Evaluating Nursing Practice through Theories and Models - Essay Example

?It was not until the 19th century that the practice of nursing was forever changed by Florence Nightingale who founded modern nursing (Klainberg ). Her nursing principles (i.e., environmental theory, holistic nursing), her astounding leadership, and her global actions led to the institution of decent standards for nursing care, helped systematise the approach to health care, and ushered in the professionalization of nursing care (Dossey 2005; Umali-Hernandez 2011). Since then, nursing has evolved into what it is now. Today’s nurses are no longer regarded as mere handmaidens to physicians, but as competent and essential part of the health care team (Quan 2006, p.28). One way to look at the development of nursing is to study its theories and philosophies since these are the core knowledge base of the profession (McKenna 1997) and these serve as “the foundation of nursing thought, teaching, and practice” (Sitzman 2002, p.118). These nursing theories essentially provide the scientific bases for the claim that nursing is not only an art but also a science (Parker 2010). In this essay, three nursing theories will be analysed and criticised purposely to understand and learn how to effectively use these theories in everyday nursing practices. Then, Dorothea Orem’s self-care deficit theory will be applied to a case study (see Appendix 1). Jean Watson’s Theory of Human Caring The Theory of Human Caring, according to Watson (2000), was developed between 1975-1979 as her initial attempt to distinguish nursing from other health professions by combining the seemingly irreconcilable concepts of science and caring. She also regards her theory as “a humanistic approach to nursing that emphasizes human-to-human responsiveness rooted in upholding humanistic values” (Kim 2006, p.301), as she pays attention not only on patients but also on nurses, believing that both are interconnected. Watson (2000, p. 2) expands this further by explaining that nursing like teaching is not simply a job that can be mechanically done, but it is “a life-giving and life-receiving profession for a lifetime of growth and learning” which only becomes possible if caring is incorporated in nurses’ daily works and lives. Thus what distinguishes the nursing profession is caring and love. Watson’s theory is a good reminder to nurses of four important points: that the patients are all human beings that deserve equal care and love; that the knowledge and skills of nurses are only tools to assist them in which therapeutic effect depends on how much nurses care; that healing is a two way-process both in going through the healing process and in benefitting from it; and that nursing as a caring profession is a humane profession because without care humanity may perish. Furthermore Suliman et al.’s (2009) study, which aimed to assess the effectiveness of Watson’s theory in a multi-cultural environment found that Watson’s theory is measurable using the caring Behaviour Assessment Tool and is applicable to patients of various cultural backgrounds. However, it may be argued that Watson’s theory is too subjective as it greatly depends on the nurse’s commitment and caring consciousness. Every individual has his/her own way of expressing and accepting care. Thus, the expression of Watson’s theory may vary along individual personalities and cultural backgrounds of nurses and patients. Remaining two models will be discussed in the assignment 1. Case study, Applying Orem’s Self-Care Deficit Theory (Case: see Appendix 1) Introduction The author chose the application of Orem’s Self-Care Deficit theory on this case for two important reasons. Firstly, the aim of Orem’s theory fits well in the case. Secondly, Orem’s nursing process is clearly defined in terms of objective and technical components. Thus, this will be a good learning exercise for the author as to how nursing for self-care is conducted. In Orem’s theory (1959-2001), the nursing process is the method by which nurses can determine the person’s self-care deficits, from which roles of nurse and other possible direct care providers are defined to provide the needed self-care (Current Nursing 2012a). Thus, a nursing care plan is prepared for this case study by applying the nursing process: assessment, nursing diagnosis, plan, implementation, and evaluation within Orem’s self-care framework. Case study Based on the present physical, emotional, and family condition of Mr. Lim, a nursing care plan following Orem’s theory of self-care is hereby proposed. Self-care involves the patient and his immediate direct care provider, in this case, his wife. Hence, this nursing care plan shall be discussed with them to achieve common understanding and ultimately their full cooperation. Without their full cooperation any nursing plan is futile. Assessment: Basic conditioning factors: Mr. Lim is 78 years old and married. His medical diagnosis is that of end stage renal disease (ESRD) and peritoneal dialysis has been commenced. He lives with his wife who becomes his primary caregiver because all his children are working. He has developed low self-esteem due to his illness feeling that he is no longer useful but a burden to the family. Worse, even his wife feels stressed and tired of taking care of him. Thus the patient and the primary care giver are both depressed. Universal self-care requisites: Mr. Lim does not maintain a sufficient intake of air due to his low blood pressure (94/60 mmHg) as a result of increased ultrafiltration (UF), causing him to experience difficulty in breathing. Added to this, he had a history of Diabetes Mellitus, hypertension and heart failure. He also fails to maintain a sufficient water and food intake because