Applying Theory to a Practice Problem - Research Paper Example

? Applying Theory to a Practice Problem Pamela Moore March 27, Practice Problem Part Applying theory to a practice problem has been the goal of major nursing theorists in their efforts to save human life. Various nursing theorists such as Dr. Margaret Jean Watson and Katharine Kolcaba are successful and inspiring nursing theorists who formulated the caring theory and the comfort theory respectively. Katharine Kolcaba was born in 1944 in Cleveland, Ohio. She is an American nursing professor and nursing theorist. Kolcaba is developed comfort theory, a nursing theory that has been implemented at various institutional levels. She earned a nursing diploma from St. Luke's Hospital School of Nursing. She earned both Master of Science in Nursing and a PhD from Case Western Reserve University in 1987 and 1997 respectively. Currently Kolcaba is serving as Associate Professor of nursing at Akron College of Nursing. Kolcaba has received many awards, including the Midwest Nursing Research Society award of Advancement of Science Award and the Case Western Reserve University award Cushing Robb Prize. Since retiring from professional teaching, she has been volunteering with the Honor Society of Nursing and the American Nurses Association. She has done various publications including Comfort Theory and Practice: A Vision for Holistic Health Care and Research. On the other hand, Dr. Margaret Jean Watson was born in 1940 in West Virginia and grew up in an extended family (Watson, 2010). Watson graduated with her bachelors of Science in Nursing at the University of Colorado. She earned her master’s in psychiatric-mental health nursing, and a doctorate’s in educational psychology and counseling (Johnson & Webber, 2010). She joined the teaching profession and became a distinguished Professor in Nursing and holds a Chair in Caring Science at the University of Colorado Health Science Center (Johnson & Webber, 2010). She also served as Dean of Nursing at the University of Colorado Health Science Center and became the president of the National League for Nursing (Johnson & Webber, 2010). Her caring theory was derived from personal beliefs, values and experiences. Watson established the theory of human caring which formed part of her doctoral studies in psychology and counseling (Watson, 1997). Dr. Watson is a fellow in the American Academy of nursing. She has national and international honors (Watson, 1997). When Watson created the caring theory, she had in mind the purpose to capture the medical standard of the patient and the environment in which they lived (Watson, 2008). This paper seeks to describe a nursing theory established by the above described nursing theorists and the influences contributed by the theorists, the concepts and the propositions of the theory, and then apply the theory to a practice problem through demonstrating the links to the elements of the theory and the problem. According to Kolcaba (1993), comfort theory addresses the satisfaction of human needs that arise from stressful health care situations. The paper seeks to apply this theory in the field of patient negligence. This involves the lack of coordination and communication in care, and also the management and control of symptoms, before the disease is aggravated. This problem is experienced in both the public and private sector hence Kolcaba (1993) sort to address this issue and return sanity in the administration of patient care. According to L.J. Morrison and R.S Morrison (2006), palliative care are important in the care of elderly people as they require close monitoring. The problem is quite a matter of interest, quoting from statistics most patients die due to negligence by nurses. If the issue is addressed appropriately this will prevent the end of avoidable deaths. Kolcaba (1993) acknowledges that various scientific steps such as the muscle relaxation procedure and the therapeutic touch have been made to ensure that patients are well taken care of. In addition to the acknowledgement of the work of Katharine Kolcaba, The University of Philippines (2011) makes the observation that care can be provided in two ways. The first way is through the provision of compassion and concern towards the patient and secondly the provision of comfort in the care room. Katharine Kolcaba combines the two to come up with a comprehensive process. Nurses are forced to hurriedly get to the next patient, so that they can finish their assessment and rounds. Some nurses are so overwhelmed and always trying to get in and out of a patient’s room. Nurses, because of their production line approach, they tend to forget to ask the patient regarding their pain or do they have any discomfort. And for patient’s that cannot verbally express them themselves, nurses do not take the time to view there facile grimacing. They do not recognize the patient’s discomfort. Nurses are important, the more the reason this problem is of huge magnitude, they ensure the families are aware of the problem, they can deal with it and at the same time live with it. Katharine (1993) describes comfort as existing in three defined forms. They include relief, ease, and transcendence, She continues to add that the forms occur in four contexts, that is physical, psycho-spiritual, socio-cultural and