Middle Range Nursing Theory - Research Paper Example

Running Head: NURSING THEORY Nursing Theory (Your School) Introduction Middle range theories focus on a restricted dimension of the nursing reality. The theories can be depicted in a model which is comprised of concepts. These concepts are related and vital in guiding research and practice in nursing. Self-management of chronic diseases is an important theory in nursing. It is not only beneficial to the patients since they are made aware of how to manage themselves better but nurses as well. As much as the patients need to be offered guidance by the nurse, management of the disease is primarily the work of the patient. However, the two parties must work as partners. This partnership has an aim of enabling patients better manage and control the disease. If properly administered and adhered to by both parties, the partnership helps reduce social, economic, physical and psychological effects of chronic illness (Fowler, Kirschner, Van Kuiken and Baas, 2007). In the 21st century, the needs of patients, more so those with chronic illness, continue to draw attention from researchers. The nature of chronic diseases is that they last for a long period of time, developing slowly but surely. Since the majority of the illnesses have no cure, it becomes difficult to predict effects in the long-term. However, with medication some of the symptoms and problems can be tackled. On the contrary some patients find themselves severely affected by the disease. Diseases such as diabetes, depression arthritis, and hypertension may limit individuals’ daily activities. As much as these chronic conditions might have clinical differences, needs arising from the illnesses are similar for patients and their families. For instance it is important to have behavioral changes, emotional and social impacts of symptoms, disabilities, approaching death must be dealt with. The patient must endeavor to take medicines consistently and continue to interact with medical care (Marquis and Huston, 2009). On the other hand it is the duty of health care practitioners to ensure patients are better informed and allowed access to the best treatment. In this way the patients will be able to effectively manage their health and death. This goal cannot be realized without effective leadership and management skills by the nurses. Apart from the skills which as vital for the nursing practice, the recovery process can be fostered by good leadership skills by the nurse (Stanley, 2008). One area where the skill can be applied is in influencing legislation and health care policy. Though the level of power of the nurse cannot be compared to that of administrators or physicians still they can propose improvements in the system. Since few nurses have the opportunity to display leadership in this manner, it is important to emphasize leadership at the bedside. A good environment that will ensure proper care can only be provided with leaders in the profession. Theory to Practice Area The chronic care disease management program is important since it helps reduce readmissions in hospitals. As health care prepares for pay-for-performance, the theory helps to improve outcomes and increase satisfaction of patients. It is important to note inability on the part of a patient to manage a particular disease would lead to readmission. Patients are therefore given enough training on how to manage their disease. This training has been useful in a sense that unnecessary hospitalization is avoided by patients. Leadership and management is an important area in nursing. It is due to earlier practice as managers that nurses can become better leaders. In the latter role it is all about taking risks. There are creative ways of doing the same things that have been done before. The role played by the nurse manager is essential in health care. It is true an organization cannot function well without a manager. The nurse therefore has a role to ensure patients get quality care, smooth process of staff recruitment and maintain success. It becomes easier since management of people is perceived as being synonymous with management of patient care. In the two circumstances, success of people and patient care is determined by the outcome. Skills in management and leadership are required by the nurse in order to be able to effectively intervene on patients under self-management of chronic illnesses. This is because nursing initially, was to do with management of a patient’s sickness. The patient is managed in a sense that things are done for him or her. For instance the nursed has to ensure the patient takes medicine, bath, assisted with other chores and tasks. The nurse will try as much as possible to see the patient continues to live a normal life despite being unable to perform some tasks. On the other hand apart from management of diseases, patients need to be perceived as people. The illnesses and everything that they go through should be looked upon with greater understanding by the nurse. The recovery process requires collaboration between nurse and the patient. Since it is the patient that knows how it feels then, in most cases the nurse will receive instructions from the patient. In chronic diseases this is even much more pronounced. The patient needs