Comparison of Nursing Theories - Essay Example

Comparison of Nursing theories Comparison of Nursing Theories Comparison of Nursing Theories Research is increasingly being used in nursing education. Gaps are existent between research and theory and practice which evidence-based practice would fill. The isolated, unsystematic clinical experiences and ungrounded opinions are de-emphasized by evidence-based practice which also improves outcomes greatly (Penz, 2006, p.250). Immense gains in behavior, knowledge, physiologic and psychosocial outcomes have been seen when patients were provided research-based nursing interventions (p.251). The outcomes of 72 % patients were 28% better than those who received normal routine nursing care. All practice in clinical settings has the tendency to improve with research. However the teaching of research use and appraisal skills may not be sufficient for nurses to use these skills in their practice (Goodfellow, 2004 in Penz, 2006, p.251). Goodfellow encouraged the use of journal clubs where students would be allowed to critically analyze research and statistically appraise it. Statistics are an integral part of nursing practice and research (Zellner, 2007, p. 55). Copies of the research articles would be circulated and the nurse students would come prepared for the discussion. Foster (2004) facilitated the nursing students to improve their evidence based knowledge by creating ‘guided research questions’ (Penz, 2006, p.251). Inadequate access to research material also affected the search for evidence to correlate theory with research (Paramonczyk, 2005 in Penz, 2006 p. 252). Research reports are not readily available and also not compiled in a single place. The ability to read, interpret and translate research into practice is a necessary ability. Clinically registered nurses require the facilities to continue their education. Qualitative research is a good method to enquire clinically into nursing practice which leads to theory and advancement in clinical practice (McBrien, 2008, p. 1286). Rigor of research needs to be enhanced. Theories of nursing Nursing theories and models impart a lot of information about the definitions of nursing and the practice, the principles which form the basis of practice and the goals and functions of nursing (Ruddy, 2007, p.1). Nursing theories reflect the creative products of nurses. Relationships and interactions within their nursing practice are described. Though several theories have been detailed by different nurse theorists, there is no single theory which is more correct than the others. Theories are classified into philosophies, grand theories and middle range. The nursing practice is facilitated and nurses are equipped to become experts in their field through these theories. The different theories of nursing are suited to various occasions in nursing. The theories define ‘commonalities of the variables in a stated field of inquiry; guide nursing research and actions; predict practice outcomes; and predict client response’ (Nursing Theories, 2005). When research based on theoretical knowledge is incorporated into the nursing practice, it leads to enhanced professionalism (Alligood and Tomey, 2002 in Penz, 2006, p.251). Nurses are exemplary in their practice when clinical thinking and decision making is guided by theory and nurses can understand what they do and why. They are also able to clarify things in front of the other health professionals (Alligood and Tomey, 2002 in Penz, 2006, p.251).Goodfellow indicated that students may not be aware of how to instill skills into practice even if they are taught how to use research and appraisal skills in their practice (2004, Penz, 2006, p.251). The suggestion to use journal clubs to promote research activities and their utilization in practice came from Goodfellow. The nursing students would be taught how to critically analyze the findings of research in terms of validity and reliability. They were also taught to read and appraise research and encouraged to apply this knowledge in their practice. The copies of the research articles would be distributed for everyone to read who can then come prepared for these discussions. The nurses found their own time for the journal clubs. Foster also attempted to teach students about research (2004, in Penz, 2006, p.251). He taught the students how to relate paediatric nursing procedure statements to current research evidence. The students created guided research questions, searched for related literature, critiqued the strength of the evidence gathered, synthesized the evidence and prepared their own interpretations of evidence-based recommendations (Penz, 2006, p. 251). The inaccessibility of nurses to current research and information and resources to support the latest information is a problem in itself. The benefits of new research and information would not be freely available for nurses to inculcate in their practice (Paramonczyk, 2005 in Penz, 2006, p. 252). Transforming research into theory and theory into evidence-based practice is possible only if the current research journals, resources and the internet are readily available to the nurses. Literature must be compiled in one place for this facility. Paramonczyk found that Canadian nurses suffered from this shortfall (p.252). Further nurses may need to have additional skills to review research and benefit from new information. Increased knowledge about ‘available evidence, the skills to search for and critique research, the ability to read, interpret, and translate research into practice, and the skills to evaluate the strength of the evidence’ is necessary (Paramonczyk, 2005 in Penz,2006, p. 252). A research in a hospital in the United Kingdom showed a low baseline of knowledge among the nurses and few searching skills. All the nurses had difficulty in ‘identifying and framing a clinical question’ (Newman, 2000, in Penz, 2006, p.253). There is a cultural resistance to change among nurses accompanied by apathy and inaction (McCaughan et al, 2002, in Penz, 2006, p 253). Many nurses just prefer to believe that the common practice is the best without question even after research has found better techniques of application (Young, 2003, in Penz, 2006, p.253). Using patient-centered approaches, nurses are to solve several problems which have been identified as 21 by early researchers like Faye Glenn Abdellah (Ruddy, 2007, p.1). The physical and sociological and emotional needs of the patient are to be attended to by the nurse. She takes care to foster interpersonal relationship with the patient and administer the essential elements of patient care. Patients are to be accorded good hygiene and physical comfort. During the course of being provided therapy, the patients are to resort to optimal activity, exercise, rest and sleep. The nurse ensures a period of safety for the patient under her care by ensuring that accidents, injury or trauma do not occur and infection is not spread. She also ensures that the patient eats well, takes enough fluids, has normal excretion processes and generally provides the patient a healthy environment to live in (Ruddy, 2007, p.2). The grand theories have a global conceptual framework which defines broad perspectives for practice and includes various ways of viewing nursing phenomena based on these perspectives (Tomey & Alligood, Nursing theorists and their work 4th ed., p. 273). The middle range theories are useful in nursing research and practice. They have a limited number of variables which can be tested directly (Nursing Theories, 2005). The core, care and cure model of Lydia Eloise Hall, the cultural care of diversity and universality of Madeleine Leninger and Newman’s theory of expanding consciousness are all grand theories. Huth and Moore’s pain management for children, Barnard’s child interaction and Pender’s health promotions are middle range theories. Theory of Human Caring of Jean Watson. Jean Watson, Ph.D, RN, FAAN, HNC, provided the theory of human caring. She is a professor at the University of Colorado Health Sciences Center School of Nursing in Denver. The caring science indicates a humanitarian approach to caring processes, phenomena and experiences. Leninger adorns the only endowed chair in caring science in America (Davidhizar, 2005, p. 314). Watson believes that her theory honors the ‘deepest human experiences and moral longings’. She has just started her work and expects others to expand on the theory. Her work has been expansive and she has authored or co-authored many books, essays and articles on holistic nursing, nursing science and alternative therapy journals. Her book “Caring Science as Sacred Science” speaks of mind-body-spirit nursing, medicine and health care (Jean Watson, 2004). The theory provides a value based context for caring as a model for compassionate, professional human caring and healing. The caring science considers humans as unique, whole, indivisible and changing frequently. Pillemer et al conducted two randomized control studies which highlighted the theory of caring and enhanced interpersonal relationships and reduced interpersonal stress from caring for Alzheimer’s patients. The research hypotheses were as follows: a) members of care-giver networks were more likely to be a source of support and less likely to be a source of interpersonal stress like criticism, direct interference or unmet expectations for support. The first study was a social support intervention for people who wanted to become family care-givers (Pillemer et al, 2003, p. 19). It included a pre-interview and a post interview of 115 participants. There were 54 in the treatment group and 61 in the control group. The participants in the post intervention group included the volunteer peer supporters recruited by the Alzheimer’s Association of New York. They were given training in communication and listening skills. They were matched with a family care-giver of recently diagnosed Alzheimer’s who was visited frequently by the trained person and ideas shared on a friendly basis. The benefits of similarity were maximized. Theory and research helped to develop an intervention considering a single factor: enhancing g care-givers social networks with ‘experientially similar others’ (Pillemer, 2003, p. 26). A limitation was that the problems of care-givers could be multidimensional and therefore a specific intervention could not be finalized. Multi- component interventions could be better accepted. The Comfort Theory of Katherine Kolkaba Dr. Katherine Kolkaba, PhD, RN, FAAN is an Associate Professor in the University