environmental. Relief is mainly addressed when the individual needs of a patient are met. It may generally involve the administering of analgesia which gives a relief to pain. Ease according to Kolcaba (2011) is the state of serenity and satisfaction that ensures that the patient is protected from stress and anxiety is reduced. (March & McCormack, 2009, p.9) defines transcendence as “the state of comfort in which patients are able to rise above their challenges”. The physical context seeks to address matters relating to the body feelings and responses to various stimuli. Psycho-spiritual contest seeks to focus on matters that relate to the person’s self-esteem, personal uniqueness, and also the relationship with God. Sociocultural issues are issues relating to culture and the society and how they affect the behaviour of an individual. In this case nurse is under the mandate to involve the patients' family and give a step by step progress report. The environmental In text, according to Kolcaba (1993), Nurse have to start taking the time to fully explain produces to the patient and their family. So that the family can take proper care of the patient, and the patient understands what is happening to them during their disease process. Nurses are sometime so overwhelmed until they do not focus on the patient’s surroundings, such as the patient’s room cluttered or the curtain’s not being open so that they can get sunlight. The external human background experiences such elements as light, temperature, colour, odour, sound, furniture, and landscape. Therefore, a positive environment is a very important aspect in providing care. The rationale for the selection of this practice problem with the chosen comfort theory comes out well in Cara, (1999) who says that if nurses are incapable of being vulnerable with themselves and other people, they become mechanical, robots, depersonalized and detached in their lives and profession. Nursing theories assist in the understanding of the essential element that Jean Watson was trying to express through her caring theory; both of these theories are similar. If nurses do not begin to show compassion and love to patients, the patient loses confidence with in nurses. In addition, this can interfere with their care. If nurses continue to use the professionals a routine cycle or just performing a duty, or job. They begin to lose cite o f the human person. They will then begin to view the profession as and the patient as an identification number. It is ideal when nurses can assist patient with a life-long process of staying healthy and understanding their disease process. However, by doing this, nurses let go of the judgement al attitude and began to understand that they are working with human being. When working with people, nurses must be receptive and understanding of others. By exhibiting a positive and a caring, and comforting attitude this assist patient to believe and gives them the will to fight to get better. The problem facing the practice; the gap between theory and the practice in nursing has widened over the years. Nurses have to become skilled, and knowledgeable regarding becoming subjective to research, theories, current professional standards, that governs nursing practices, and various clinical settings. According to Sabah (2013), It is increasingly becoming complex for the nurses to apply multiple theories, this is because of the conflicting knowledge they have in their day to day practice. In most theoretical portions of work in nursing, major threads of theoretical thinking are difficult to identify (Sabah, 2013). Some of the theories have been test in several different ways, making many theories to become problematic and complex. Some facilities have begun to implement, and educate staff members, regarding certain theories that will be put into place. Although the facilities have recognized that, there will be some problems, which will transpire. They are willing to try several different theories, to help with the many problems that facilities are enduring, today. Problems in the practice that has been encountered is that, many theorists have used the term theory as interchangeable with such terms as conceptual framework, conceptual model, and paradigm. Some theories cannot be applicable when trying to provide patient care. Some of the theories are just not plausible, when patient are being examined (Masters, 2011). Many scholars have stated that the grand nursing theories or the conceptual framework requires further specification to be called theories. Some professional are very critical concerning nursing theories and do not believe in some of the theorist findings. Theorist should develop a more rigorous debate regarding the normative nature of prescriptive theories and their effects on the development of nursing science and application to nursing practice in the context of philosophy of science. Martha Roger’s concept of science of unitary human beings, and principles of homodynamic theory views human beings as a unified whole, possessing individual integrity and manifesting characteristics which are more than, and different from the sum of parts (Sabah, 2013). While Dorothea Orem’s Self-care theory defines human being as a spice that can reflect, symbolize and to use symbols (Sabah, 2013). That is; she thinks