Nightingale Philosophy and Middle Range Theory of Nursing - Assignment Example

? Personal Framework Introduction Considering development in technology and the world population growth, many careers have been developed. Nursing is a profession that centers its work by joining forces among professionals to deliver quality care and promote the best result among clients or patients. Therefore the nursing practice constitutes of the interaction between people, health, environment and nursing. The practice entails face-to-face service, which is given to the patients in a population or even a community throughout the life term. The nurse-patient relationship takes place with the intention of reacting to the needs of the service whereby intensive care is the critical role in the nursing practice. In case whereby the patient is not able to respond to the nurse, the parents or relatives are entitled for the response. Whenever there is a complex situation concerning a certain client, more intensive care and extra resources is needed. This enables the nurses and key stakeholders identity the most appropriate category of nursing for the patients care reflecting on the environment factors, client and the nurse. Every professional has his or her expectations in the field of specialization. In the nursing practice, I have several expectations involved, which will enable me deliver the best possible outcome to the patients. With reference to the three-factor framework: client, nurse and environment factors, various nurses’ expectations can be outlined which help nurses in making effective decisions. The client factors are influenced by complexity, predictability and risk of negative outcomes from the client. Any nurse is able to deliver to a client who is less complex more predictable and has low risk of negative outcomes. The more complex the situation is, the more consultation is expected to deliver effectively. As a future nurse, I expect to be able to have self-sufficient practice in nursing and knowledge, which will guide me to deal with complexity of a client thereby establishing effective care and managing the health condition of this type of a client. I also expect to be able to deliver to clients such that they can realize predictable changes in their health conditions to identify their future care requirements. Regarding the nursing factors I anticipate to be able to offer safe and ethical care to the patients through leadership, decision making and through skills obtained from critical thinking. I look forward to be able to apply the knowledge and determine when and where to apply the acquaintance and considering the necessary resources for consultation. As a nurse, I should be able to recognize my competence and practice by being an expertise in the field of nursing. Most nurses enhance their competence and knowledge through proceed in education and experience which is not the case in most cases coz this does not always mean that that u will acquire a foundational competence like most competent nurses. One can become an expert in the nursing practice within his or her own nursing category. It is expected of me that I will be able to have time and resources for effective consultation to provide the best to the clients by being able to provide the paramount consultative results. Considering the environment factors, which are practice supporters, consultation resources and stability of environment, I expect these resources to be supportive in my decision-making. The environment should also be more stable for high proportion of nurses and many consultation resources, which will be more effective for me as a nurse to deliver best to my clients. With dedication and practice in the nursing practice, I will be in a position to achieve goals and objectives. The goal of pursuing the nursing practice will be to provide safe, competent and ethical care to my clients or patients. As a nurse, I am accountable for the practice. I will only be able to achieve the above goal through commitment to developing and applying the practice standard by persistence, critical skills and knowledge and then positive attitude and judgment. However, I focus my care to be able to be responsible and accountable in the nursing practice to meet the occupation and law requirements. I also center to acquire skills, knowledge to deliver competent, and expertise nursing practice. Provision of nursing services to the public in partnership with clients and other health professionals will have a significant effect in attaining my objective. The current paper looks forward to describe an existing philosophy of nursing practice, telling a theory that fits in the future philosophy of nursing practice and specific concepts that will be part of my personal framework. The recent document also provides a model, which describes the relationship among the specific concepts. Nightingale Philosophy of Nursing Deheny (2001) argues that nursing profession deals with rapid changes in knowledge and practice with nurses clarifying their roles and capacity of their practice. Nurses are identifying their beliefs and values as changing demands and expectations of greater roles and extra time pushing them to the values. One should be able to understand what a philosophy is before developing one. Baxter (n.d) defines the term philosophy as used in nursing as “an attitude toward life and reality that