Basic Structure Developed to Organize a Number of Concepts: the Function of Frameworks - Essay Example

?Part A theoretical framework has been defined as “a basic structure developed to organize a number of concepts that are particular set of questions” (Meleis, 2011, p.28). The function of frameworks is perceived as “to provide direction for research projects” and they develop from both theory and research (Meleis, 2011, p.28). In comparison to theoretical framework, theory is defined as “an organized, coherent and systematic articulation of a set of statements related to significant questions in a discipline and communicated as a meaningful whole” (Meleis, 2011, p.29). Here, it can be seen that theory anchors in the theoretical framework, and the framework is something that preexists theory and gets modified once a theory is born, that too, as per the newly articulated theory's parameters. Hence the framework is an evolving design that inspires and facilitates theory and gets inspired and modified by it. The major “components” of a theoretical framework have been identified and listed as given below by Fitzpatrick and Kazer, 2011): (a) concepts that are identified and defined, (b) assumptions that clarify the basic underlying truths from which and within which theoretical reasoning proceeds, (c) the context within which the theory is placed, and, (d) relationships between and among the concepts that are identified (no page number). Following the method adopted by Schmieding (2006), this researcher has adopted an “integrative nursing theoretical framework,” a framework that has the many advantages (p.463). The benefit of an integrative theoretical framework is that it can be made as comprehensive as possible through bringing in different aspects of the same topic picked up from different theories and frameworks. The benefits, according to Schmieding (2006) are that: It serves as a guide for both clinical and administrative decisions, forms the basis of the nursing philosophy, facilitates communication with patients and colleagues, helps identify congruent supporting theories and concepts, provides a basis for educational programmes, helps to differentiate nursing from non-nursing activities, and enhances nurse unity and self-esteem (p.463). My theoretical framework incorporates Callista Roy's adaptation model of nursing and the Orem self-care deficit model developed by Dorothea Orem and also a conceptual approach that nursing profession and education needs to have as their basic ethos, the values of equality and transparent communication (Masters, 2011; Hartweg, 1991). I have integrated these two theoretical frameworks because the Roy model has a patient-centered approach that anchors itself on the patient's adaptive abilities and the Orem model on the other hand focuses on the role of the nursing practitioner, by saying that it is the role of the nurse to address the self-care deficits of the patient (Masters, 2011; Hartweg, 1991). In this manner, these two frameworks together gives a comprehensive new framework that integrates the role of the patient and the nurse in nursing care. This model thus balances the possible errors involved with top down and bottom up approaches. This model also facilitates proper communication just because in the Roy model and in the Orem model, the nurses have to constantly interact with the patient to find out how the status quo is evolving and what changes in their approach is needed. The Roy model views “the person as a holistic adaptive system in constant interaction with the internal and the external environment” and observes that “the main task of the human system is to maintain integrity in the face of environmental stimuli” (as cited in Masters, 2011, p.128). The role of the nurse here is only in a supportive role and “is to foster successful adaptation” (as cited in Masters, 2011, p.128). The results of successful adaptation is understood as “optimal health and well-being, (…) quality of life, and (…) death with dignity” (as cited in Masters, 2011, p.129). This theoretical model has talked about three levels of human conditions, namely, (1) integrated level where adaptation is totally successful and balanced, (2) compensatory level in which there is a change away from full adaptation and a subsequent effort to fall back to adaptation, and (3) compromised level that represents a condition in which adaptation has become partially or fully compromised (as cited in Masters, 2011, p.129). In this model, equal importance is given to the “coping mechanisms” within an individual, including physical, mental and genetic make up that facilitates coping, and also to those are “acquired” by the person (as cited in Masters, 2011, p.129). Four adaptive modes have been identified in this model and they are “physiological-physical mode, self-concept-group identity mode, role function mode and interdependence mode” (as cited in Masters, 2011, p.137). There are also four “metaparadigm concepts” delineated in the Roy model by which the person, environment, health and nursing are candidly defined (Roy, 2009, p.12). Person is defined as the “adaptive system with cognator (neurological, chemical and endocrine coping mechanisms) and regulator subsystems (cognitive and emotional coping mechanisms) acting to maintain adaptation in the four adaptive modes” (Roy, 2009, p.12). In other words, this is an adaptive mode that works within the person. Environment is defined as “all conditions, circumstances and influences surrounding and affecting the development and behavior of persons and groups, with particular consideration of mutuality of person and earth resources” (Roy, 2009, p.12). The interaction between the environment and the person is implied here and the resultant external influence and external stimulations have been included in this. The definition of health according to this framework has been as “a state and process of being and becoming an integrated and whole that reflects person and environment mutuality” (Roy, 2009, p.12). In this