that human being have feelings, senses and that they have needs and can take care of themselves. Faye Glenn saw and held that nursing is indeed a call to do services for society, and should be done with a great deal of care and love (Masters, 2011). That nursing is in fact a service, which is rendered by those who have the compassion and empathy for the helpless and vulnerable people. She realized that people have to begin helping each other and remain mindful and understanding of the patient’s human concerns and needs. When people are hurting, this is when they are at their most vulnerable point, they need the love and compassion of another person to offer assistance. It is clear that, human being is individuals with the capability to live among other being and can adapt to the changes of their environment. They are individuals with feelings, reflections to things and have a high reasoning capability. They have physical, emotional and sociological needs. Dorothea’s definition of human being can be more close to my own thinking of the spices. This is because she views human being as individual with the capacity to reflect, symbolize and use symbols (Sabah, 2013). In trying to explain the definition of human being, each theorist used his or her own view of the meaning. Every person interrupters the meaning of human being in so many different ways, although there words may vary, the meaning is somewhat similar. The theorist, Callista Roy’s adaptation theory view of human being focuses on the ability of individuals, families and societies to adapt to change. The individuals can cope and interact with the change to the environment (Sabah, 2013). In the current nursing environment, the situations that nurses undergoes through each day calls for the revisiting of knowledge schemes, and the extent to, which they assist in improving the health care in society. Some of the schemes that have been used in nursing are the nursing theories that have been used in encountering problems that nurses undergo. Knowledge development among nurses has been the main accomplishments of nursing scholars. A higher level of expertise will be critical as the nursing profession began to focus on improving the healthcare system (Barker, 2009). This has led to the development of a range of nursing theories since the mid- 20th century to date. Nursing scholars have moved from developing nursing Meta theories to building theories that encounter specific problems related to nursing practice. The shift in nursing is to prepare the advance practice nurses for the future and shape the profession to meet the demands that facilities has begun to put into place (Barker, 2009). Some theories have been said not to cover completely nursing phenomenon. It may be argued that it is because some countries have little theoretical development, and cannot understand the concept. However with this argument, many believe that the discipline of nursing is less affluent. It has also been facilitated by the transference of American nursing theories to other countries. As other countries began to try to understand or adopt the clinical practice of the American theories, countries began to invite theorist to their country. The expansion has the, theorists going to other countries, holding conferences and participating in translation of books. Nursing theories have often been founded in the conviction that the nursing body of knowledge should be control or influence clinical practice rather than being defined by it (American Nurses Association, 2010). Through time theories have helped to shift the paradigm form being a place where nurses only perform skills and duties, to a place where illness is treated with compassion and respect. Nursing theories can be used in differentiating the focus of nursing from other professions (American Nurses Association, 2010). Concepts of theories have been used to guide all phases of the nursing process, including planning, implementing, and evaluating nursing care (Finkelman, 2012). In addition, they have been used in describing and explaining desired responses during nursing practice. Nursing theories assist nurses to be focused on the goal set, hence making them more alert and confidence in their practice. When nurses are focused, and dedicated they can become more effective in giving care to patients as well as being indispensable members of our affiliated nursing profession. Theories has helped to guide nurses into research; validate and modified the theory, hence enhancing communication. By doing so, this has also assisted nurses with being able to understand, and initiate better changes within the developmental process of how care is delivered to accommodate the patient’s needs. In addition, by being able to strengthen communication between the patient and the nurse this has empowered nurses to make better decisions. Theories have been used to contribute to the development of the nursing disciple body of knowledge. The nursing profession has been slow in embracing the theoretical idea (Barker, 2009). Some theories are more worthy for certain situations, for example, one theory can be used to a patient in a home health care setting, whereas a patient in an acute care environment will use a different theory (Sabah, 2013). The nurse has to be aware that not all data applies to all