evolves from each nurses beliefs”. One of the existing philosophies of nursing practice is the Nightingale Philosophy of Nursing. According to Selanders (2010) Florence Nightingale philosophical basis of modern nursing is normally explained by her contribution to the society change. The nursing theorist assumed that a healthy environment was necessary for good nursing care and remains the basis of holistic nursing care. For a healthy environment, the following are the essential elements: pure air, pure water, efficient drainage, clean less and light. The nursing philosophy was put into practice in that the responsibility of nurses is to situate patients in the best way possible for nature to act on them. Nightingale’s theories are based on her philosophical assumptions and beliefs considering all aspects established in the metaparadigm of nursing. The nursing metaparadigm is explained under the following: Nursing: The goal of nursing is to deliver the best possible outcome to the patient and put the patient in a healthy condition. Nursing is considered to be a necessity for everyone’s well-being and should be delivered in every condition. Person: The nurse-patient relationship should be mandatory in the nursing practice (Southern Luzon State University-College of Medicine , 2008). Nurses should perform health services to people regardless of their multidimensional, biological, physiological, social and spiritual backgrounds. Health: Health is not only considered to be well but also being able to utilize the power we have. Being sick or unhealthy is believed to be lack of comfort. Environment: Health or good environment is usually regarded as the best for effective health. The nursing theorist claims that environment could be adjusted to improve conditions for natural regulations to allow healing to prevail. Considering the above philosophy, the values and beliefs that will guide by practice is fact that to be able to succeed as a nurse, I should be able to deliver intensive care and have the attitude to continue attaining and applying knowledge throughout my vocation. Another value that will guide me is that I should be able to utilize the technical resources for me to be competent. As a nurse I should live the philosophy of nursing on a daily basis thereby delivering health care in any kind of environment or location for I do not have to be at work place to deliver to the public. Ethical values or principles are the principles that nurses come across when making decisions in the nursing practice. The ethical principles to be discussed in this paper include bebefience, justice, veracity and autonomy. The College and Association of Registered Nurses of Alberta (2010) define Autonomy as the “right to choose for oneself what one believes to be on ones best interests”. With reference to the above definition, one should be able to be in charge. Several duties arise from this value, which include respecting the patients option of cure and their need to make the decisions in matters of life and death. Other duties realized here are rights to refuse to treatment, to privacy, to truth telling and to confidentiality. Autonomy results to self-determination in clients and is aimed to building relationships with respect to differences or cultures, which may alter clients, thought of restrictions to autonomy. Delivering the truth to the clients plays a bigger role in the client’s decisions. This principle relates to my future nursing practice in a way that I will be able to care and respect clients decision by not interfering with their decision. The ethical value of benefidence is termed as the responsibility to benefit others through assistance and welfare contribution to the public by doing something in the best interest of the clients. Willingness of doing good towards others by considering their best interests by not paying a lot of attention to the principle of autonomy leads to affectionate care in health care. Considering this principle, I intend to be in a position to offer continuous opportunities to clients by enabling them make certain decisions to perform precise treatment and care even if a client or patient is sick or hurt. Generally value of beneficence is doing well by giving health benefits to clients, balancing the benefits and risks of harm and then determining how a patient can be best helped. Shmary and Jehany (2000) argue that Veracity is moral principle, which implies that nurses should tell the truth to their clients and not lies. This principle helps in building trustworthy relationships in between the clients and their nurses. Regarding the principle, truthfulness is an essential thing in my future nursing experience to gain trust in my clients. According to the College and Association of Registered Nurses of Alberta (2010) the value of Justice suggests that all individually should be treated equally by nurses keeping away from judging the clients. This principle values that all individuals should have access to means of life and health equally but more resources or great attention should be to the most disadvantaged individuals. Health care facilities and efforts needs to be fairly distributed both at regional and provisional levels to enhance effective primary care. Concerning my future nursing practice, the principle of equity is fairness according to the need will always hold to my practice to deliver the best outcome