Theoretical and Conceptual Frameworks in Nursing Practice - Research Paper Example

Theoretical and Conceptual Frameworks in Nursing Practice: Catheter-Associated Urinary Tract Infection and Preventive Nosocomial Nursing Strategies The nursing profession had come a long way from mere comforting of patient in need into a formal body in health care through evidence-based theoretical practice. Thresyamma (2005) described nursing multidimensional clinical profession that encompasses as an art and a science, where nurses render “service to human being to help him...keep normal state of body and mind...(and) relief from physical pain, mental anxiety or spiritual discomfort” (p. 2). By being an art, nurses are substantially encouraged to be practically creative and resourceful in delivering services that are efficient and effective. At the same time, it is a science for nursing practice should be anchored on theoretical and conceptual bodies of clinical knowledge in ensuring that every action promotes safety and enhancement of patients’ health. The patients’ overall well-being should be at the central of nursing. In line with this, nurses need to relate professional knowledge into clinical practice, through theoretical and conceptual frameworks bridges, dynamically linking care between health personnel and care recipients, in consideration with environmental factors. The body of knowledge in nursing had been divided into several categories to distinguish bulks of nursing concepts constructed. Fawcett (1995 as cited in Timmins, 2005) identified hierarchical structure in nursing knowledge, where different levels are interconnected in clinical fields: “(1) metaparadigm (2) philosophy (3) theory (4) conceptual models.” Metaparadigms are quite broad in context, which translate clinical values indicated in constructed philosophies, while theories are more specific in experiential nursing fields. Fawcett (1994 as cited in Masters, 2005) added that conceptual models, being the last, pertain to sets of nursing abstracts and propositions that are meaningfully integrated for valid reference in nursing disciplines. One of the fundamental bases in modern nursing profession is the theory created by Florence Nightingale. Her philosophical concepts are simple in construct, though, it primarily stabilized how nurses act in deference to patient interaction. In her environmental model for nurses, Nightingale proposed that elements observed in environment can have a significant impact on patients’ health conditions (Butts & Rich, 2010). The model substantially linked three important entities together: the patient, nurses, and their environment. Her meta paradigm in Figure 1 (please see Appendix A), showed these three factors that may influence outcomes in health, where emphasis can be made on the nature present in the environment that can be manipulated, such as conditions in light and temperature, nutritional intake, hygienic provisions, and emotional support as essential in providing dynamic nursing services (Masters, 2005). At this point, health promotion and disease prevention seemed at the heart of Nightingale’s environmental model, as largely observed in current priorities in modern day nursing practice. On the basis of Nightingale’s philosophical proposition, her conceptions on how to deliver nursing services may be too broad in specific nursing fields, but clinical areas can benefit from environmental modification emphasis in her mode. As affirmed by Alligood and Marriner-Tomey (2006), nursing models bridge the gap between professional knowledge and practices, as its communicative quality translates knowledge base into clinical actions. In application, the said metaparadigm can be generated in preventing hospital-acquired bacterial transmission in urinary tract infection (UTI). According to several reports, hospital-acquired (nosocomial) infections compose almost 40% of cases, where majority (80%) had been contracted during “indwelling urethral catheter use” (Nicolle, 2007, p. 251). The alarming rate of infection transmission from health care providers to care recipients demonstrated discrepancies on implementation of safe clinical practice. In direct care of patients, nurses have greater responsibility in ensuring care is based on sound philosophies and conceptual guidelines. In association, Nightingale’s environmental reform had been represented through the canons in the model, including measures to ensure patients’ personal cleanliness (Masters, 2005). At this point, the impact of environment on patients’ safety and maintaining well-being is delineated, including role of nurses in altering environmental factors for better health status. In detailed account, the transfer and accumulation of bacteria through urethral catheterisation is probable, even in hospital institutions. Introduction of bacteria is possible due to openings offered by catheter device, which is normally defended by physical and chemical barriers