of Akron College of Nursing, Ohio. The feeling of being strengthened when relief, ease, and transcendence occur following physical, psychospiritual, social, and environmental experiences are the holistic comfort. Offering this holistic comfort is behind the comfort theory of Katherine Kolkaba for nurses. This is a mid range theory first published in 1994. It includes a small number of propositions and concepts, low level of abstraction and it is easy to apply (Kolkaba, 2005, p.188). Comfort has been defined as soothing in distress, being relieved from distress, person affording relief, a state of ease and enjoyment, free from worry and anything that reduces distress and provides relief. (Webster, 1990). The strengthening property along with enhanced comfort is especially required in nursing. Kolkaba defined holistic comfort as ‘the immediate state of being strengthened through having the human needs for relief, ease and transcendence addressed in four contexts of experience (physical, psychospiritual, socio-cultural and environmental)’ (Kolkaba, 2005, p.188). Alleviating a state of discomfort is relief. The absence of specific discomforts is ease. Specific discomforts could include a difficulty in breathing, stress-related illness or depression, dehydration, bleeding or vomiting. The nurse is equipped to foresee such possibilities and provide relief. Transcendence is the ability to rise above discomforts when they are inevitable. Interventions which provide transcendence can hope to improve the environment or increase social support or provide reassurance. (Kolkaba, 2005, p.188). These interventions are more effective when coming from families but nurses would do well to motivate them. As the different aspects of comfort are interrelated, total comfort is greater than the sum of the parts. Caring attention to one part could increase the total comfort a great deal (p.189). Pain can be transcended by positive messages, optimistic body language of the nurses and reassurance as to the safety. Comfort is a positive and desirable outcome essential to the discipline of nursing. Prevention of discomforts is easier than treating discomforts. When the nurses intervene to apply the comfort theory, they do so in a caring manner as the theory offers an efficient system to plan care and provide interventions that work (Kolkaba, 2005, p.189). Comfort is a positive outcome that helps to empower patients. According to the Comfort Theory, enhanced comfort strengthens the recipients to participate in activities for achieving health and remaining healthy. After distressing events, nurses are the first people they come into contact with. The nurses are supportive for recovery and rehabilitation. Occasionally a ‘good death’ is what is necessary. The nurses and families must prepare the patient for such an ultimatum but adjust the circumstances to make it as comfortable as possible (Kolkaba, 2005, p. 190). To institute the Comfort Theory in a hospital or community care center, the provision of holistic care must be clear-cut and well-documented. Institutional commitment and support are of utmost importance. Future research must highlight on how to enhance comfort during procedures, traumas and death. Palliative care is given to those who are nearing the last days of their lives when providing the best quality for remaining life is more significant than prolonging a miserable life (National Ethics Committee, 2007). Sometimes even aggressive high quality palliative care does not relieve them of symptoms like vomiting, dyspnoea and severe pain which become refractory to treatment. Keeping them from pain, communicating with them and providing spiritual relief could perhaps work wonders and provide satisfaction to their near and dear ones. The nursing of a dying patient involves many aspects, all of which impinge on the comfort zone of the patient and his relatives. . The improvement of the patient’s and family’s comfort and their quality of life are in the hands of these professionals. Miyashita conducted a study among 178 nurses who administered to dying patients. The Death Attitude Inventory, the Pankratz Nursing Questionnaire and the Frommelt Attitude Towards Care of the Dying Scale were used. In Japan where the cross sectional survey was conducted, 79% of all deaths occurred in the hospitals. A private general hospital with 482 beds in an urban area of Tokyo was the setting. The participants included nurse managers, assistant nurse managers and staff nurses. It was found that a clear life purpose resulted in a positive attitude towards working as a nurse and a positive attitude towards caring for a dying patient. Theory of Transcultural Nursing by Madeleine Leninger Madeleine Leininger, PhD, LHD, DS, RN, CTN, FRCNA, FAAN, LL is Professor Emeritus of Wayne State University (Detroit) and Adjunct Professor University of Nebraska Medical Center (Omaha) Colleges of Nursing. She is the Founder & Leader of Transcultural Nursing and Leader of Human Care Research. She was a pioneer nurse anthropologist and was first appointed in the School of Nursing in Washington. A trip to New Guinea in the 1960s opened her eyes to the necessity of understanding patients’ culture and background for doing full justice to patients of diverse cultures. Thus she founded the