without judging the patients. All the above principle helps nurses in ethical decision making considering certain situations in their nursing practice. Middle Range Theory of Nursing According to Smith and Liehr (2008) each practice constitutes of a certain knowledge that distinguishes it from other fields. Nursing knowledge is mainly obtained from philosophies, theories, research and wisdom from normal practice of the profession. Many discipline professions gain their knowledge from theories. Middle range theories give a clear picture of structure of nursing practice. The theory suggests that nursing is a professional discipline different from other academic disciplines and nurses have well grounded profession practice with them. Regarding the theory, many researchers claim nursing to be only a practice which is not the case because knowledge is not about practice only but also about substantive fact of concern to discipline. Failure of considering discipline as knowledge by putting more emphasis on practice has led to nursing being termed as a vocation instead of a profession, which has led to a misunderstanding of whether discipline in nursing really exists. Smith and Liehr (2008) argue that nursing is the study of human healing through caring contradicting other scientists who have defined nursing in different terms. The definition clarifies the fact that healing is a process changing and developing while caring is the lane to healing relating an individual to the environment. The theory implies that from the above definition, the nursing knowledge constitutes the entire life of human beings in development and experiences to changes, which is the target of knowledge development in discipline of nursing. Therefore defining nursing as a professional discipline does not degrade the term practice of nursing. The middle age theorists suggest that the center of practice comes from the definition of discipline. Middle range theories take in hand knowledge of discipline by emphasizing on facts that are related to caring and healing process. One of the examples of middle age theories is the theory of self-tradence, which stresses on how as one grows old focuses on the meaning of life both intrapersonally and interpersonally, uniting with others and the environment (Smith and Liehr, 2008). This theory is closely related to healing and has been identified in research as a vital guidance for nurses in their practice. The use of middle age theories has led to expansion of knowledge of discipline in nursing. Most of the nursing researchers have organized the knowledge in discipline in paradigms. Middle range theory uses the paradigm structure whereby each type of this theory has its organization in a paradigm. The beliefs and values on human being view, human environment relation, health and caring are explained in the paridigms.The above beliefs and values affects the meaning of the middle range theory therefore philosophy should be clearly defined in the paradigm. The popularity of middle range theories is growing as time goes by and can be extracted from a grand theory or openly linked to a paradigm. Smith and Liehr (2008) argue that middle range theories are related directly to research and practice since they have been developed through researches and practical observations. Nurses can therefore use the middle range theories in developing and boosting their practice in nursing. The use of this theory enhances organization of discipline in practice and research in the nursing profffession.Growth of knowledge in discipline is highly dependent on nursing knowledge in practice and expansion of new knowledge. Middle range theories gives a consistent framework of facts being researched by disciplinary teams for growth of knowledge is expanding in nursing since more emphasis is being laid on this theory. Health centers and hospitals are expected to focus on theoretical viewpoints that guide nurses in their nursing practice. The theories of middle age theories form the basis of my framework in future in that, the theory guided practice in nursing will lead to quality partnerships among nurses. Therefore application of the knowledge retrieved from the middle range theory and other nursing theories will result to enrichment in care improving the quality of life of patients and other individuals. Application of middle range theory will guide me in my nursing practice through application of knowledge in practice and discipline. Specific Concepts that will Form Part of Framework Several concepts from philosophy of nursing practice, ethical values and theories discussed above helps individuals in everyday nursing practice when facing medical difficulties and when a lot of attention to clients is needed. The following concepts are going to aid me in my personal framework as a nurse practitioner. Respect for the decisions of individuals during delivery of care and healing by nurses to the patients without discrimination. The concept implies that health services should be equally and fairly give to individuals by not taking into consideration of race, religion, age, gender, beliefs or position in society. Another concept that I will apply in this nursing practice is building a trustworthy relationship between me and the patients .This will give assurance to the patients and their relatives while attending to them in their cultural and social perspective to