definition, health is seen as the result of a dynamic interaction between the person and the environment. Last but not least, this model defines nursing as an activity “to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behavior and factors that influence adaptive abilities and to enhance environmental factors” (Roy, 2009, p.12). Thus the nurse has not only to facilitate the person-level adaptation but also environment-level, and health-level adaptation as well. The role of the nurse also spans across a life time as he/she is expected to support not only health, but quality of life and death as well. The definitions of environment and nursing in this model are so comprehensive that they can address the social, communal and cultural factors involved. This correlates with the universal human values that I believe in. This in turn is also in accordance with my professional policies based on equality and democracy. By putting the patient at the center of the model and asserting that it is the patient who finally has to adapt to the environment, the authoritarian top down approach in nursing is replaced in this framework with a more democratic approach. The four metaparadigms of nursing education and practice, namely, person, environment, health and nursing in combination have the social, cultural and other demographic parameters duly acknowledged by them. This is so because, at person-level, and environment-level, all these factors are acknowledged as at work, and at health-level and environment-level, these socio-cultural aspects are duly addressed. When the Orem model is integrated into this framework, the role of the nurse gets more delineated and elaborated upon (Hartweg, 1991). Orem (as cited in Basavanthappa, 2007) has categorized nursing into three types and they are, 1) the “nurse compensates for the patient's total inability to perform self-care activities”, 2) the “nurse compensates for the patient's partial inability” as the patient has partial ability to perform self-care and 3) the nurse only helps and educates the patient as he/she the ability to perform self-care with certain level of help alone (p.24). These three types of nursing have one common factor and that is the way the nurses' role gets clearly defined in a context-specific manner. This is in a way to accept that the intervention aspects are highly context-specific. The specific cases of geriatric nursing, child care nursing and nursing for multicultural groups and similar instances can thus be designed based on this framework. Apart from the Roy model and Orem model, this theoretical framework has also been influenced by Neuman's health care systems model that views a person as an integrated system of “interrelated physiological, psychological, sociocultural and developmental factors” (as cited in Basavanthappa, 2007, p.23). In this theory also, “wellness is equated with equilibrium” but the only difference from Roy's or Orem's model has been that they present a grand theory model while Neuman presents a mid-range theory model that is more context specific ( Basavanthappa, 2007, p.23). When these two frameworks are combined, the general and the specific aspects get covered in a balanced manner. Part-2 The above-discussed theoretical framework and also the social constructivist and behavioral learning theories can be used in combination to assess and evaluate any nursing curriculum (Bastable, 2008, p.54-65). Behavioral theory have been used by many nursing scholars to explain “health and illness” phenomena (Cody, 2006, p.304). Group learning and self-help groups have been some examples of social constructivist learning approach wherein a multi-aged and multi-ethnic group can be developed in the process of learning nursing and health care (Bastable, 2008, p.65). As a case study for evaluation, I have selected the Bachelor of Science in Nursing Program and the curriculum of this nursing course offered by The University of Vermont is discussed accordingly in the following paragraphs. While making a step by step evaluation of this curriculum, the evaluation procedure put forward by Bastable (2008) can come handy. Bastable (2008) has defined evaluation as “a systematic process by which the worth or value of something-in this case, teaching and learning- is judged” (p.558). There are many evaluation models that can be used for carrying out evaluation of this curriculum (Bastable, 2008, p.558). The Roberta Straessle Abruzzese (RSA) evaluation model has been elaborately discussed by Bastable (2008) and this model comprise of five types of evaluation- impact, outcome, content, process, and total program (p.562). Figure-1: Roberta Straessle Abruzzese (RSA) evaluation model (as cited in Bastable, 2008, p. 562). The impact evaluation is carried out to understand the “relative effects of education on the institution or the community” (Bastable, 2008, p.567). The Bachelor of Science in Nursing Program curriculum of the University of Vermont has an objective to prepare “students for entry level positions in professional nursing practice” (“Bachelor of Science in Nursing Program (B.S.)”, 2012). In other words, this curriculum has an impact on the students in such a way that they become able to enter the realm of professional nursing through this curriculum (Bastable, 2008, p.567-8). Another impact of this curriculum, as per the University's official position, has been that the students “are able to provide nursing care to individuals of all ages and families from diverse cultural backgrounds in any setting offering health care services” through learning under this curriculum (“Bachelor of Science in Nursing Program (B.S.)”, 2012). This is an impact that in spirit, carries the ethos of Roy model, Orem model and general values of equality and democracy. The environment addressed by this curriculum is any kind of clinical setting and this relates to the Roy model and behavioral learning theory that focuses on the stimulation and response patterns. The three clinical outcomes expected from this curriculum has been “health