he refuses to eat and to undertake his activities of daily living (ADL). Besides since he is undergoing renal treatment, he is under limited water and food intake. As to satisfactory elimination functions, he has difficulty urinating because of renal failure. He becomes more at rest and least active due to his ailment. He does not maintain a balance between solitude and social integration as lost interest in everything. In fact, he is even contemplating of dying wishing to unburden his family. The person he is with daily is his wife, who has become depressed and quiet; whereas, his children are all busy working. Though Mr. Lim’s environment poses no direct threat to his health, his and his wife’s psychological states pose a potential hazard not only to his health but more so to his life. Aside from the fatigue and decreased energy level that are effects of ESRD, plus the required lifestyle changes in his life, the psychological state of Mr. Lim makes him incapable of normal functioning within social groups. Develop self-care requisites and Health deviation self-care requisites: Discuss further in the assignment 1. Nursing diagnosis: Universal self-care requisites: It is apparent that Mr. Lim is deficit in universal self-care requisites causing him to lose his self-care abilities. His deficits stemmed from his ESRD which disables him to perform his usual daily activities. As a result, he needs to be cared for by his old-wife, who at her age also finds her task difficult. Their seemingly helpless conditions results into the patient and the caregiver’s depression. As such, Mr. Lim loses interest in everything which may further worsen his ailment and even the psychological condition of his wife who herself has developed depression and anxiety in the course of caring for him. Develop self-care requisites: It is apparent that Mr. Lim is unable to cope with his health condition as he has developed depression. He has not only lost control over his medical condition but is even losing his will to live, especially so that he is in his old age. His ailment prevents him from enjoying his old age. Health deviation self-care requisites: It is apparent that Mr. Lim is losing his will to become well due to his depressing negative self-image and lack of psychosocial support, causing him to lose attention to everything. In sum, Mr. Lim’s deficits are apparent in various domains: physical, psychological, social, level of independence, and environmental. Conclusion This seemingly simple yet rigorous exercise allows the author to have an initial knowledge on three nursing models, which at a glance look unrelated but deeper study shows them to be interrelated. Though each model elaborates the nursing profession from a different perspective, they actually complement each other as each tries to fill in the gap of nursing practice in three different areas: Watson’s theory provides the crux of nursing that which gives meaning on the profession; Benner’s theory elevated the theoretical significance of the nursing practice as the source and basis of nursing theories; and Orem’s theory clearly delineates the place and role of nursing intervention and nursing care in the overall journey of the patient for self-care. Finally, this exercise further deepened the author’s understanding of the nursing profession in which the author’s deeper sense of pride and desire to become a good nurse surged. Reference: Aggleton, P. and Chalmers, H. (1986) Theorieen en modellen in de verpleegkunde (Theories and models in nursing). Utrecht: Bohn, Scheltema & Holkema. Current Nursing. 2012a. Nursing theories: an overview. Available at http://currentnursing.com/nursing_theory/nursing_theories_overview.html [Accessed: October 14 2013]. Dossey, B. 2005. Florence Nightingale and holistic nursing. NSNA Imprint, February-March, pp.56-8. Available at: http://www.nsna.org/portals/0/skins/nsna/pdf/imprint_febmar05_feature_nightingale.pdf [Accessed: October 29 2013]. Kim, H. S. 2006. Synopsis of selected nursing theories and conceptual models. In Kim, H. S. and Kollak, I. eds. Nursing theories: conceptual and philosophical foundations. New York: Springer, pp. 294-301. Klainberg, M. 2010. An historical overview of nursing. In Klainberg, M. and Dirschel, K. M. eds. Today’s nursing leader: managing, succeeding, excelling. Sudbury, MA: Jones and Bartlett. McKenna, H. 1997. Nursing theories and models. London: Routledge. Parker, J. 2010. Nursing as art and science. In Daly, J., Speedy, S., and Jackson, D. eds. Context of nursing, 3rd edn. Chatswood, NSW: Elsevier, pp. 38-50. Quan, K. 2006. The everything new nurse book: gain confidence, manage your schedule, and deal with the unexpected. Avon, MA: Adams Media. Sitzman, K. L. 2002. Interbeing and mindfulness: a bridge to understanding Jean Watson's theory of human caring. Nursing Education Perspectives, 23 (3) May/June, pp. 118-124. Suliman, W. A., Welmann, E., Omer. T. and Thomas, L. 2009. Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research, 17 (4) December, pp.293-300. Available at http://watsoncaringscience.org/files/PDF/Suliman%202009%20Applying%20Watsons%20theroy%20multicultural.pdf [Accessed: October 14 2013]. Umali-Hernandez, A. 2011. Nursing-theories summary. Scribd [online]. Available at: http://www.scribd.com/doc/49781166/nursing-theories-summary [Accessed October 29 2013]. Watson, J. 2000. Theory of human caring. Available at http://watsoncaringscience.org/images/features/library/THEORY%20OF%20HUMAN%20CARING_Website.pdf [Accessed: October 14, 2013]. Appendix 1: Case study, applying Orem’s Self-Care Deficit Theory: Mr. LIM, 78 years old, is a new End Stage Renal Disease (ESRD) patient that has started Peritoneal Dialysis. He had a history of Diabetes Mellitus, hypertension and heart failure. He made a visit to the peritoneal dialysis centre accompanied by his wife, as his blood pressure was low due to increased Ultrafiltration (UF). His wife is his main caregiver because all his children are working. Upon assessment, the patient was found to have lost interest to everything. Basic parameters were BP: 94/60mmHg, Temperature: 36.4oC, SpO2: 98%, Heart Rate: 100bpm, Respiration rate: 24, Pain Score “0”. The UF within the week is from 900ml to 1500ml. He verbalized that “it will be better if I die, so that I will not be a trouble for my family.” According to Mrs. LIM, she felt very worried and tired of taking care of him. The patient had refused to carry out his ADL. Other than this, he also refused to eat since few days ago. Mrs. LIM was depressed and quiet all the time. Nursing Intervention: In Orem’s theory, nursing interventions are nursing systems which are utilised when self-care deficits require nursing agency. The three nursing systems Orem identified are 1) wholly compensatory – the patient is fully incapable to self-care that it requires a care provider to meet the patient’s self-care needs, 2) partly compensatory – the patient is still capable but needs help to self-care that it requires the participation of both the care provider and the patient to meet self-care needs, and 3) supportive-educative – the patient is capable of doing and learning how to undergo the required self-care actions (Current Nursing 2012a). Based on Mr. Lim’s diagnosed condition, two nursing interventions are found appropriate: partly compensatory nursing system because he can still perform some self-care actions and supportive-educative nursing system because he can still do and learn self-care actions. Besides, he has to learn coping skills for him not to be submerged into depression. Along these two nursing systems the following concrete interventions are administered: 1) a conference with Mr. Lim and his wife and children to situate them on his condition and together assess the available resources the family has to help provide the needed self-care; 2) a conference between the nurse, Mr. Lim and his wife and Mr. Lim’s doctor to achieve their common understanding on Mr. Lim’s condition; 3) going-back to Mr. Lim’s prescribed medical regimen and dietary requirements with close monitoring; 3) plan for his mobile and social activity within and outside home to balance his rest and activity and to attain social normalcy; 4) plan for his positive self-image building; 5) a diary where he can express in writing his everyday experiences to enable him release his negative feelings and to enable him go back to it and ponder on it. Essentially, this nursing intervention is aimed at compensating the self-care deficits of Mr. Lim and to prevent the emergence in him including his family possible additional self-care limitations. The intervention will take three months. The first week will entail daily nurse visitation to ensure that the needed supporting mechanisms from the family, friends, and neighbours are being put in place. The second and third weeks may allow a three times nurse visitation to encourage Mr. Lim that his condition is not hopeless. The remaining weeks will lessen nurse visitation to once a week to allow independence on the part of Mr. Lim and even the family. Implementation: After assessment and nursing diagnosis, the nurse presents her written report and proposed intervention to Mr.Lim and his wife. This is to make them understand his condition and to convince them, specifically Mr. Lim, that the outlined intervention is necessary for him to have quality of life despite his ailment in his old-age and that crucial to this is their full cooperation and participation. When everything is agreed upon, a memorandum of agreement is signed to bind Mr. Lim legally and also to protect the nurse. Immediately contacting his children follows and the conference with them is set. While waiting for this day to come, the conference with Mr. Lim’s doctor is pursued. Then the supporting plans for his social activity and positive self-image building are designed. All these are done in two-week time. In succeeding weeks, the nurse mainly monitors and teaches Mr. Lim and his family necessary coping skills. Evaluation: Orem’s theory focuses on improving the patient’s self-care. Thus, its emphasis on evaluation centres on the patient’s self-care improvement rather than on the nursing interventions implemented (Aggleton and Chalmers 1986). After three months the following improvements are observed in Mr. Lim’s condition. Most notable is the positive aura that he begins to project. The way he sees things has become more positive than it was before. He has also begun to accept the pains and inconveniences that his ailment is causing him. No longer has he entertained the idea of dying. From the way he discusses his condition, his primary concerns are to find more opportunities through which he and his family can deal more easily with his ailment. Even his relationships with his family, friends and neighbours have improved. His children have alternately helped their mother tend to his self-care needs. They try to find time to be together one day in two weeks, enabling them to normalise their family life. As he begins to socialise again with his neighbours and friends, he also improves his grooming which he said helped him regain his positive self-image, consequently his self-esteem. By trying to socialise again outside his home even in a very limited manner, he begun to realise that he can still live a quality life despite his ailment to which positive attitude is the key. He highly appreciated the care, guidance and support provided to him by the nurse and other care providers. Read More