in lower urinary structure (please see Figure 2 in Appendix B). Transfer of infection can be through improper preparation and introduction of urinary catheter, or during regular opening in urinary bag for regular urine drainage (Tenke et al., 2007). Most of the time, bacterial microorganisms, which had been transferred from contaminated health personnel during service delivery, are of antibiotic-resistance category (Jacobsen, Stickler, Mobley, & Shirtliff, 2008). As this may mean more expensive and potent pharmacological treatment, theoretical assumption in Nightingale’s proposition on environmental control seemed more feasible and cost-effective. One way to do so is by consistently implementing the universal infection control measure of hand washing prior to any procedure (Trautner, Hull, & Darouiche, 2005). Although implicitly indicated in the environmental model, such action falls on the category of Nightingale’s cleanliness on health staffs’ side for the patients’ sake. As such, nurses need to eliminate bacterial sources through washing of hands before proceeding with clinical obligations. Other ways to prevent UTI from personnel sources are strict provisions of sterility both in implementing procedures and equipments utilized, as well as removal of drainage bag from catheter tube during urine drainage (Kollef, 2008). In doing so, the catheter system will remain uncontaminated by bacterial organisms from contact with nurses and other health personnel. As simple as such clinical measures, the safety of patients in prolonged catheter set-up is ensured. This goes to show that part of the logic behind the environmental model is to reduce unwarranted contact between patients and nurses, as the concepts recognize the danger of bacterial contamination. Hence, physical and procedural strategies in earlier recommendations exhibit probable efficacy in reducing the introduction of pathological conditions to patients. Principles and theories applied in nursing practice safeguard the status of patients as dependent entities on the care of nurses--as experts in clinical management. The fundamentals in environmental model constructed by Nightingale had been one way to explain the significance of environmental factors when nurses deal with patients, as it represents a middle ground in which patients can generate comfort and health problems, while nurses utilized such factors to provide great comfort, and unknowingly, may cause bacterial infirmities, as well. In such scenarios, reforms in environment by better hygienic and sterile practices in administering and caring for patients with catheter can greatly reduce possibilities of urinary tract infection from personnel transmission. In doing so, Nightingale’s illness prevention approach, with improved interactions of patients, nurses and environment, is quite novel in quality, and assists nurses in ensuring patients’ safety and healthier conditions in the long run. References Alligood, M.R., & Marriner-Tomey, A.M. (2006). Nursing Theory: Utilization and application. United States of America: Elsevier Mosby. Butts, J.B., & Rich, K.L. (2010). Philosophies and Theories for Advanced Nursing Practice United States of America: Jones and Barlett Learning. Jacobsen, S.M., Stickler, D.J., Mobley, H.L.T., & Shirtliff, M.E. (2008). Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirablis. Clinical Microbiology Reviews, 21 (1), 26-59. Retrieved from http://cmr.asm.org/cgi/reprint/21/1/26 Kollef, M. (2008). SMART Approaches to reducing nosocomial infections in the ICU. CHEST, 132 (2), 447-456. Retrieved from http://chestjournal.chestpubs.org/content/134/2/447.full.pdf Masters, K. (2005). Role development in professional Nursing practice. United States of America: Jones and Barlett Publishers. Nicolle, L. (2007). The prevention of hospital-acquired urinary tract infection. Clinical Infection Disease, 46, 251-252. Retrieved from http://cid.oxfordjournals.org/content/46/2/251.full.pdf Tenke, P., Kovacs, B., Johansen, T.E.B., Matsumoto, T., Tambyah, P.A., & Naber, K.G. (2007). European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. International Journal of Antimicrobial Agents, 31S, S68-S78. Retrieved from http://download.journals.elsevierhealth.com/pdfs/journals/0924- 8579/PIIS0924857907004189.pdf Thresyamma, CP. (2005). Fundamentals in Nursing. India: Jaypee Brothers Medical Publishers. Timmins, F. (2005). Contemporary issues in coronary care Nursing. United States of America: Routledge. Trautner, B.W., Hull, R.A., & Darouiche, R.O. (2005). Prevention of catheter-associated urinary tract infection. Current Opinion on Infectious Diseases, 18 (1), 37-41. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955262/pdf/nihms-242470.pdf Appendices Appendix A Figure 1. Nigthingale’s Metaparadigm on Environmental Model (Masters, 2005, p. 37) Appendix B Figure 2: Bacterial Process during Urinary Tract Contamination (Jacobsen, Stickler, Mobley, & Shirtliff, 2008, p. 28) Read More