Various Classifications of Nursing Theories - Article Example

? Nursing Theory Nursing Theory Nursing theories comprise concepts, relationships, definitions, and assumptions or propositions obtained from nursing models, and outline a purposive methodical view of observable facts by designing precise interrelationships among concepts for reasons of illustrating, explaining, foretelling and prescribing (Parker, 2005). There are various classifications of nursing theories which include meta theory, grand, middle range and practice theories. These theories are descriptive, explanatory, predictive or prescriptive. Metatheory brings about the identification of specific phenomena through abstract concepts. Grand theory gives provision of a theoretical construction under which the main concepts and principles of the discipline can be recognized. Middle range theory is more precise. It examines a particular situation with a limited variable numbers (George, 2010). Nursing theories are useful in assessing patients’ conditions, identifying the patients’ needs, demonstrating an effective communication and interaction with the patient. The nursing practice theory provides the basis for nursing practice. Practice theory explores a particular situation in nursing and identifies clear goals and details of ways of achieving the goals (Masters, 2012). In this essay, focus is intently on the nursing caring theory which is fundamental and fits my nursing practice. The caring theory basically comprises of two vital constructive backgrounds of emotional response, and mutual and mutual interdependence. In this case, the ethics of care leads to the rejection of reasoning and judgements that are dispassionate and partial, that are dominant with the paradigms and models of bioethics (Parker, 2005). To be precise and more specific, we are going to select the Swanson Caring Theory. This is a middle-range theory, and as described earlier this theory is precise, examines a particular situation (in this case it is about caring), with somewhat limited variables (unchealthcare.org). The Swanson theory developed from the Carolina Care Model, at the University of North Carolina Hospitals. They designed the model so as to aid in the actualization of caring theory, support practices that uphold patient satisfaction, and bring a transformation in cultural norms. This is precisely what will enable the dealing the nursing issue of caring that is a concern in my nursing practice. I suppose that the model and the theory are specifically vital for scrutinizing the issue at hand. Furthermore, evaluation has suggested that this approach to care delivery boosts the hospital experiences of patients and families and smoothes the progress of the desired outcome (unchealthcare.org). With the current practice setting, the theory presents itself as the guide to an ideal caring practise in comparison the current situation in care delivery. The Swanson theory may possibly be remarkable in accelerating the progress towards the ideal in caring. The structure offers an articulate explanation of the relations between caring processes and the patient’s well-being (unchealthcare.org). The sub dimensions of every process at a deeper level, offer proposals for what can be done to create the correlation connecting theory and practice to be comprehensible and valuable to clinicians. Caring theory suggests that nurses showing they care about patients is as imperative to patient well-being as caring for them via clinical means e.g. prevention of infections and administration of medications. The implementation of this model would be an approach to actualization of caring theory across a health care firm through systematic incorporation of interventions linking nursing actions, caring processes, and expectations (unchealthcare.org). Overview of key demographic data, health issues and diagnoses within the populations The region where we offer our nursing services is cosmopolitan. They are people from different cultural and racial backgrounds. They are from different dialects, hold different education levels, and are from different socioeconomic backgrounds. The region comprises of African Americans, Caucasians, Hispanics, Asians and American Indians. The demographic data obtained from various centres of health statistics. The population distribution of these groups within the region in the year 2010, given in percentage rates to the total population was: Hispanic 8.4%, American Indian 1.2%, African American 21.8%, White Non-Hispanic 66.2%, and other races 2.4%. The major diagnoses in the region are diabetes, cardiovascular diseases, chronic lower respiratory disease, and cancers of different types, with lung cancer being the highest and prostate cancer being the least diagnosed, injuries, homicide and suicide (www.schs.state.nc.us). Maternal and child indicators comprise of percentage teenage pregnancy from ages of 15-19 indicate that the highest percentage is 88.1% in the American Indian group, followed by 81.8% in African American group. The least percentage of teenage pregnancy is 40.5% in the White Non- Hispanic group (www.schs.state.nc.us). Communicable diseases found in these populations are HIV & AIDs, Chlamydia, gonorrhoea, and syphilis. Behavioural risk factors found in these populations are high blood pressure, smoking, diabetes, too much physical activity without leisure and fair or poor health in adults (www.schs.sate.nc.us). . It is notable that chronic diseases cause up to 60% of all deaths in the region. Leading causes of death in the region is heart disease and diabetes, which can be avoided through prevention by changing health behaviours. Diabetes comes out as one of the major cause of death and disability in the region. It is almost becoming an epidemic in the region (www.schs.sate.nc.us). Minority health issues in the