Part 3 Applying Theory to Practice - Essay Example

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Pain was just one of the many complaints but it was a significant and widespread one. Pain was a physiological complaint which distressed patients by the unpleasant sensation with affective…
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Applying Theory to Practice Angelique Harris Grand Canyon October 26, Applying Theory to Practice Part Globally the nursing profession was facing a great number of problems in patients. Pain was just one of the many complaints but it was a significant and widespread one. Pain was a physiological complaint which distressed patients by the unpleasant sensation with affective experience (Peterson & Bedrow, 2008). In spite of pain assessment, appropriate management, evaluatory monitoring and educational research having been included in important guidelines like those from the Joint Commission and the National Guidelines Clearing House, the under-treatment and negligent management of acute and chronic pain were still evident (Bines & Paice, 2005). Gillaspie (2010) convey the depth of the problem by pointing that the delivery of effective pain management has become a pressing national issue in healthcare. Patients had a right to be managed for pain relief (Zalon, 2008). The problem of pain management has thereby been identified by me as my practice problem.
The nursing profession has several theories by which the problems in patient care were managed. Similarly I would be employing a theory to execute effective pain management in my hospital. The theory would be logical for application and concurrent with observations made daily. It would similar to those previously used in successful programs. Past research would have supported this theory (Croyle, 2005). It would contain the highlights of the nursing profession. Foundations for nursing practice would be made. Patient care would be made better, professional growth would be enhanced, interpersonal communications among the nurses would be motivated for improvement, and guidance would evolve for education and research. The multidisciplinary approach to health care would be targeted. Criteria which improved the quality of care would continuously be identified. Middle range theories promoted nursing practice by helping to understand the behavior of the client, suggesting useful interventions and offering credible explanations for the efficacy of the interventions (Peterson & Bedrow, 2008). The practice theory could be built up from the critical reflection of experiences. The purpose of the paper is to identify a middle range theory for my selected practice problem of management of pain and then use a borrowed theory to manage the same symptom of pain.
Rationale for selection
The more common reason for patients seeking help from nurses was pain. The unpleasant sensation could cause the patient to even lose consciousness. The overwhelming effect could produce long-term adversities (Peterson & Bedrow, 2008). Wound healing became delayed and the immune system lost its activity. Metastasis of tumor cells could also occur. Acute pain was noticed in wounds or injuries, following surgery, in labor and in sickle cell crisis. Chronic pain was evident in skeletal muscle illnesses and gastrointestinal conditions. Hospital procedures like lumbar puncture, venipuncture and removal of chest tubes were accompanied by pain (Peterson & Bedrow, 2008). Infants suffered from pain in critically ill conditions or when close to death. The enormous extent of pain faced by the nursing profession was an indication for nurses to learn all the methods of relieving the pain. Clinical pain had a holistic and emotional impact apart from the physical distress (Peterson & Bedrow, 2008). Life could be affected and fears to arise. I am also much worried about the fact that in spite of specific guidelines for pain management, the patients were not being accorded the benefits of the guidelines. Nurses needed to develop their own theories which included interventions for relief of pain (Peterson & Bedrow, 2008). These are the reasons for my selecting the management of pain as my practice problem and using a middle range theory to guide me.
