Ethical Knowing and Economic Effects on Nursing Theory - Article Example

? Nursing Theory This is a short review of nursing theory and how it relates to the education of today’s nursing which will later affect the professional nurse in a nursing career. There are many ways to look at medical cases, yet each one is distinctly different than the next one and therefore, adequate knowledge in practice and in nursing theory is essential to a well-rounded professional nurse. In closing, the economy is brought forth as an indicator for possible changes in those theories and practices, something which all nursing students and professional nurses must learn about, in order to make the appropriate adaptations to the current state of the medical practice. Introduction Nursing theory is essential to all nurses as they develop their knowledge through their extended studies and learn to evaluate the different cases they will encounter during their careers. Most notably, understanding ethics in nursing theory is also important as part of the evaluation process as concerns patients and their health. In a global society, technology and research knowledge are advancing at a rapid rate, and more so now than ever before, future nurses must engage in continual education and developing their theories of nursing. The term, ethical knowing, outlines the fundamental pattern of knowledge, theory and purpose in the business of nursing (Carper, 1978; Noureddine, 2001). Ethical Knowing It should be understood that while nursing goals and actions within the terms of ethical knowledge is evaluated within the framework of each medical case the nurse will encounter. While a simple solution might be viewed as obvious, in a further review of the circumstances surrounding a case, it may be determined that another path of treatment would be far better for the patient rather than just the accepted book-learned course of treatment. In reviewing ethical knowing from a philosophical viewpoint and through terms of ontological and epistemological dimensions, the ontological dimension refers to ethical traits which nurses must possess – empathy and compassion. In the epistemological dimension, the moral validity of what nurses must be is to be truthful and maintain the confidentiality of the patient (Noureddine, 2001). Ethical theories encompass the deontological, utilitarian, right-based, intuitionist theories which are associated most often with ethics in nursing. Deontological, duty-based theories have four major principles: the personal liberty to act; doing no harm; action which improves the welfare of others; and justice in treating people equally and fair distribution of resources (Noureddine, 2001). Utilitarian theory is action-based with the outcome as the basis, which is also referred to as maximizing the good for everyone rather than addressing individuals. Right-based theories are more concerned with the individual as the center and protecting individual choice. Autonomy and self-determination are part of right-based theories. Intuitionist theories, on the other hand, put the elements of duties, rights and goals on the same level, and it is up to the nurse and her moral intuition to make the ethical decision for any particular situation (Noureddine, 2001). Yet, as nurses have discovered for themselves, occasional cases may show that two theoretical frameworks may apply, and determining the more salient resolution, becomes a dilemma for the nurse in the process of caregiving. Initially, nurses might question why there is such a thing as nursing theory and for those who are first encountering the concept of theory, the reaction is one of fear and trepidation (McEwen & Wills, 2010). The point for theory in nursing is that it educates nurses to think on a more evolved level which will assist them later as professional nurses in assessing individual cases. Theory can also be from outside of the nursing field when assisting in looking at and analyzing a case from all angles. Ultimately, theory is ‘guidance through interpretive assumptions, principles and propositions which help explain and guide actions’ (Young, Taylor, & Renpenning, 2001: McEwen & Wills, 2010). Development of Theory Over time since the first days of nursing, theory has evolved and identified in the ranges of most complex to the least complex. There are four levels of theory which are considered the primary categories: Metatheory, Grand Theories, Middle Range Theories and Practice Theories. There are also Partial Theories at the lowest level which represent those theories still in development which Keck (1998; McEwen & Wills, 2010) said are derived from the social sciences and that also includes nursing. These, however, are exclusively partial theories because of the inability to fully explain any one particular phenomenon (Keck, 1998; McEwen & Wills, 2010). The Nursing’s Metaparadigm In the structural hierarchy of nursing knowledge, the metaparadigm is a generalized perspective that identifies a primary phenomenon within a discipline, and explains, within that discipline, how it is dealt with in a unique manner (Fawcett, 2000; McEwen & Wills, 2010). This provides conceptual models and theories for scholarly research, as well as the guidelines for operations in theoretical concepts, assisting in summarizing missions in the discipline, intellectually and socially, and also providing boundaries on the subject matter (McEwen & Wills, 2010). Subsequently, four requirements for identifying a metaparadigm are listed below. Fig. 1 (McEwen & Wills, 2010, p. 39) Nursing scholars in the 1970s and 1980s proposed that a consensus within the community identified dominant phenomena in nursing science as revolving around the concepts of person, health, environment and nursing itself. The ‘person’ is a collection of intellectual, biochemical and psychosocial requirements, one who is interactive and adaptive with the world on several levels. Nursing theories generally conceptualize those who receive nursing care mostly through the individual focus but, in some cases, this will also include the family or surrounding community of that patient (McEwen & Wills, 2010). ‘Health’ is referenced as the utility of the whole inner package of the person: the mind, body and soul as a collective force in achieving the fullest capabilities for embracing life. The ‘environment’ reflects on the outer package or casing of the ‘person’ which affects the internal choices made as to how to interact, or react, to outside causes and effects. Examples of such effects would be economic, religious or social circumstances, and for each person, the results would be uniquely different, based on the levels of these effects (McEwen & Wills, 2010). ‘Nursing’ as the last component, involves caring and caregiving from the perspectives of science and creative thinking as an art, through a practice discipline. The goal of a nurse, ultimately, is to promote the best harmonious interaction between nurse and the patient that will allow for a complete healing environment for that patient. These four concepts have also been put forth as related to each other through the writings of Donaldson and Crowley (1978) and Gortner (1980) in the following propositions. 