Advanced Nursing Theory - Literature review Example

Running head: IMPACT PAPER Impact Paper Alfreda Richardson BSN, RN Advanced Nursing Theory N5208 July 20, 2009 Impact Paper Every discipline and field of artistic or scientific endeavor has a set of theories or ideas which formulate the basics of what the field is about and what parameters define how individuals in the field are suppose to operate. Even if a given field lacks any pertinent or guided theories, there are sets of ideas which may be agreed upon by researchers or those who study those fields. Nursing is no exception to this, and both advanced nursing and basic nursing practices are affected by the changing theories which guide the members of the field (Reed, Shearer, Nicoll, 2003). This guidance comes from accepted theories of nursing which are based on organized and systematic expressions that form a set of relevant statements that seek to answer questions that the profession of nursing puts to the researchers (Reed et al., 2003). In fact, a theory of nursing can also seek to explain the relationships that may exist between the work done by a nurse and the impact the work has on society at large, and the patients under his/her care in particular (Sell and Kalofissudis, 2009). The usefulness of a theory becomes clear when we consider that it is a compact method for describing, explaining as well as predicting and controlling a set of variables that may be faced by all nurses in practice. Advance practice nurses make use of these methods as part of the knowledge that is attained with the integration of theory and practice (Chinn and Kramer, 2004). The distinct discrimination between basic nurses and advance practice nurses are the roles that they play in the health care sector. Registered nurses can be defined as basic care nurses where they perform their tasks under the supervision of other health care providers. While advance practice nurses’ act more independently and have more leadership roles as health care providers. The advance practice nurse can be compared to having a Masters Degree in Nursing with their advance studies in clinical and nursing education. This is why it is very important to put theories to practical use. It is an umbrella term for the new roles nurses have in providing primary care to patients. The new roles they undertake are almost similar with physicians and other specialized medical fields (Advance practice nursing, 2009). Furthermore, theories in the field of nursing are as applicable as they are in other fields, since they are based on hypothesis and can be tested, evaluated and validated (Reed et al., 2003). Advance practice nursing makes use of theories in clinical trials and evidence based research in order to expand their knowledge having leadership roles in decision making for patient care outcomes. Thus, existing knowledge can be made better while new knowledge can be created by refining and developing old theories. This is particularly important in the field of nursing ethics, since ethics come from a professionally mandated set of guidelines that have to be followed by all nurses regardless of their level of practice or theoretical background (Chinn and Kramer, 2004). Nursing theory and the nursing profession certainly provide for advanced practice. In the nursing profession, there are four levels of theory, of which two are related to advanced practice (metatheory and grand theory). The other two (middle range theory and practice theory) are directly related as to how the nurses interact with the patients under their care, and they are less abstract that metatheory or grand theory foundations, which give the profession its very foundation. This means that nursing theory is both basic and applied because nurses can work with meta or grand theory, as well as middle range and applied theory in their field (Sell and Kalofissudis, 2009). For example, a metatheory may take a global perspective on nursing and, to a large extent, may become quite abstract when it comes to the application or practice of nursing skills. However, it does give ideals, philosophies and the general principles on which the field finds its foundations and meaning for individuals (Chinn and Kramer, 2004). These bring us to the grand theories which take a broad perspective of nursing, but not a global one. It is based on general concepts that could be difficult to test with empirical means. However, these two genres of theory give us the foundations from which practical theories can be created rather than abstract ones (Sell and Kalofissudis, 2009). For instance, the middle range theories that have a limited number of variables in a limited scope can be tested in practice since they have a direct relationship with nursing practice (Chinn and Kramer, 2004). Since they do not cover the full range of experiences in nursing practice, their focus allows nurses to apply and use them based on the situation. The kind of knowledge which is created through these sets of theories is both abstract and practicable, but the abstract theories and the abstract knowledge lead towards practical principles and rules that can be used by nurses at the basic level to perform their duties more effectively (Sell and Kalofissudis, 2009). Thus, with these three levels of theory, we can interrelate concepts and ideas such as wellness, pain, grief, self-esteem, the concept of human dignity and the measure of the quality of life. How these concepts are applied in actual practice brings us to the practice theory level. This is the fourth level of nursing theory, and it gives actual models for how nurses are to behave and act in real world situations. The process of isolating causes, relating factors and given situations to practice behavior, as well as the process of controlling situations, are found on this level of nursing theory (Sell and Kalofissudis, 2009). These theories are very important for nurses simply because the application and the meaning of these theories have a direct impact on the patients who are under the care of the nurses. For advance practice nursing, these impacts are taken on a higher level than with basic nursing care. True, basic and advance nursing goals are the same which is to provide patient care, but with advance practice nursing the data gathered from applying theoretical approaches in patient care are used as evidence for the innovation in health care. Nursing theory belongs to all levels of practice since all practitioners are essentially nurses in one form or another. The demarcation of levels is perhaps more academic than practical because it is difficult to separate how nurses work with a given set of theories in their day to day professional practice. For example, a nurse who turns a patient to prevent bed cramps could be said to have applied several theories in this simple act ranging from the actual practice preventative care to the high level of theories of ethic, which suggest that the main priority of a nurse is to the patients under his/her care. But with advance practice nursing care, the turning of the patient to prevent bed cramps are made because the results will be used as evidence in clinical trials and what innovations can be made from the data. At the same time, the differentiation between the levels of theory make it quite clear that the majority of the time, a practicing nurse would be more concerned with the practice theory and the lower levels of nursing theory than the ideals which form the foundations of the profession (Advance practice nursing, 2009). One of the knowledge that is critical for advance practice nursing is the focus to learn more in terms of innovations in health care. As with any technology or trade, even in the health care sector changes are being made even in the roles nurses have and their contributions by providing much needed data in patient care. Nurses have more interaction with patients than most physicians do. That is why advance practice nurses with their expertise in protocols and medication can act as mediators in explaining to patients and their families the pros and cons of such protocols. This also gives a chance for nurses to expand their roles as leaders in the health care sector by being active participants in these changes, rather than having the traditional nurses’ role of being subordinates to physicians (Advance practice nursing, 2009). In conclusion, it becomes easy to see that nursing theory at the higher levels is relevant to all nurses because it has the foundation for nurses in terms of ethic and the principles which are applied to their profession. However, the importance of the lower levels cannot be denied simply because they guide the nurses and give practical and applicable ideas that move the process along for the ideals that come from the higher levels of nursing theory. In essence, the ideals and ideas of nursing both relate to nursing theory from the highest level to the lowest depending on what is being sought by the nurse at any given time. With the integration of nursing theories and application of skills in advance practice nursing leadership skills are developed and new avenues for nursing roles are opened where they become important players and decision makers in the advancement of health care. References Advance nursing practice a national framework (2008), Canadian Nurses Association, Retrieved August 7, 2009 at: [http://www.cna-aiic.ca/CNA/documents/pdf/publications/ANP_National_Framework_e.pdf] Chinn, P., & Kramer, (2004). Integrated Theory and Knowledge Development in Nursing. : Mosby. Reed, P. G., Shearer, N.C., & Nicoll, L.H. (2003). Perspectives on Nursing Theory. : Lippincott Williams & Wilkins. Sell, S., & Kalofissudis, I. 2009, Formulating Nursing Theory. Available online at: http://www.nursing.gr/theory/theory.html Read More