Literature review
Efficient pain management reduced the experience of pain and prevented the psychological and physiological complications (Gillaspie, 2010). Current research in MEDLINE and Cochrane databases indicated that the facilitation of pain management for infants now focused on non-pharmacological pain management (Hardy, 2011). However it could never stand alone or replace pharmacological therapy. Both had to be used strategically according to the assessment of the situation (Harrison, Yamada, & Stevens, 2010). Problems in learning and social adaptation could arise due to unmanaged pain (Carbajal, Rousset, & Danan, 2008). Prevention was considered the best management but this was not always possible (Harrison, 2010). Providing sucrose solution, allowing non-nutritive sucking, kangaroo care by the parents, music therapy and breast feeding were some of the non-pharmacological methods advised by Hardy (2011) for infants. Theories of relief of pain have become an essential part of a nurse’s life. The symptom of pain was inevitable in patients. The nurse was the closest person in a hospital who could use her techniques for relieving a patient in distress. The moves made by her should conform to the guidelines of the American Pain Society (Peterson & Bedrow, 2008). The age-old prescriptive theory indicated that oral or injected opioids provided good relief in patients with moderate or severe pain (Peterson & Bedrow, 2008). The injections were given into the blood vessels, muscles, or epidural space. The explanatory theory dealt with the mechanism by which the drugs relieved pain. The opioids were believed to have an affinity to the mu and kappa opioid receptors in the brain. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) provided relief at the site of pain by lowering the quantity of inflammatory substances released as part of the normal reaction of the body to pain (Peterson & Bedrow, 2008). These inflammatory substances caused the sensitive nerve fibers to respond to the pain. The decrease produced reduced the sensation of pain. The mechanism of action of the NSAIDs, Aspirin, Acetaminophen, Ibuprofen and Ketorolac, was different from that of the opioids. They did not bind to the receptors. The nursing profession has to conform to the position statement on pain management and control of distress in dying patients:
“Nurses must use effective doses of medications prescribed for symptom control and nurses have a moral obligation to advocate on behalf of the patient when prescribed medication is insufficiently managing pain and other distressing symptoms. The increasing titration of medication to achieve adequate symptom control is ethically justified.” (ANA, 2003)
Middle range theories were most suitable for application as they were based on qualitative research of the phenomenological and grounded theory types. Fawcett (2005) spoke of descriptive, explanatory and predictive theories as varieties of middle range theories. The descriptive theory was the most basic and easily studied by qualitative or quantitative research. Peplau’s theory of interpersonal relationship was one. The explanatory theory was one which defined the relationship between two or more concepts. Study involved a co-relational research of quantitative design. One example was Watson’s theory of human caring. The predictive variety of theories described how changes occurred in a specific phenomenon. The relationship between concepts was decided by predicting the precise relationship in an experimental quantitative research. An example was the Orlando’s theory of deliberate nursing process (Fawcett, 2005).
The nursing discipline had built its knowledge by incorporating philosophies of distinguished nurses and other leaders, theories which had provided results, ongoing research with its credible findings and the wisdom born of practice (Smith & Liehr, 2008). Fawcett (2005, 17) had explained the metaparadigm of nursing to be a “study of the interrelationships among human beings, environment, health, and nursing”. Middle range theories were better circumscribed and delineated concepts which were definite. They also included the inter-personal relationships which could be the feeling of uncertainty, the level of self-efficacy and how meaningful they were (Smith & Liehr, 2008).
American Nurses Association. (2003). Position statement on pain management and control of distressing symptoms in dying patients. Retrieved October 26, 2011, from American Nurses Association:
Bines, A., & Paice, A. J. (2005). Are your pain management skills up-to-date? Nursing, 35(1).
Carbajal, R., Rousset, A., & Danan, C. (2008). Epidemiology and treatment of painful procedures. JAMA, 300(1), 60-70.
Fawcett, J. (2005). Middle range nursing theories are necessary for the advancement of the disciple. Aquichan, 5(1), 15-21.
Harrison, D., Yamada, J., & Stevens, B. (2010). Strategies for the prevention and management. Cure Pain Headache Rep, 14, 113-123.
Masters, K. (2011). Nursing Theories: A framework for professional practice. Washington: Jones and Bartlett Learning.
Peterson, S. J., & Bedrow, T. S. (2008). Middle Range Theores: An application to nursing research. NewYork: Williams and Wilkins.
Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. NewYork: Springer Publishing Company.
Tomey, A. M., & Alligood, R. M. (2008). The Right to Pain Treatment. Nursing theorists and their work, 23(1), 93-101.
U.S. Department of Health and Human Services: National Institute of Health. (2005). Application for Health Promotion and Health Behavior (Second Edition). Monograph: Theory at a Glance. Read More
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