The Role of Nurses in Meeting Health and Social Needs - Essay Example

Nursing Theories Name Course Date Introduction Older people have recently been given a lot of focus in health and social care policies in various countries. These policies ensure that the continuing health needs of the elderly are met. These needs include environmental, emotional and nursing care needs. The policies recognize that health and social needs of the elderly are interrelated and each of the needs must be addressed. The role of nurses in meeting these needs are discussed by various nursing theories among them Nightingale's Environmental theory, Hildegard. E. Peplau nursing theory and Faye G. Abdellah’s theory which is about patient centered approaches to nursing. These three theories recognize the great role that nurses have in restoring and maintaining health and social needs of the elderly. This papers looks at the philosophies behind each of the three theories and how nurses can apply them to be able to provide comprehensive care to the elderly. Background behind each theory Nightingale's Environmental theory Florence Nightingale developed her environmental theory in the second half of the nineteenth century. Her theory is based on the environment which she defines as all conditions and forces external to an organism which influences the life and development of that organism. According to Nightingale, those conditions can affect the health of the organism either by preventing disease, suppressing already present diseases, contributing to diseases, or even causing death of the organism. The theory mentions three types of environments: physical environment which consist of physical components at the place where the patient is being attended to, psychological environment which consist of communication that takes place between the patient and other people around him/her, and social environment which consist of the patient’s home, hospital room and the community surrounding the patient (McEwen & Wills, 2011). Physical environment can affect both psychological and social environment and includes environmental cleanliness. Poor physical environment can affect psychological environment because it is supposed to keep the mind active. It can therefore lead to stress. Components of physical environment such as clean water, good drainage and clean air are part of social environment that surrounds the patient. The theory considers disease to be part of the process of restoring health and therefore the role of the nurse is to create a balanced environment that will promote restoration of the patient’s health. Nightingale believed that the difference in recovery among patients is due to the suitability of the environment provided (McEwen & Wills, 2011). Hildegard. E. Peplau nursing theory Hildegard. E. Peplau’s theory focused on the therapeutic role of nurses. He believed that nursing is therapeutic, a healing art where the nurse assists sick individuals and those seeking healthcare. He explains that the interaction between the nurse and the patient is based on a common goal which motivates the therapeutic process. It is due to this goal that the two respect each other because each of them learns and grows from the other. Peplau talks about four phases through which the therapeutic relationship develops. The first phase is the orientation phase which is directed by the nurse as he/she engages the patient during treatment including offering information and explanations for patient’s questions. The second is identification phase where the two starts to work interdependently and are able to express feelings to each other. The third is exploitation phase when the patient makes full utilization of the nurse’s services. The final is resolution phase where the patient gains independence and no longer needs the nurse’s services. This phase marks the end of the therapeutic relationship. During this relationship, Peplau encourages the nurse to be considerate of the culture and background of the patients as they try to adjust to the routine of the hospital (McEwen & Wills, 2011). Faye G. Abdellah’s patient centered approaches to nursing In this theory, Faye G. Abdellah attempted to properly position the relationship between nursing practice and its restorative and preventive roles in meeting all the needs of a client. She explained that the health needs of a client can either be apparent (overt) or hidden (covert). Hidden problems are often overlooked and yet solving them may even solve the overt problems. The theory explains that professional nurses must be able to identify and solve both overt and covert problems. She therefore came up with ten steps and that can help nurses in identifying the patient’s problems, and eleven skills that they can use to come up with a nursing care plan. The ten steps and eleven skills were collectively referred to as “the typology of 21 nursing problems” (McEwen & Wills, 2011). Application of Theories to Practice Nightingale's Environmental Theory This theory emphasizes on the important role of the nurse in critically assessing the patient to know the type of care that is appropriate for the patient. This way, they will be able to create an environment that will permit nature to restore health. This theory can be applied in nursing practice in the care for the elderly in comprehensively assessing the geriatrics and the healthcare institutions. Comprehensive geriatrics assessment (CGA) is an intervention that involves thorough assessment of physiological and psychological aspects of the elderly’s environment to be able to understand factors that contribute to their age-related impaired abilities. Comprehensive geriatrics assessment is defined as an integrative diagnostic and treatment procedure that involves identification of medical, psychological, social and functional abilities of an older person so as to come up with a comprehensive medical plan that will maximize his/her health at old age. Nurses can apply Nightingale's Environmental