region gives a reflection of the measures of health status that is worse for minority populations compared to whites. This is due to factors e.g. lack of medical insurance cover, poverty, and lack of access to health care. The socio-economic status of an individual has a critical link to their general status of health. Individuals who live in conditions of poverty are likely to have higher rates of death and more problems of health than individuals with higher socio-economic status (www.schs.sate.nc.us). Lack medical insurance coverage makes it difficult to access effective primary and specialized health care. Due to lack of access to timely primary health care, the uninsured individuals with chronic conditions such as diabetes, hypertension, cardiovascular diseases, high cholesterol and chronic lung conditions look for treatment when they are in a late, dangerous and costly stage of illness (www.schs.state.nc.us). The occupational and environmental health is also critical in the region. The concerns of environmental health are gaining a lot of attention in the region. The demographic data of health hazards related to poor air and quality of water are yet to be outlined. It is clear though, that there is a rise in the ozone levels due to the increasing industry in the region, the increasing traffic and the warm weather. The Agency responsible for environmental protection states that ozone at ground-level, has an impact on those with respiratory problems, and also on the well-being and health of healthy adults and children (www.schs.state.nc.us). The elderly individuals and children who do vigorous exercises outdoors, folks with compromise immune systems, and persons with respiratory diseases are the people that are mainly at risk with the ozone effects. Ozone may also have an effect on infant and maternal health (www.schs.state.nc.us). The role that I have in this setting as a practising nurse is to identify these issues that directly relate to the health situation within these populations by carrying out the research as above. The acquisition of such background knowledge helps in finding out and identifying the specific measures which could be taken to alleviate the health condition in a corporate and individual sense. The approved identified measure could be passed on to the concerned parties in the course of practice in delivering care practices to patients. Sensitization on lifestyle changes so as to reduce and manage diabetes could be championed to help the patients that are battling with the disease to manage it, and help the uninfected individuals to take immediate effective measures. This role is also vital in my practise within this setting as another way of observing top-notch health care delivery to patients and families in and beyond the hospital vicinity. In identifying the ideal, the role of taking appropriate action to strive towards it will be of critical and useful value in my nursing practice. The identification and selection of caring theory, analysis and overview of demographics of the current setting of nursing practice enables an understanding of the prevailing situation. This is crucial in identification of what is not taking place that should be taking place, and then take the necessary measures to ensure that it happens, with the objective of improving the kind of care services offered to patients. Why the middle-range theory I considered the middle-range nursing theory as the best fit for the practice setting and in educational and school-based practices. It is more specific, thus, deals with the issue of care in a more specific and precise manner compared to the other theories. This theory employs few variables, which makes it convenient for the case at hand. The Swanson Caring theory, which is a middle-range theory, is the one that got the consideration as the best fit for the case (unchealthcare.org). The Swanson’s structure of caring provides an opportunity for rational explanations for the relationship between the patient-well being and the caring process. This addresses the issue of caring in my nursing practice. It provides a path to the development of consistent behaviours which communicate caring to patients so as to improve patient satisfaction. The behaviour-sets would be a demonstration for expression of care. The theory’s structure has its foundation on five caring processes that interrelate; ‘maintaining belief’, ‘knowing’, ‘being with’, ‘doing for’ and ‘enabling’. Maintaining belief entails upholding faith in others’ capacity to transition and have lives that are meaningful. Knowing is about striving to have an understanding of events as they have connotation within the life of the other. Being with is being present emotionally to the other. Doing for, entails doing for the other that which they would have done for themselves if they were in a position to do so. Enabling is the facilitation of the capacity of others to care for family members and themselves (unchealthcare.org). The levels of hierarchy in the theory deal with critical issues of care. Level 1 deals with the caring capacity (whether or not the nurse has what it takes to be caring). Level 2 entails concerns and commitments (whether or not the nurse has a commitment to relate in a caring way). The third level deals with the condition (whether or not the environment is supportive to nurses who are capable and committed to practice caring). The fourth level looks at caring actions (whether or not the practice consists of actions founded on knowing, enabling, doing for, being with, and maintaining belief in patients). The fifth and final level is on caring consequences; analyses whether acting in a certain manner promotes the intended outcome (unchealthcare.org). Relationship between middle-range theory (the caring theory), and nursing metaparadigms The metaparadigms