Nursing as a Whole: Defining Nursing and Talking about Florence Nightingale - Essay Example

Question A-critical overview of nursing as a whole (defining nursing and talking about Florence Nightingale),Discuss common nursing models: ROY, OREM,CARPAR PEPLAU. In the contemporary and to some extent retrospective setting, the role of nurses in provision of health care services has largely remained the same over the years albeit under radically different circumstances. They provide direct and indirect patient care; in addition, they asses, record patient symptoms and communicate with them and their families acting as liaisons between them and physicians. Their duties include among others, cleaning wounds, changing dressings, disbursing medication and updating medical charts (Barrett, 2002). The history of nursing can be traced back centuries ago when old and unemployable women would be made to work as nurses. However, the profession was taken more seriously with time and in the middle ages, there were more people working formerly as nurses (Ehrenreich and English, 2010). However, most of them were women of low standing in society with little training or organization (Dingwall, Rafferty and Webster, 2002). The history of nursing was revolutionized by the entry of Florence Nightgale who dedicated her life to helping the suffering and ill after she witnessed the thousands of people dying untended for during the Crimean war in 1854 (Dossey,2009). Thanks to her efforts, modern and professional nursing came about and today nursing is considered both and important and respectable career. Consequently, a great deal of research has been carried out on the professional and to this end, several nursing models have been developed. Roy’s model of nursing is based on the conceptualization of a person as a holistic entity with individual elements coming together to form a complete being. It is grounded on the following core components person, health, environment, and nursing; this model posits that the environment in which a person lives must be taken to account. This is because there is a constant interchange of information, matter and energy between the individual and the environment (Roy and Andrews, 1999). The model’s major strengths include the fact that it provides an efficient guide for nurses to use in interviewing and carrying out individual patient assessments, and it is easily applicable in nursing practice. However, it is weakened by the fact that it requires a great deal of painstaking effort to apply and with so many components, and as a result, it is rather challenging to get a reliable outcome. Orem’s theory provides a model that determines the self-care deficit and then defines what roles both patient and nurse need to play to meet the discovered self-care demands (Orem, Taylor and Renpenning, 2003). Orem puts a great deal of emphasis on the combination of technology with the interpersonal and social pressures that may arise within a nursing situation. The main strength of Orem’s model is that it can be used in any field apart from nursing; therefore, different perspectives can be accommodated in practice through the theory, and furthermore, it is applicable for both the novice beginner and the experienced career nurse (Alligood and Marriner-Tomey, 2006). Its limitation is that it does not encompass all the elements of nursing and/or needs of a specific client. Peplau’s theory focuses on the interpersonal process as well as the therapeutic role the nurse plays in the patients healing process. The theory’s major assumptions are that the kind of nurse one becomes is based on their ability to learn from their own experience, therefore, the nurse should focus on fostering personal development as they mature in the profession. It simplicity is its main strength since it can be adapted to numerous situations but it is weakened by the fact that it does not provide a suggestion for patients who may not be withdrawn or needing therapeutic attention. Question 2. In-depth discussion of Roper Logan theory (its strength and advantages The Roper-Logan-Tierney nursing model is based on various activities of daily living that are often abbreviated as ADLs or ALs; the model is commonly applied in the UK public sector. The primary objective of this theory is to create an assessment that can be used throughout the patient care process. In simple terms, it can be looked upon as a sort of checklist that is often used to assess the extent of change in a patient because of their illness or injury (Roper, Logan and Tierney 1980). It attempts to define the meaning of living by categorizing the activities of a living person through a comprehensive assessment that guides the intervention support and interdependence in areas it assumed the patient might have trouble addressing on their own. Ideally, the model is designed to ensure that patients depend as little as possible on the care technology and processes and as much as possible on themselves. However, Roper (2000) asserts that the activities of daily living should not be used as a checklist per se, but rather as contributing factor to the assessment and care of the patient. By thinking of it in these terms, the nurses will better be placed to understand it in a more comprehensive manner since they will see the care process and a depended and independence continuum, as a result their work is to determine if the patient is improving or deteriorating (Roper, 2000). The activities that have to listed on the chart include; Breathing Communication Controlling temperature Eating and drinking Elimination Maintaining a safe environment Mobilization Sleeping Washing and dressing Working and playing Sexuality and death are also considered in this list, but they are often disregarded based on the particular setting and the doctor directions. The model proposes five factors that influence the aforementioned activities, these factors when incorporated into the theory of nursing ideally make it a holistic model; conversely, if they are ignored the ensuing assessment is vulnerable to flaws and prone to incompletion. These factors include biological, psychological, sociocultural, environmental, and politico-economic; the biological factors focus on the influence of the overall health and illness in the patient’s anatomy and physiology. The psychological factors account for the emotional, cognitive, spiritual and capacity for comprehension in a patient; Roper describes this as being about “knowing, thinking, hoping and believing”. The social cultural factor has to do with the impact of society and the culture in context of the patient’s condition, this encompasses expectations and values based on class stratification, culture and relevant social cultural traditions (Ignatavicius and Workman, 2002). The environmental factor has resulted in the model frequently being referred to as “green”; this is because the theory takes into