situations. The information will be examined and there will be different methods according to the situations. All the approaches are valid as long as the nurse recognizes the value and usefulness of nursing theory as a tool for effective nursing practice. There are many theories used in the nursing arena to solve problems encountered while attending to a patient by the professional nurses. An example of a theory to show how theories have been used in practice; Faye Glenn’s human needs theory, which was set to guide in providing human needs to those in hospitals, but also has relevance for nursing care in community setting. Faye Glenn used this theory to promote the image of the nurse who was not only kind and caring, but also intelligent, proficient, alert and prepared to be creative, therapeutic, and very responsible. The Nurse was also nonjudgmental, receptive and intuitive, and well prepared to oversee that the patients was provided with quality services. This theory influences the nurse’s judgment in the selecting steps, in solving the patient problem and focusing in taking care of the patient. The nurse was to make sure that all of the patient needs were met, so that the patient could have a better healing process. Practice Problem Part-2 The nursing theories are used to direct ethics in nursing practice. It is used for developing and guiding the nursing practice, and research with the core aim to improving the quality of patient care. In theories, conceptual and theoretical models are utilized in developing in nursing knowledge and to act as a guide to nursing practice (Moreno, Duran, and Mernandoz, 2009 ). For more than 20 years, critical thinking has been put forward to emphasize on nursing practice and education (Cody, 2002). One of the theorist who has contributed a good foundation and skills for nurses to implement and formulate into practice is Dr. Margaret Jean Watson, she has created and further broadened her theory by applying this theory into the nursing curriculum (Karnick, 2008). Jean Watson theory has been noted as a grand theory and a middle range theory. Jean Watson is a nurse theorist whose cardinal focus is based on human caring. Watson’s (2008) theory of human caring is broadly applied in nursing as knowledge relating to acquisition and application in practice by identifying the caring theory as a science and art, which has a philosophical and ethical implications (Watson, 2008). In other words the caring theory highlights and creates the human phases of patients’ lives and their families (Johnson & Webber, 2010). The theory is known as the caring theory which was published in 1988 (Johnson & Webber, 2010). Her theory and philosophy of human caring has assist with nursing in most parts of the world. The theory is taught and introduced in most nursing curriculums (Watson, 2010). Watson’s core concept was, that nurses can help the ill discover new knowledge that will assist with recovery and promote harmony (Watson, 2010). In order for the patient to become healthy, there had to be harmony, within the mind, body, and spirit (Watson, 2010). She believe that when all three states came together that this would assist the bodies healing process (Watson, 2010). She also believed that both the patient and the nurse are link together to form a relationship, which further formulates a healing process. This implies that human beings are connected to one another in a caring process, and that in a transpersonal caring relationship, a holistic approach can have a positive impact (Watson, 1992). The humanity of a nurse embraces the humanity of others in order to preserve and maintain the dignity of the patient by providing a one to one self-existence, and also the family that is involved with the patient care. According to Watson, (2001) the major elements of the caring theory are: the curative factors, the transpersonal caring relationship, and the Caring Occasion in the Caring Moment. The curative factors according to Watson’s views forms the core guide for nursing (Watson, 2001). These elements were developed in 1979, and revised in 1985 and in 1988. The element honors the inner life of a nurse and the human dimensions of the work and the subjective experiences of the people, whom the nurse serves (Watson, 1997). The carative factors consist of ten sub- elements; human care relationship, sensitivity to self and others, mental and spiritual environment, expression of negative, and positive feelings , creativity in problem solving and existence of phenomenological spiritual forces (Watson , 1986) . Watson introduced the renounced concept of clinical caritas processes. It emphasizes to the reader to observe a greater dimension of spirituality in all of the nursing processes. According to Watson (2001), the word caritas is a Greek vocabulary which means to cherish and to offer or give a special loving attention to other beings. Transpersonal Caring Relationship According to Watson (1999), transpersonal caring relations are a science in itself which promotes a kind of human care relationship which consists of the following: A moral commitment of the professional nurse is protecting and promoting a caring nature, self-respect and human dignity (Watson, 1999). The consciousness of caring of the nurse in a communication environment in order to preserve