be able to deliver the best. Considering the principal of nursing, we derive the concept of respect of clients or patients right to accept or refuse health systems and take into consideration the best interests of clients. Therefore as a nurse practitioner this will enable me in respecting my clients’ interests through contractual agreements with other professionals and the client’s family. The concept of ensuring that patients pay attention to the disciplinary teams and health perspectives in which they have laid their confidence in to remain in the best health care possible. Considering the ethics and values discussed above, the ability of being able to work independent and in collaboration with other professionals in the nursing practice will assist me as a nursing practitioner. This will be vital in sharing skills, level of competence, professional knowledge thereby producing the best outcome to the patients. Another concept that will guide me in my nursing practice is the responsibility of professional confidence; respect for patient’s decision and protecting their data, trough the use of professional ability so as provide optimal health care to clients while acknowledging their weaknesses using the available resources. One of the most important concepts in the nursing practice is the respect of the philosophy of the nursing practice and working under the framework based on the philosophy and the awareness of the rules and regulations that govern the nursing profession. Being truthful to the patients by providing information regarding their state of health to their level of understanding is one of the best concepts that I will apply in my personal framework in nursing practice. Davies (2007) argues that giving full support to clients in the area in which the nurse is an expertise in is a concept that will guide me in my personal framework for it helps clients in making structural decisions about their health care system. Another concept is offering skills and education to clients about health care that will help patients participate in their care and maintain their health condition. Another concept is accurate verbal communication between the nurses and other expertise nurses and continuous record keeping. One of the major concepts in nursing practice is self-motivation and encouraging a positive atmosphere of interaction between colleagues, students, visiting staff and clients thereby resulting to excellent outcomes. Using guidelines provided by the healthcare facility and practicing them is a major concept that will help me in my future nursing practice. However, from the middle range theory and other nursing theories, the following four concepts are mainly used in the nursing theories: the patient, health and nursing. The most important concept among the three is the concept of the patient since the focus of nursing is to provide the best possible outcome to the patient. The concepts illustrated above from nursing theories will be part of my personal framework in nursing practice since they are independent to each other. Model Description of the Model From the above model, the sub concepts of the responsibility, profession and accountability concepts are expressed in a blue background. The arrows are used to depict the relationship between the concepts, which illustrates that they are interdependent to each other. After the practitioners have achieved their responsibilities and professional roles they are able to perform the health assessment and diagnosis effectively to the clients. Performing the health assessment and diagnosis role leads to health promotion and prevention of illness and injury enabling nurse practitioners to collaborate with other professionals and acting as consultants in performing of therapeutic management hence nurse practitioners become responsible and accountable in their profession. From the above model, the following concept will guide me in my future nursing practice, which summarizes the concepts discussed in the previous page. According to the College and Association of Registered Nurses of Alberta (2011), for a nurse practitioner to be competent in the nursing practice, they should play the profession role, be responsible and accountable in accordance with the foundations of practice. Other skills include collaboration, consultation and referral, research and leadership. Similarly, the nurse practitioner practices nursing in accordance with rules and regulation by the state and the health sector by considering ethical standards and the policies in the health care system. The nurse is also required to work in collaborating with other professionals through consultations in conditions, which he or she is not competent in delivering to the clients. The nurse practitioner should also accept referrals and act as a consultant if competent from both the health care providers and non-health care professions. Considering research, the nurse practitioner should apply research and relevant theories through utilization of available resources to ensure that clients receive organized health services and best outcome from the nurse by application of this research knowledge. The nurse practitioner provides leadership in the management of health care system by acting as a mentor and giving skills to other nursing colleagues hence promoting the role of a nurse practitioner. Considering the arguments from the