concepts in nursing deal with the sick individual, health, environment, and nursing. The nursing paradigm looks at the individual who is sick as autonomous and unique, and treats them in such a manner; a real person who is not a sheer object of professional scrutiny and care (Parse, 1987). Nursing metaparadigms does not deal with health in the strict clinical sense. Health’s definition is rather in theoretical terms; it is in context and negotiated. It is subsists in the context of the individual’s health problem. The metaparadigm’s explanation of environment is in the full context of precisely, health care and nursing. It entails the sum of all things impacting the patient’s recovery. Mental state, home life, physical pain, addictions, chances of relapse. All these have an impact on the recovery of the patient, and even their desire for the same. This also comprises dimensions that are of social and cultural nature e.g. religious believes and general attitudes toward suffering and death (Parse, 1987). Nursing, according to the metaparadigms, refers to any medical treatment that is ‘hands-on’, from the nurse to patient. It is the paradigm of kindness, genuine concern and empathy. The reason why nurses become nurses is to lend a hand and alleviate suffering. It is a paradigm of ethics and emotions that goes to the deep foundations of nursing as a profession with rewards of a kind of its own (Parse, 1987). From the viewpoint of nursing caring theory, the focal point and objective of nursing as a discipline of understanding and a service of professional levels has a grounding in primary suppositions that being a human being is to be caring, and the discipline and profession’s activities of nursing combine in coming to the knowledge of individuals as considerate and fostering them as individuals living and growing in caring. The theory revolves round the metaparadigms (Fawcett, 1993). The nursing theory of caring proposes that a person should have an environment that exudes a sense of an atmosphere of nurturing that helps the person to grow in caring while revealing the wealth of nursing. The theory also looks at the idea of nursing as defined by caring and that nursing is about caring for people physically, and all round (Fawcett, 1993). The theory gives an outline that the fundamental nature of caring is highly indispensable in the course of providing care that is holistic, that the patient needs. These are the same issues that the metaparadigms project. The core issues of the theory and its stipulations relate to the nursing metaparadigms as illustrated above (Peterson & Bredow 2004). Intentions formed and authentic presence lead the nurse in choosing and categorizing empirically based knowledge for practical application in every nursing situation that are normally unique. Since caring sees a unique crafting at the moment of response to a unique experience call for caring, there cannot be a prescribed expected result for caring since responses can be highly personalized and varied. However, the nursing experienced by the ones receiving health care and others in the situation, can be valued and given a description (Peterson & Bredow, 2004). Nursing caring is a selfless, active expression of kindness and genuine concern, done intentionally. Nursing as a discipline and profession uniquely has a central focus on caring as its fundamental interest and the direct purpose of the practice. The view that caring prologues the revolution of nursing practices outline and show the value of nursing in the modern health care (Watson, 2002). Theoretical and abstract linkages in the model recognize and relate to indicators giving logical consistency required for validation. This is helpful and critical in translating the hidden work of nurses, into objective work that can be put under test. Scientific demonstration of its worth will enable the advancement of professional nursing, and concurrently improve the quality of health care (Peterson & Bredow, 2009). Change process of implementation of theory into practice Implementation of nursing theory into the culture of health care requires one to strategize, be creative and involve members of staff at all levels (Watson, 2002). Having chosen and analyzed the middle-range theory that would be a best fit to the setting in practice, a thorough introduction would be done. The use of posters could be employed to catch the nurses’ attention on the upcoming sessions that would be dealing with the theory and its practice in nursing. The purpose of the theory would be to organize the knowledge in the discipline. This would advance the development of systematic knowledge, give the means of dealing with challenges within the discipline, and deliver a language that will be useful in framing of ideas of interest within the nursing discipline and unifying of ideas. Were the caring theory to be implemented in my setting, the change process would take a systematic approach. First, a focus group would be conducted. This would be achieved by inviting nurses who are in leadership and in roles of direct-care to attend a group session that would last for three to four hours in the focus group. These nurses would have known about the goals and objectives of the sessions; to analyse the caring theory and successfully put it to practice in their day-day work. Presentations of the evidence-informed practice model would be done during the sessions. The model would serve as a blueprint for transition from concept to action. There would be detailed illustrations for the model to facilitate the ease of understanding the ways of pointing out clinical and administrative challenges, evaluating, and implementing solutions. The opinion of the participants would be taken at every stage. The second step would be to make presentations with the help of the participants steering the