the spirit of avoiding reducing a fellow or self-person to the moral status of an object. The consciousness of using the experience and self- mindfulness to heal and for intended connection. The transpersonal caring relationship describes how the nurse need to consider objective assessment as a way of showing concern towards nurses regarding, the patient’s to recognize their own health and illness (Watson, 1999). This approach gives concerns to highlighting the uniqueness of the nurse and the person under care. It also highlights the mutualistic spiritual benevolence between two individuals which is the fundamental basic ingredient of a relationship (Watson, 2001). According to this element, the one to be cared for, and the one caring, seeks meaning in the spiritual transcendence of suffering (Watson, 2001). Nurses are to provide respect compassion and providing care to patient, to assist them with the transition from illness to healing. A Caring Moment A caring occasion according to Watson, ( 1988b, 1999) is the moment when the nurse and the person beings to heal and the patient’s needs are provided, this is when the two person’s come together in order to create an occasion of human caring. With their unique astounding fields, both persons have high chances of interacting in a human caring transaction. A phenomenal field (Watson 1988b, 1999) refers to the entirety of the spiritual beliefs, feelings, exceptions, and meaning of ones observations of the patient’s goals thoughts and environment are also taken into concerns deliberations. All of these depend on the past life history, the present situation and the anticipated future. The nurse who is the caregiver must be conscious, of their own authentic presence at the particular moment when caring for the patient (Watson, 1990). The caring moment becomes transpersonal if the spirit of both permits spiritual presence as a way of expanding human capabilities without limits (Watson, 1990). The task of caring and healing are to a great extent heart- centered and extends to examine the self-existence, of others unlike the predictable nursing (Watson, 2008). The heart of nursing is caring and this forms the standard obligation to both the patients, their families, communities and the universe as a whole. It is clear that nurses, nurtures and natures the patient’s physical needs and as well as their minds and soul (Watson, 1994). Propositions and application of the theory in practice In most cases, theories are not put into practice in the usually adopted conventional nursing settings, because most attribute theories with situational complexities (Marten, 1998). According to the Marten, Hecomovich & Le., (1998) it is the duty of nurses in their advanced nursing practice to describe the theories in a simple transformed language to engage it in nursing practice . Increased technology and the demands (Watson & Foster, 2003) that have been placed on nursing care may cause a negative impact to the human caring practices. It is ideal for the bedside nurses to have an in-depth understanding of the caring theory and capable of providing effective patient care, without feeling overwhelmed. If the nurses become overwhelm, this will not allow them to be compassionate and perform tasks, this then becomes a routine. To enhance and promote healing, nurses and patients must be connected through caring and loving relationships (Watson, 2010). Watson’s theory is a tool with an excellent theoretical framework whose application is diverse with different settings and populations (Karnick, 2008) The theory can be adopted by staff nurses with ease. It helps the nurses to comprehend the elements and concepts of Watson’s theory without straining or stressing self. (Karnick, 2008). Clinical application According to Watson (1988b) a person’s life consists of three spheres, the mind, body, and soul. A person cannot be considered without the contextual environment, which includes family, community, culture, society, environmental dimensions, and others (Cara, 1999). In a clinical setting, the nurse needs to utilize the following concept of upholding the human dignity. Viewing the ‘Patient’ Person through Watson’s Caring Lens The essential wholesome of a being are composed of the mind, body, and the spirit all of the three components are essential elements. Therefore, this calls for full wholesome consideration that cannot collect data related to the body physical feelings, as it is the case with conventional medicines (Watson 1979). The mind of the patient corresponds to intelligence, memories and emotions. A patient may doubt whether they will survive having undergone several surgical operations because of their friends who may not have survived the same type of surgery, because of this same type of problem, this causes the patient to challenge their inner spirit. The spirit of the patient relates to inner spiritual self, and is the essence of the person. The patient quotes the name of God or relates his suffering to a past failure or misconduct. The spirit allows patients to transcend the present, the past and the future. This is when the nurse needs to pose questions that will enter into the patient personal phenomenal field. Questions like tell me something yourself, tell me about your life experiences, spiritual and cultural beliefs, goals