1. Person and health: nursing principles and laws that govern the life process, well-being, and to optimize the functions of persons, both sick and well. 2. Person and environment: nursing within patterns of human behavior regarding interaction with normal and critical life situations as per that person’s environment. 3. Health and nursing: the process of nursing actions that promote positive changes in health status. 4. Person, environment and health: nursing that encompasses the complete package of the person, based on their environment and the continued interaction with that environment. Fig. 2 (Fawcett & Malinski, 1996; McEwen & Wills, 2010, p. 40). Fawcett and Malinski (1996) also put forth that these four concepts meet the metaparadigm requirements because they are perspective-neutral, do not reflect specific paradigms or models, and are also not specific to any one country or culture (McEwen & Wills, 2010). Economic Effects on Nursing Theory Nursing theory and the parameters of nursing care are sometimes affected by economic situations in the environment and this will have a bearing on how nurses react to how they can give care to patients, particularly those in minority classes. The report produced by the Institute of Medicine (IOM, 2003) showed clearly that patients fitting into racial or ethnic minorities received a lower quality of health care. In an environment of this nature, it is sometimes hard for nurses to find solutions to care for their patients when money is an issue. This was most noticeable in the care given for illnesses in cardiovascular disease, cancer and diabetes (Roy & Jones, 2007). Since the creation of the National Center on Minority Health and Heath Disparities under the umbrella of the National Institute of Health in 2000, the goal has been to reduce the inequalities of healthcare throughout the medical field. Nurse scholars have greatly assisted in developing strategies to eliminate these equalities and to garner funding that will help finance areas with health disparities. This also includes the educational process and the advent of the Nursing Doctorate in the 1930s which is practice-based but now, also allows for respected scholarly research in practices and in more developed theory (Roy & Jones, 2007). The Roy Adaptation Model In 1976, Sister Callista Roy promoted the Roy Adaptation Model (RAM) as a guide for nursing practice as part of break-out sessions during the Nurse Educator Conferences in Chicago (1977) and in New York (1978) and this was the first shift in the emphasis from research to theory at a national level. While there was no one particular theory as a theme at these conferences, subsequent conferences focused more on the need for more developed nursing theory and this field has grown exponentially since then. A brief summary of the RAM is that the foundation of the RAM presents the basis from which nursing curriculum is developed, as well as nursing judgments regarding clinical experiences, and provides a framework on which nurses make decisions regarding patient care. The adaptation is ‘the process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create human and environmental integration’ (Roy, 1976). The RAM also addresses adaptive mechanisms for individuals, groups, levels of adaptation, the integrated life process, the compensatory process, the compromised process, and four adaptive modes, three as psychosocial and one as physiological (Roy, 1976). The Nursing Process and RAM in a nutshell at the end of the model provide a basic set of steps for evaluating any case initially. The first level assessment will assess the behaviors, such as ‘the what.’ The second level assessment identifies stimuli, such as ‘the why.’ The third step is the diagnosis which is ‘what does it all mean?’ Planning as the forth step is ‘what do you want them to do?’ The implementation step is ‘what are you going to do about it?’ which addresses how the intervention will help meet the goal. The evaluation step is ‘how did it work out?’ and whether you should keep the same process or change it for a better solution. (Roy, 1976). The RAM also indicates how professionals address actual and potential problems through a holistic process by assessing the diagnosis first and then building the process through nursing history of the patient, which includes the physical, assessment notes and narrative notes (Roy, 1976). Conclusion As noted earlier, those in the medical field overall are being impacted by economic issues of today’s recession, technological advances that have good and bad consequences on care givers’ careers, and the need to adjust in accommodating these changes. Nursing theories are also impacted and challenged due to the economic changes, and future research in both theory and practice must subsequently address these problems. As a professional nurse, I would want to study the economics and effects of the medical industry as relates to patients and how economics plays a factor, for good or bad, in health and wellness of our patients. This also includes the effects of the Affordable Care Act which will be in full effect by 2014, and will affect many areas of medical practice and insurance issues, both positively and negatively. Resources Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), pp. 13-23. Fawcett, J. (2000). Analysis and evaluation of contemporary nursing knowledge: Nursing models and theories. Davis, Philadelphia, PA. Fawcett, J. & Malinski, V.M. (1996). On the requirements for a metaparadigm: An invitation to dialogue. Nursing Science Quarterly, 9(3), pp. 94-97, 100-101. http://www.ncbi.nlm.nih.gov/pubmed/8850982 Glennister, D. (2011). Towards a General Systems Theory of Nursing: A Literature Review, University of Hull, U.K., http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569 Keck, J.F. (1998). Terminology of theory development. In Tomey, A.M. & Alligood, M.R. (eds.), Nursing theorists and their work, 4th ed., pp. 16-24, Mosby, St. Louis. McEwen, M. & Wills, E.M. (2010). Theoretical Basis for Nursing, 3rd ed., Lippincott Williams & Wilkins, North American Edition. Noureddine, S. (2001). Development of the ethical dimension in nursing theory, International Journal of Nursing Practice, 7, pp.2-7, http://deepblue.lib.umich.edu/bitstream/2027.42/73773/1/j.1440-172x.2001.00253.x.pdf Reed, P.G. (2007). Scholarly Reflection on Nursing Practice: Undergraduate Student Discoveries from Four Case Studies, University of Arizona, College of Nursing, http://www.juns.nursing.arizona.edu/articles/Fall%202007/Scholarly%20Reflection%20on%20Nursing%20Practice.pdf Roy, D. (1976). The Nursing Process and the Roy Adaptation Model. http://ahn.mnsu.edu/nursing/facultyformsandinfo/nursingprocessandram.pdf Roy, C. & Jones, D.A. (2007). Nursing Knowledge Development and Clinical Practice, Springer Publishing Company, http://www.springerpub.com/samples/9780826102997_chapter.pdf Read More