to be given a chance to manage the illness. This means the nurse has a role to empower the patient. Little has been done to ensure patients are prepared accordingly to manage their diseases in the long-term (Higgins, Madjar and Walton, 2004). A number of challenges are faced by patients as they cope with disability, discomfort and regular treatment programs. The most important and urgent thing to undertake is change of behavior. There work and social lives must adjust to symptoms experienced. The care given to patients can only be effective if they can participate actively in the entire process. First, patients must be able to report and or interpret the symptoms. They should also be able to judge how the illness is progressing and further, participate in management decisions alongside health care professionals. Patients with chronic diseases have been for a long time recipients of care. However, with the knowledge of leadership and management, health care workers see the need to empower patients. This ensures patients actively participate in their own recovery process. The treatment process relies so much on active participation of patients. The control of the lives of patients must be bestowed in their hands. In order for patients to be able to manage their own diseases, education is a key factor. There is always lack of knowledge among patients making them unable to collaborate in decision making process. For instance, in a number of cases workers lack necessary skills or tools to have a meaningful collaboration with patients. On the other hand patients are sometimes faced with problems with interpretation of prescriptions. There are those that choose not to take medication since they do not understand or simply administer it wrongly. All this arise due to the gap between physician or nurse and the patient (Sullivan and Decker, 2001). The behavior of patients must be taken into consideration as physicians give orders. This can only be done if a patient is understood as an individual and made to manage his or her own disease. Hospitalization can be reduced greatly once patients are able to manage their disease (Smith, Pace, Kochinda, Kleinbeck, Koehler, and PopkessVarter, 2002). The rate of readmission will also decline. There are a number of chronically ill patients in rural areas (Scott, 2000). It has become a great challenge for health care system to be able to support the growing number of chronically ill patients. Since a higher percentage of health care expenditure is directed towards those that are chronically ill then there is need to cut costs (Scott, 2000). The current situation indicates that chronically ill patients consume greater percentage of admission, hospital days and visits to emergency department. Self-management will ensure a reduction in these numbers. Nursing leadership in the rural context poses a great challenge to nurses. Rural health care is plagued by limited access to services, health care personnel and fiscal resources (Scott, 2000). It is as a result of these limitations that patients with chronic illnesses in rural areas face constant readmission in care facilities. Compared to those in urban areas, rural patients face many challenges. They not only face limitations indicated above but suffer from poor health in general. In addition to being in rural settings most patients are old and physically worn out. Rationale for Application The future of health care in the contemporary society lies in healthy lifestyle as opposed to treating the sick. The agenda for public health therefore puts much emphasis on personal responsibilities and positive behavior to ensure good health (Tullett and Neno, 2008). However, there are patients who rely on services and suffer from long-time conditions. For this group of people an early intervention is favored. This will greatly reduce instances of emergencies leading to hospitalization. In order for care management to run smoothly nurses have to be better qualified. This will greatly enable them intervene across care support systems, professions and agencies. It is indeed difficult for individuals to adopt healthy lifestyle if they do not see the likelihood of contacting illness. This is even less likely if they consider the illness to have fewer effects on them. Further, healthy lifestyle can be shunned once individuals realize there is less which can be done to reduce the likelihood of a certain illness. It is for these reasons that education and training is important for both patients and healthy individuals. People need to get used to care for themselves such that in case of illness, few difficulties will be experienced. The theory of self-management of chronic diseases is important to leadership and management. This is not only because it empowers patients but greatly enhances relationship between nurse and patient. A patient who knows how to manage his or her illness makes the work of health care workers easier. It becomes a little less costly and effective to care and provide treatment for such a patient. Again, leadership skills of health care workers are brought to the fore (Willmer, 2007). It becomes vital for practitioners to lead by example and not simply being able to give care. The patient can be shown how well to respond and care for