promotion, health maintenance, (and) disease prevention” and these once again can be founded in the integrative theoretic framework put forward by me. Special care needs of specific populations have been properly addressed in this curriculum and this can be seen as an application of my theoretical framework that puts patient in the center of it. The incorporation of humanities in this curriculum also fits in to this holistic framework. Considering all the different aspects of impact discussed above, the impact evaluation can be concluded observing that this curriculum is worth in terms of its impact. The second type of evaluation as per the RSA model is outcome evaluation and this has to answer the questions about the nature of teaching, the effectiveness of teaching, the attainment of objectives, and the appropriate application of the skills learned (Bastable, 2008, p.566). With respect to this curriculum, this type of evaluation can be made only when the data on how many students who completed this course got entry into the field of professional nursing and how they perform their duties, are available. The third type of evaluation according to RSA model is content evaluation and relates to the content of the learning experience (Bastable, 2008, p.567). The curriculum under investigation has set a balance between professional nursing subjects and also general arts and science subjects, thereby taking into account the socio-cultural and developmental factors involved. This is in coherence with my chosen theoretical framework that aspires to ensure equality despite race, nationality, culture or any other demographic factors. This is also in accordance with the social constructivist theory of learning. By learning general arts and science subjects, like psychology, human development, nutrition, and philosophy/religion/ethics in the first in the first year of the course itself, the students who follow this curriculum will get an orientation towards removing socio-cultural biases (“Bachelor of Science in Nursing Program (B.S.)”, 2012; Bastable, 2008, p.65). In the third year of the curriculum, health promotion across a life span and specific care requirements for persons belonging to different age groups are learned by the students (“Bachelor of Science in Nursing Program (B.S.)”, 2012). These subjects justify the Roy model, Orem model, and Neuman's theory by stressing upon the holistic approach to the patient's autonomy and the birth-to-death coverage involved. The specific nature of each person's health needs is acknowledged in this part of the curriculum which is an acceptance of the definitions offered by Roy for the person, environment, health and nursing. Especially, the fourth year's subjects in the curriculum have a comprehensive approach towards the theoretical framework and learning theories adopted by me. The subjects learned in the fourth year are, Chronic illness and end of life, different dimensions of care, and contemporary issues in nursing (“Bachelor of Science in Nursing Program (B.S.)”, 2012). The three expected outcomes of successful adaptation as is delineated by Roy, namely, “optimal health and well-being, (…) quality of life, and (…) death with dignity,” are addressed by this subject selection (as cited in Masters, 2011, p.129). The content evaluation is completed when it is made out whether the students have learned the skills that are expected to be learned by them as per this curriculum (Bastable, 2008, p.564). Process evaluation is the fourth type and this relates to the modifications that have to be made as and when required in the entire learning process and also has been described as a “happiness index” (Bastable, 2008, p.563). It is the learners and teachers, who have to provide information that can generate data on this aspect (Bastable, 2008, p.563). Last but not least, the total program also needs to be evaluated as per the RSA model (Bastable, 2008, p.569). It is against the goals set and objectives formulated that this evaluation is made (Bastable, 2008, p.569). Data generated from the curriculum review by expert panels and overall student skill outcomes have to considered while making this type of evaluation. The objectives of this curriculum being set in view of sociology, environmental sciences, and diversity, the expected outcomes are complex and specially relevant to a multicultural society. Hence the curriculum can be seen as an effective and relevant one for our society and time. The metaparadigm for any theory on nursing education being based on human wellness, the chosen theoretical framework and the evaluation of the given curriculum using that framework thrive to achieve the same. Such a metaparadigm necessarily has to comprise of the categorization of person, health, environment and nursing, in order to attain the status of a complete global vision (Cody, p.298). References “Bachelor of Science in Nursing Program (B.S.)”, (2012) Retrieved from http://www.uvm.edu/~cnhs/nursing/?Page=undergraduate.html Bastable, S. B. (2008) Nurse as educator: Principles of teaching and learning for nursing practice (3rd ed.), Syracuse, NY: Jones and Bartlett Publishers. Basavanthappa, B.T. (2007) Nursing theories, New Delhi: Jaypee Brothers Publishers. Cody, W.K. (2006) Philosophical and theoretical perspectives for advanced nursing practice, Sudbury, MA: Johns & Bartlett. Fitzpatrick, J.J. and Kazer, M.W. (2011) Encyclopedia of nursing, Berlin: Springer. Hartweg, D. (1991) Dorothea Orem: Self-care deficit theory, London: SAGE. Masters, K. (2011) Nursing theories: A framework for professional practice, Burlington: Jones & Bartlett Publishing. Meleis, A.I. (2011) Theoretical nursing: Development and progress, Philadelphia: Lippincott Williams & Wilkins. Roy, Sr.C. (2009) The Roy adaptation model (3rd ed.), Upper Saddle River, NJ: \ Pearson. Schmieding, N.J. (2006) An integrative nursing theoretical framework, Journal of Advanced Nursing, 15 (4), pp.463-467, Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.1990.tb01840.x/abstract Read More