Theory to understand the aspects of the environment that they need to critically asses and which have an influence on the health of the elderly. This understanding will help them to achieve their role as stated in the theory to create the best possible environment that will allow nature to preserve or restore health (Lihavainen, et al., 2011). Nightingale's Environmental Theory can also be applied in nursing practice in geriatric institutional assessment which involves assessing the hospital environment for its readiness in promoting high quality geriatric care. This assessment focuses on the knowledge, attitude and perceptions of hospital staff in regard to geriatric care and its integration into the hospital. Institutional assessment is conducted using a tool referred to as Geriatric Institutional Assessment Profile which helps hospitals to evaluate three critical areas: their readiness as an institution to be able to provide quality geriatric care, any notable changes before and after a program for geriatric care is implemented, and the quality of care that the hospital provides to the elderly and make it a benchmark that can be used by other hospitals in promoting geriatric care. Other hospitals can use it to evaluate knowledge, attitude and perception among their staff in regard to geriatric care and other issues and organizational factors that influence geriatric care (lmeida &Leite, 2013). Hildegard. E. Peplau nursing theory The therapeutic relationship between the nurse and the patient discussed in this theory can be very useful in nursing care for patients with mental health needs. These diseases affect the cognitive abilities of an individual including ability to communicate. In addition to the use of pharmacological interventions in management of these conditions, psychotherapeutic interventions play a very important role. This calls for therapeutic relationship with healthcare providers. This is developed through counseling but makes use of ‘therapeutic conversation’ which is defined as conversation whose intentions are therapeutic. The role of the nurse in this conversation is to be an active listener who gives an opportunity for the client to express his/her feelings and concerns. The nurse should have the ability to understand the patient’s impaired communication, be able to recognize their expression of feelings and also offer them emotional support (Tappen & Christine, 2009). The therapeutic relationship described by Hildegard. E. Peplau is also essential in the contemporary clinical management of mental illness which promotes active involvement of the mental health patient in their treatment and care plan. This requires them to be engaged through dialogue and sharing of information between the patients and the clinicians. For this to happen, a therapeutic relationship must first be established (Procter & Merritt, 2010). Faye G. Abdellah’s patient centered approaches to nursing This theory requires that a professional nurse must be able to identify and solve the patient’s problems, both the apparent and the hidden. The ten steps in identifying the patient’s problems, and the eleven skills for coming up with a nursing care plan can be used to tailor nursing training in a manner that it will meet the increasing needs of the elderly. They can guide nursing training so that they can be able to offer a range of geriatric care practices to the elderly as they move from independent stage, to assistive stage and finally to a dependent life. The elderly are increasing in number and are facing various challenges such as chronic diseases and declining functionality. Nurses must therefore be able to use well articulated steps in identifying their needs as well as skills in managing the identified needs (Scott-Tilley, et al., 2005). Nurses can acquire such skills and abilities by undertaking ‘End-of-Life Nursing Education Consortium (ELNEC)’, a geriatric training programme which helps nurses advance in their skills and be able to offer quality end-of-life care in facilities for the elderly. The training focuses on provision of palliative care to the elderly by being able to understand the physiological changes that take place as one age, those on medication and use of a person-centered approach in managing those suffering from chronic diseases (Kelly, at al., 2008). Similarities and Differences The common thing about the three theories is that they recognize that multiple factors play a role in healing. Nightingale's Environmental Theory recognizes the role of physiological, psychological and sociological environmental factors, Hildegard. E. Peplau nursing theory recognizes the role of the relationship between the nurse and the patient while Faye G. Abdellah’s patient centered approaches to nursing recognizes the role of skills of the nurse in identifying and managing the patient’s problems. The factors that the three theories focus on are non-pharmacological. However, each theory addresses unique elements of disease management. Nightingale's Environmental Theory gives more responsibility to things surrounding the patient, Hildegard. E. Peplau nursing theory gives responsibility to both the nurse and the patient while Faye G. Abdellah’s gives responsibility to the nurse’s profession. Conclusion Due to the dependent nature of the elderly caused by their declining abilities, nursing theories talk about various factors that need to play in order to preserve and restore their health. These are non-pharmacological factors that require efforts of the patient, those around him/her and the clinicians. Nurses can apply these theories to come up with strategies that will help them successfully manage the health of geriatrics. References Kelly, K., Ersek, M., Virani, R., Malloy, P., & Ferrell, B. (2008). End-of-Life Nursing Education Consortium Geriatric Training Program Improving Palliative Care in Community Geriatric Care Settings. Journal of Gerontological Nursing, pp. 28-35. 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