themselves. This means responsibility is shifted from health care workers to the patient. The theory allows for nurses to provide interventions to patients and caregivers at home. In this way they are able to trust others with responsibility. However, as much as the nurse will keep a distance from the patient, still provides much needed support. It is becoming obvious that families will prefer homecare as opposed to institutional care. This preference comes despite the fact that requirements for homecare are quite high. The family and patient are required to undertake much learning and care giving procedures. It is because of this craving on the part of family and patient that nurses are able to put their management and leadership skills into practice. The nurse must not only show willingness to teach but be available whenever they are needed. The theory is important to management and leadership since it addresses challenges in the health care profession. It is a new way to tackle some of the problems that continue to affect those in health care profession (McGuire and Kennerly, 2006). With the continued change in scope of nursing, the approach to patients must also change. It is apparent worldwide of a continued shortage of nurses. This problem cannot be solved merely by recruiting more in the profession but through patient training. The patient, family and those requiring care such as the elderly must be trained in self-management. As much as this kind of approach greatly reduces the burden on the nurse, it is also the way forward in the nursing profession. Self-management of chronic diseases makes patients and or families part of the recovery process. This manner of care giving is natural and has been in the community since long ago. It is only patients and their families who can better understand their needs. Since the care is provided in the home environment, it becomes easier to monitor the disease. In case of improvement or an emergency, the nurse can be contacted in order to provide guidance in accordance to practice. The nurse therefore acts like a consultant who has the greater role and responsibility to ensure everything goes well. The context of care giving in the case of self-management of chronic diseases is always home environment. The patient, family or care givers enjoy home environment as they provide or respond to the care. This is to mean nurses will have to provide training and interventions to people of diverse backgrounds. Just like any other leader, the nurse meets subjects on their terms. He or she is valued for the important contribution made in recovery process. In order to effectively respond to the demand of patients, one must have passion. The challenges might be great but with necessary skills, nurses are able to address the problems. There are a number of skills which nurses will have to put in practice once patients embrace self-management of chronic illnesses. It is not only knowledge and skills accumulated over the years that are important but communication skills as well. In order to understand progress made, a nurse must have both good listening and speaking skills (Marquis and Huston, 2009). There are times when patients have problems with comprehension. Sometimes due to sickness, instructions are flouted. These challenging times are a test of leadership and management skills of the nurse. It is a time when the nurse has to exercise great understanding, passion and patience. There are some instances where intervention of nurses does very little in helping patients. For instance, in cases of chronic pain nurses not only ignore patients but do very little to alleviate the pain. In a number of situations patients themselves have come up with creative ways to ease the pain (Laurent, 2000). The nurses assume that among the elderly, chronic pain is normal and therefore can be ignored. On the other hand most patients find it difficult to express exactly how they feel to the nurse. Since any kind of pain is stereotyped as similar, most patients call for attention only when the pain is severe. Examples in Practice Area It is apparent in order for recovery process to be successful then the patient and nurse must collaborate. Without collaboration and coordination, the recovery process can never be successful. The patient has the ability to know more about the disease than the nurse. Since he is the first to experience symptoms and at the same time feel effects of medication, information provided by the patient cannot be ignored. The nurse on the other hand will study the patient and respond to all queries directed to him or her. The patient must not withhold any information which might be useful to the nurse. Most of the chronic illnesses are associated with the elderly people in society. Since painfulness is expected for those suffering from diseases such as arthritis then it becomes the norm to be ignored. In some cases the nurse might be busy attending to other patients whereas other times nothing can be done. After taking too much of pain killers most patients soon learn to do away with services of the nurse. The nurses simply cannot help much in such situations. The pain encountered by the elderly varies greatly with location, intensity and duration. However, unlike young people, the elderly