group, to the leadership groups and the councils of nursing so as to get organizational support. This would be essential in integrating the theory in to all nursing practice aspects. The nurse managers would be communicated to effectively and clearly what the objective of the intended implementation would be. Once the organizational support has been obtained, general sessions of an hour each would have been developed to share the theory and its intended practise with the health care team. So as to maximise on reaching as many direct-care nurses as possible, sessions for day and night shifts would be made. The sessions would be intensive, brief and clear. The objective would be to provide a basic understanding of the middle-range caring theory, and give explanations on when to put it to practice and who to contact should questions arise. The implementation sessions would start with sessions of training for select practice council and committee members. They would be the group that deals with policy development and research. The theory and its model would be tools for evaluation of evidence from many sources so as to create and update the policy. Evaluation processes would then follow so as to analyse the effectiveness of the theory in practice. The methods to employ so as to carry out the evaluation would include carrying out a survey electronically to establish the attitudes of the nurses toward the model and practice of the caring nursing theory. The model would also be used as a lead to review the results that would be in association with the revised procedures, policies, and protocols. These processes, were the theory to be put in place, would provide a foundation for a successful establishment of a culture of care based research. Were it to be employed, the health organization would see to it that patients and concerned parties would receive care that is not only based on intuition, rituals or clinical experiences, but also on sound evidences which are scientific. Lessons learnt From start to the end of the assignment, it is evident that the nursing discipline is an outstanding profession of selflessness, compassion, ethics, commitment and dedication. It is also clear that the nursing theories comprise of a body of vast knowledge that is useful in the explanation of various features of the profession. The various classes of theories are useful in the description of aspects, their prediction and prescription. The demographic findings about the region give an insight of various health aspects within the region. It outlines the major health factors and the general characteristics of the total population. This information enables an understanding of the challenges of health faced by the communities within the vicinity. This is helpful in providing effective help to the communities medically, and giving pieces of advice on probable ways of curbing and eliminating lifestyle illnesses where possible. The theories of nursing are a set of perceptions that interrelate and give a systematic view of observable facts that is naturally predictive and explanatory. In as much as nursing is practical, it is realizes its strength through theoretical and conceptual knowledge applied scientifically, and artfully. It is also clear that theory helps in maximizing skill. The nursing caring theory also relates to the nursing metaparadigms in this case. The metaparadigms give an explanation of the sick individual under holistic care, i.e. the patient, the environment, health, and nursing. There is a linkage and relations between the nursing caring theory with the concepts of nursing metaparadigms. Through research and findings, caring appears to be at the core of nursing. Jean Watson in her theory of human caring identifies caring as a science. She explains how caring is a science encompassing a humanitarian, the processes and experiences of human caring, and human science orientation (Watson, 2009). The standards of caring could be improved if the theories were analyzed and put to practice. High standards of caring nursing could be set which will be useful in ensuring what the profession expects of the nurses, in promoting, guiding, and directing professional nursing practice which is important for evaluation and assessment of practicing nurses. It will also be instrumental in the growth of an improved understanding and response to different and complementary roles that nurses play. Professional standards in nursing would ensure that top-notch quality levels in health care are upheld. They would provide a method of ensuring that clients are getting health care services that are of high quality. References Fawcett, J. (1993). Analysis and evaluation of nursing theories. Philadelphia: F.A. Davis Co. George, J. B. (2010). Nursing theories. Upper Saddle River, N.J: Prentice Hall. Masters, K. (2012). Nursing theories: A framework for professional practice. Sudbury, MA: Jones & Bartlett Learning. Parker, M. E. (2005). Nursing theories and nursing practice. Philadelphia: F.A. Davis. Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. Philadelphia: Saunders. Peterson, S. J., & Bredow, T. S. (2004). Middle range theories: Application to nursing research. Philadelphia: Lippincott Williams & Wilkins. Peterson, S. J., & Bredow, T. S. (2009). Middle range theories: Application to nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Watson, J. (2002). Assessing and measuring caring in nursing and health science. New York: Springer Pub. www.schs.state.nc.us. (2012). Health Profile. Retrieved on December 21, 2012: From www.unhealthcare.org. (2012). Transltheory. Retrieved on December 21, 2012: From http://www.unchealthcare.org/site/Nursing/nursingmedialibrary/articles/transltheory.pdf> Watson, J. (2009). Assessing and measuring caring in nursing and health sciences. New York: Springer Pub. Co. Read More