transcultural nursing. Transnational migration and globalization require nurses to be thoroughly prepared for a complex health environment full of challenges. A nursing workforce that can respond well to diverse peoples coming from many cultural backgrounds, languages and worldviews must be trained (Campesino, 2008, p. 298). Recent transitions have developed national standards for preparing the workforce for health care. Transcultural nursing theories allow the development of good nursing care for the culturally diverse populations. The basic cultural knowledge helps nurses to promote positive health behaviors and provide ‘culturally sensitive and congruent care’ (Campesino, 2008, p.298). Limitations have been noticed by nurse educators especially in transcultural nursing (Gustafson, 2005 in Campesino, 2008, p.299). Transcultural nursing has a humanistic philosophy to it (Mulholland, 1995 in Campesino, 2008, p. 299). Quality health care can be provided through ethical caring and respect for individual client’s values. Differences between the nurse and client based on race, ethnicity or culture must be eliminated by the nurse increasing her knowledge of cultures. The comfort theory is my selected theory for nursing. Children and families have a holistic response to complicated stimuli affecting health. Comfort is a holistic outcome that is essential to the discipline of nursing (Kolkaba, 2005, p.189). In the effort to meet their basic comforts, children and families may require the strong support of the nurses and other professionals. The nurse has to strive to prevent discomforts rather than allow them to develop. When environmental chaos or pain are inevitable, the families and children must be guided to experience relief through comfort interventions that portray hope, success caring and support for fear (Kolkaba, 2005, p.189). In applying the comfort theory, the nurse efficiently ministers in a caring manner to the complex person that a human being is. The enhanced comfort that the nurse delivers strengthens the recipients and guides them into activities essential for achieving health and remaining healthy. The nurses are the first link with normalcy after a person has a frightful experience (Kolkaba, 2005, p.189). The nurse provides a supportive environment for recovery and rehabilitation and progress of his health-seeking behaviors. Children are especially guided through their development phases so that children have better outcomes and the families are totally satisfied. Standard comfort interventions would include the maintenance of homeostasis and relief of pain (Kolkaba, 2005, p. 190). Coaching would be done to relieve the child and family of anxiety. They would be reassured and hope instilled. Plan for recovery would be helped. Comfort food or some extra nice things that nurses can do to make everybody feel cared for would strengthen the message of comfort. If it is death that will happen, the nurse has a duty of peacefully sending the patient onward after bidding a fit farewell to all his dear ones and help the others to cherish the memories of the lost patient. The most significant nursing act would be to facilitate a peaceful death without much physical or psychological pain. Generally speaking, nurses cater to the physical comfort needs, environmental comfort needs, psychospiritual comfort needs and sociocultural comfort needs of a patient (Kolkaba, 2005, p.190). I feel that my selection of a nursing career would help me achieve maximum satisfaction in life. References: Campesino, M. (2008). “Beyond Transculturalism: Critiques of cultural education in nursing”. Journal of Nursing Education, Vol. 47, No.7, July 2008. Pg 298-304 Davidhizar, R. (2005). “Caring Science as Sacred Science”. Nursing Education Perspectives, Vol. 26, Issue 5, Proquest Educational Journals, Sept. /Oct. 2005, Pg.314. Kolkaba, K. and DiMarco M.A. (2005). “Comfort theory and its application to paediatric nursing”. Paediatric Nursing, Vol 31, No.3, May/June 2005, Proquest Educational Journals, Pg 187-194. McBrien, B. (2008). “Evidence based care: enhancing the rigour of a qualitative study”. British Journal of Nursing, Vol 17, No.20, October 2008 National Ethics Committee, (2007), “The Ethics of Palliative Sedation as a Therapy of Last Resort”, American Journal of Hospice & Palliative Medicine Volume 23, Number 6, December/January 2007, Pgs.483-491 2007 Sage Publications Nursing Theories, 25/5/05, Retrieved on 14/12/08, http://www.nursingtheory.net/ Nursingtheory.net Penz, K.and Bassendowski, S.L. (2006). “Evidence-Based Nursing in Clinical Practice: Implications for Nurse Educators”. The Journal of Continuing Education in Nursing · November/December 2006 · Vol 37, No 6 Pillemer, K. et al. (2003). “Integrating theory, basic research and intervention: two case studies from caregiving research”. The Gerontologist, Vol. 43, March 2003, Proquest educational journals. Ruddy, M. (2007). “Models and Theories of Nursing”. Revised Ed. Cardinal Stritch University Library, Milwaukee. http://library.stritch.edu Tomey & Alligood, Nursing theorists and their work 4th ed. Webster New World Dictionary (1990). NY: Pocket books Zellner, K. et al. (2007). “Statistic used in current nursing research”. Journal of Nursing Education, Vol 46, No. 2, Feb 2007 Read More