Neill, 2005). Yamashita (1998) applied Newman's theory in family caregiving situations in mental illness in Japan. The important observation is that Japanese mindset fits well with Newman's model. In this qualitative study, Newman's theory of health as praxis proved to be a viable methodology for this population indicating validity of person-environment interaction patterns (Yamashita, 1998). Congruence with Personal Beliefs For an average nurse like me, the primary aim of my profession is to use nursing theories to improve practice. Among these three, the most practical and relevant in my opinion is the Nursing Process theory which has a judicious mix of practice, action, research, and abstraction. It is very evident from these theories presented here that they see person, environment, health, and nurse from different perspectives; however, all these contexts despite being true may not be explicit enough in the practice setting. For a practitioner, thus the nursing process theory has mot categorical dimensions that can be widely applicable in various settings of nursing practice. Through this, professional nursing can determine the immediate needs of the patients from perceptions related to observed patient behaviors. Thus it indicates nurse must explore their perceptions, thoughts, and feelings in order to assess a patient through the process. This means there is a role of deliberative process in the nurse which strengthens the practicality of critical thinking in the nursing profession. Through implementation of nursing process in practice, the nurse can successfully be a part of the dynamic nurse-patient relationship that involves reciprocity between the nurse and the patient. The nurse can also use reflection as a part of the critical thinking process to ascertain the actual meaning of the patient behavior, and this may evolve depending on the initiating event, length of contact, and the ability of the both to accomplish. This would also mean, this process would involve the patient in the process, making the patient a partner of the nurse in the process of determination of the need. The current holistic approach of nursing practice that is person-centered is appropriately embodied in this theory, where nurses observe, seek information, critically analyze them to reach a diagnosis so the care needs are fulfilled to the maximum. Therefore, I prefer this theory, and I use consistently this in my practice. Reference List Bezanson, JL., Strickland, OL ., Kinney, MR., and Weintraub, WS., (2002). Assessing data adequacy for clinical research: reliability and validity of a surgical database. Journal of Nursing Measurement; 10(2): 155-64. Endo, E., (2004). Nursing Praxis within Margaret Newman's Theory of Health as Expanding Consciousness. Nursing Science Quarterly; 17: 110 - 115. LoBiondo-Wood, G. & Harber, J. (2006). Nursing research (6th ed.). St Louis: Mosby. Neill, J., (2005). Health as Expanding Consciousness: Seven Women Living With Multiple Sclerosis or Rheumatoid Arthritis. Nursing Science Quarterly; 18: 334 - 343. Potter, ML., Vitale-Nolen, R., and Dawson, AM., (2005). Implementation of Safety Agreements in an Acute Psychiatric Facility. Journal of the American Psychiatric Nurses Association; 11: 144 - 155. Tomey, A.M., & Alligood, M.R.. (2006). Nursing Theorists and Their Work. (6th ed.).St Louis: Mosby Yamashita, M., (1998). Newman's Theory of Health as Expanding Consciousness: Research on Family Caregiving in Mental Illness in Japan. Nursing Science Quarterly; 11: 110 - 115. Read More