College and Association of Registered Nurses of Alberta (2011), based on health assessment, diagnosis, the nurse practitioner uses both discipline, and practice knowledge to get the necessary information required for diagnosis and the client needs. The nurse practitioner also works in collaboration with the clients so as to be able to determine the health risks and promote understanding of heal issues and behaviours.The above is achieved through assessment of necessary tools and requirements needed for the health services considering the client’s needs and condition. The nurse should be truthful to the clients when diagnosing diseases and disorders by building a trustworthy relationship between the clients. Under therauptic management, nurse practitioners collaborate with clients to create an effective environment for communication of diagnostic and therapeutic intervention to take place. The nurse practitioner uses evident information from research and through collaboration and consultations in determining the alternative therapies a client needs by considering the benefits and risks involved in the client’s health. Health promotion and prevention from injury is a concept used by nurse practitioners to focus on improving and restoring health of individuals. The nurse practitioner collaborates with other professionals to promote health and lower the risks of complications, illness and injury in clients or individuals in a fair manner throughout the population. Conclusion Nursing practice entails the continuous practice, freedom of making and exercising decisions, accepting responsibilities and being accountable for actions in the health care system. Critical thinking and application of both practice and discipline knowledge enables nurses to discover and examine evidence, stuations in the nursing practice leading to a high level of delivery and decision-making. Nurse practitioners should also be in a position to exercise their expertise in complex situations concerning a patient by making critical decisions and deciding on how to effect the decision to achieve the best outcome. Considering theories and philosophy discussed above, individuals should be aware of their values and beliefs. These values and beliefs suggest that nurses should work in collaboration with patients to build a trustworthy relationship in between and care is negotiated with the patient as n equal partner. The nurses should be n a position to deliver a professional practice which s evidence based and within the health care service, by acting as role model among other nursing colleagues hence exercising the duty of nursing. Considering the middle range theories and other theories in nursing, theories are going to play a big role in my future nursing practice. The use of theories will assist me in organizing thoughts and ideas in the nursing practice thereby making decisions on what and when to do. Theories will also provide a framework of communication with other nurses and other members of the health care system in my future nursing practice. In my future career of nursing, theories will be effective in my practice since they assist the discipline of nursing in simplifying beliefs, values and goals thus contributing a lot in the care of clients. Therefore nursing theory is necessary in my nursing practice since it is essential for development and emerging of the discipline of nursing. The field of nursing and health care is changing as time goes by therefore use of theories in my nursing practice through nursing research will build an effective knowledge in nursing. References Baxter, C. Personal Philosophy of Nursing. Accessed April 25, 2013 from www.juns.nursing.arizona.edu/articles/Fall%25202008/Personal%2520Philosophy%2520of%2520Nursing.pdf College and Association of Registered Nurses of Alberta (2011). Nurse Practitioner Competencies. Edmonton: College and Association of Registered Nurses of Alberta. College and Association of Registered Nurses of Alberta. (2010). Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and recommendations. Accessed April 25, 2013 from www.nurses.ab.ca/Carna-Admin/Uploads/Ethical%20Decision%20Making%20for%20RNs.pdf Davies, G. (2007). A Personal Concept of Nursing care. Accessed April 25, 2013 from www.nursingtimes.net/a-personal-concept-of-nursing-care/227351.article Deheny, J. (2001). Articulating Your Philosophy of Nursing. Journal of School Nursing, vol. 17, no. 1. Parsons, M. & Robichaux, C. (2009). An Ethical Framework for Developing and Sustaining a Healthy Workplace. Critical Care Nursing Quarterly. 32,199-207. Retrieved April 25, 2013 from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=867329 Selanders, L. (2010). The Power of Environmental Adaptation Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing. vol. 28, no. 1. Accessed April 27, 2013 from http://jhn.sagepub.com/content/28/1/81.abstract Shmary, K. and Jehany, H. (2000). Ethical and Legal Issues in Nursing Practice V. Accessed April 25, 2013 from http://faculty.ksu.edu.sa/26606/Seminars/health_care_system.pdf Smith, M. & Liehr, P. (2008). Middle Range Theory for Nursing. New York: Springer Publishing Company. Southern Luzon State University-College of Allied Medicine. (2008). Nightingale’s Environmental Theory. Theoretical Foundations of Nursing. Accessed April 27, 2013 from http://slsu-coam.blogspot.com/2008/08/nightingales-environmental-theory.html Read More