consideration the impact of environment on the patient’s daily living activities as well as their impacts on the environment. Finally, the political economic factor takes to account the matters of government support, political climate and the patient economic condition or those responsible for their wellbeing (Holland et al., 2008). One of the model strengths is that it does accomplish what it set out to achieve which is to provide framework for patient assessment. It is very practical and applicable given that there is strong and obvious link between the model and the actual nursing process. By taking to account the various factors that impact on daily living, a nurse practitioner is left in a more informed position making them competent and effective (Alligood, 2013). The other key advantage is that it often leads to consistency in the methods of care provided, which improves the aspect of continuity, which contributes a great deal to accelerating and controlling the healing process. In addition, it results in reduced conflict within the teams of nurses since the rationale it renders makes it considerably easier for any of the nurses to comprehend and apply it. It is self-explanatory nature also assists trainee nurses to develop a critical way of thinking based on the aforementioned 12 activities of living. Nonetheless, the model also has several weaknesses for example the ADL are often misunderstood and as Roper explains, they tend to be used as a checklist rather than applied in a practical way. One of the major complains against the model in the UK is that it is often abused by nurses who have simplified it to a checklist of how patient is performing without considering or adjusting their level of independence or dependence based on the finding (Siviter, 2008). Care plans have been found to be mere paper experience when they are by nurses who do not reflect on the actual problems or the impact care given. Question 3. Nursing processes overview. Discussing APIE(Defining each of the letters. ASSESSMENT,APPLICATION,IMPLEMENTATION,and EVALUATION APIE is a strategy used for problem solving in the direction of individuals in a systematic way through assessment, planning, implementation and evaluation. From a nursing perspective, the process can be examined in the context of how it is applied in provision of individual care focusing on not only the symptoms but also the patient’s holistic wellbeing. During the Assessment stage, a variety of data is gathered both qualitative and quantitative in nature consisting of information such as weight, blood pressure, height etc. The data is collected through different methods such as direct observation measurement and previous mental history. In this stage, other considerations have to be made such as the psychological social and even cultural background before determine the treatment plan (Handler et al., 2006). For the nurse to be effective, they must apply their professional knowledge and critical thinking skills so they can distinguish between what is important, irrelevant or relevant to the case study. Planning is the second stage through which the nurse organizes the treatment schedule based on the information they gathered during the assessment stage. The planning stage is where treatment goals are set; however, these goals should be structured in such a manner that they are flexible and can be adjusted with time based on the patient’s condition (Polit and Beck, 2008). Goals like the assessment should be documented as well as the patient’s response to them since they are considered legal documents through which the nurse can be held accountable in posterity. The goal setting process should be directive and give an indication of where the patient is heading after the care they will receive (Meterko, Mohr and Young, 2004), these should be evaluated by the medical team involved and assessed so they can be measurable, observable and recordable. They can be short, medium or long term depending on the patient’s needs. During implementation stage, the patient’s care goals in the planning stage are put into action so that they can benefit from them, but before the care plan is implemented numerous factors need to be considered. These factors include the patient’s belief and culture; for example, patients from some religious faiths do not believe in blood transfusion. Therefore, the medical team will have to either convince the patient to agree to the transfusion or come up with alternatives. The care must be implemented in an individualized, patient centred way and be grounded on evidence-based research taking to account all the ethical and legal factors (Rodney and Varcoe, 2001). In addition, all the care given in the implementation should be recorded according to NMC guidelines for the sake of accountability. Evaluation is the final stage in which the effectiveness or all the other stages of the care plan are assessed so that the nursing team can decide if the care was given correctly. During this stage, several factors need to be considered, this include; if the assessment had been accurate, if the goals had been realistic and if the treatment was realistic and relevant to the patient’s needs. Overall evaluation determines if the care process was successful and if it was not why, and who is to blame and what action should be taken in mitigation. References Alligood, M. R. (Ed.). 2013. Nursing theorists and their work St. Louis, Missouri : Elsevier. Alligood, M. R., & Marriner-Tomey, A. (Eds).. 2006. Nursing theory: Utilization & application. St. Louis, Missouri : Elsevier. Barrett, E. A. M. 2002. What is nursing science?. Nursing Science Quarterly,151, 51-60. Dingwall, R., Rafferty, A. M., & Webster, C. 2002. An introduction to the social history of nursing. London: Routledge. Dossey, B. M. 2009. Florence Nightingale: mystic, visionary, healer. Philadelphia : F.A. Davis. Ehrenreich, B., & English, D. 2010. Witches, Midwives, and Nurses: A History of Women Healers (Contemporary Classics). New York: Feminist Press at CUNY. Handler, S. M. et al. 2006. Patient safety culture assessment in the nursing home. Quality and Safety in Health Care, 156, 400-404. Holland, K. et al. 2008. Applying the Roper-Logan-Tierney model in practice. Edinburgh : Churchill Livingstone. Ignatavicius, D. D., & Workman, M. L. (Eds). 2002. Medical-surgical nursing: Critical thinking for collaborative care Vol. 2. Philadelphia: Saunders. Meterko, M., Mohr, D. C., & Young, G. J. 2004. Teamwork culture and patient satisfaction in hospitals. Medical care, 425, 492-498. Orem, D. E., Renpenning, K. M. & Taylor, S. G. 2003. Self-care theory in nursing: Selected papers of Dorothea Orem. New York: Springer Publishing Company. Polit, D. F., & Beck, C. T. 2008. Nursing research: Generating and assessing evidence for nursing practice. Philadelphia : Lippincott Williams & Wilkins. 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