expect pain to last indefinitely. According to one elderly, painkillers such as panadol can only be taken once the pain becomes severe. This is because painkillers have side effects. Normally a patient will complain of stomach upsets. Furthermore, there is little that nurses can do about complaints raised by patients. It therefore remains the responsibility of patients to feel hopeful about the entire situation. The patient is also faced with another dilemma considering that he is unable to communicate effectively. As much as nurses can be contacted, still little can be done to alleviate the pain. Most of the patients suffering from chronic pain call for assistance only when the pain is intense. Some patients confess that the pain is too much that it saps away their will power, strength and energy. The patients will only ask for pain relief once the pain becomes unbearable. These request come after the patient has contemplated for a long time whether or not to inconvenience the nurse or doctor. There are many instances when a patient will request for analgesia but only to be ignored or request forgotten. It becomes hard on the part of the patient to remind the nurse of an earlier request since they are perceived to be busy. The trend for the majority sufferers has been to forego this privilege. There are some patients who are totally disabled and rely on the nurse for their positioning. An example of one such patient with a knee amputation, diabetes, left-sided paralysis and cardiac disease also suffers from arthritis. In his situation this patient has to be lifted to his bed. After this positioning, he expects no more attention not until the nurse comes back. At night it becomes even more painful since he is unable to move. The increase in discomfort translates to more pain and suffering. It can therefore be noted that most of the patients are constantly in pain. For this reason they try as much as possible to come up with creative ways to ease the pain. As much as the methods are inadequate somehow it helps relief pain. For instance there are those who choose to remain in solitude, message or in case of painful joints use heated wheat bags. The description of the pain by the patients is horrible and discomforting such that anything done to relief it is welcome. The nurses on the other hand perceive pain relief as less important. This is especially so with the elderly whose pain is viewed as inevitable. Due to the slow response or being ignored by nurses most sufferers have tried to put up with pain. It is believed there is less help to be expected from the nurses to alleviate the pain. Conclusion It is a fact that the shortage of nurses continues to plague health care system. This problem has been in existence for a long period of time and it is not about to end soon. There is a better and effective way in which the problem can be addressed. The self-management of chronic disease has proved useful in helping both patients and those in the health care. For patients it is an opportunity to better understand their body needs and administer what is compatible with their constitution. They are able to understand the disease such that nurses become partners in the recovery process. It also reduces dependency on the nurse. In most cases it is dependency that cripples most of the patients since they are unable to perform even the most basic roles. On the other hand nurses are able to enhance their leadership skills. Leadership and management require one to delegate responsibility. The leader must be able to give advice and intervene whenever there is a problem. Once the nurses have allowed patients to manage their diseases it becomes easy to provide direction and leadership. One way is through training patients such that they understand how to respond to particular symptoms. Since they can closely monitor there own bodies and how it responds to treatment, patients can provide the much needed feedback to the nurse. References Fowler, C., Kirschner, M., Van Kuiken D., & Baas L. (2007). Promoting self-care through Symptom Management: A theory-based approach for nurse practitioners. Journal of American Academy of Nurse Practitioners, Vol. 19(4) pp. 221-227 Higgins I., Madjar, I. & Walton, J. A. (2004). Chronic pain in elderly Nursing Home Residents: the need for Nursing Leadership. Journal of Nursing Management, Vol. 12(3), pp. 167-173 Laurent C. L. (2000). A Nursing Theory for Nursing Leadership. Journal of Nursing Management, Vol. 8(2), pp. 83-7 Marquis, B. L. & Huston, C. J. (2009). Leadership Roles and Management Functions in Nursing: Theory and Application. (6th Ed). Wolters Kluwer Health. Lippincott Williams & Wilkins McGuire E & Kennerly, S. M. (2006). Nurse Managers as Transformational and Transactional Leaders. Nursing Economics, Vol. 24(4), Pp 175-85 Scott, J. (2000). A Nursing Leadership Challenge: Managing the Chronically Ill in Rural Settings. Nursing Administration Quarterly, Vol. 24(3), pp. 21-32 Smith C. E., Pace, K., Kochinda C., Kleinbeck, S.V., Koehler J., PopkessVarter, S. (2002). Caregiving Effectiveness Model evolution to a mid range theory of home care: a process for critique and replication. Advances in Nursing Science, Vol. 25(1), pp. 50-64 Stanley, D. 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