and expectations. This will promote spiritual- mental and bodily compliance and a rapport with the patient, to assist with decreasing the anxiety. It’s good for me as a nurse to respect the option of the patient first before charging the patients attitude. A patient negative attitude can come from being uncomfortable with certain procedures. Viewing the person’s health through Watson’s caring Lens Watson’s definition of health does not actually mean simple absence of a disease but identifies one’s mind, body, and spirit (Watson, 2001), . A patient may feel that his health’s deteriorating i.e. the mind, body, and spirit congruence to force the feelings. Mostly the patients gets most of their information from the environment which makes them feel hopeless, but tries to put their beliefs in the information from the health professionals (Watson & Smith, 2002). Among the questions that can promote psychological preparedness include, tell me about your health, how do u feel regarding your situation, how do you perceive your situation, what meaning are you corresponding this situation to, tell me about your health priorities and what balance do you wish to reach. Such questions will enhance instilling meaning to people to accept the health arising in their life (McGraw, 2002). Viewing Nursing through Watson’s Caring Lens According to Watson, (1988b) nursing is a human science of persons and human health. Nursing is a science and art. In 1999, Watson exemplifies the artistic role of nursing as a developing transpersonal caring and healing modalities. Artistic domain is part of the role of a nurse in caring for the patient and their families (Duqueete & Crava, (2000). Watson (1999) includes caring as a special being in relation to one’s self being, the environment which is mostly dominated with others. To promote a peaceful co-existence of inner being, I elected to engage the following reflective questions. What is the essence of caring for a persons and their families and for myself, How do I show commitment to a person, health, healing nursing and environment, how can we as nurses make difference in people’s suffering and life as a whole, how can nurses use Watsons’s caring theory of clinical curative process. The above questions if well applied will assist me as well as other nurses, in promoting a meaningful caring spirit towards others and assist me in with my life as a professional nurse. Conclusion In the conclusion it is evident that for better patient care, the nurse should consider both the physical and emotional needs. For a complete service delivery the family should be involved. In a way that leads to a considerable decrease in the rate of deaths experienced in health institutions It has been acknowledged that patient’s healing process occurs when positive an interaction between the nurse and the patient ensues. The patient’s health and wellbeing has to constantly be observed, and evaluated to recommend if the care is being of service. Nurse have the capabilities to assess the patient condition, identify the needs of the patient, to demonstrate effective communication and interaction with the patient without many problems (Alfaro-LeFevre, 2011). The nursing process; which includes planning, implementing, and evaluating nursing care (Finkelman, 2012).This is part of the nursing profession and should be done on a regular bases, to prevent patient from not being able to get adequate care. Although nursing has many theories that has been researched, evaluated and proven useful regarding the educational process, comfort is one theory that helps the patient with the holistic healing. Which is a theory to use when trying to identify a patient comfort level? In the nursing professional theories has help to devlop the nursing practice because there are many. Theorists have different definition of human being in relation to their theories, but all somehow can interact. Through documenting, the essential elements of Watson’s caring theory is well selected and promoted in the clinical setting if only nurses conceptualized the contents of the theory. It is ideal if one preserved the long-lived culture of human caring. It can be applied in the contextual environment to bring positive impact to both the caretaker and the one who is being taken care of (Watson, 2001). Nursing can progress in its quest to expand its built in science and art to promote foundational caring healing models. (Watson, 1999) It is true and clear that the nurse provides care and love to a patient. She uses a curative factor measure to make the situation apprehendable to both the self-being and the person under her care. The nurse offers holistic care that can promote the self-worthiness and inner humbleness, which can only be developed with time and through acquisition. This defines the effectiveness of commissioning Watson's theory of human care in order to gain the ability to learn and practice. Lastly, we have seen that clinical care needs the inner being to identify, both the outer and inner as it relates to aspirations of the patient as this is known to be the best ingredient for healing. References Alfaro-LeFevre, R. (2011). Applying Nursing Process, London: Prentice Hall. American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed). 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