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Evidenced Based Practice, Nursing Theories, Nursing Research
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Topic 4 DQ 2
Select two different nursing theories and describe how they relate to patient care. How could you use them for inciting behavioral changes? Discuss the pros and cons of applying each theory and how they could be integrated into your future practice. Are there any particular ethical issues related to the integration of these theories that should be considered?
Solution to Topic 4 DQ 2 Nursing Theories
Nursing scholars identified the core of nursing and then established theoretical formulations that would reflect the above. Consequently, DeNisco and Baker (2016) argue that several theories promote theory-based practice of nursing since it bases its operation on the paradigm of care. In particular, Nightingale’ environmental theory and Watson’s Theory of Human Care can play an important role in patient care. Nightingale’s nursing theory operates under the assumption that the environment plays an important role in disease progression (McDonald, 2017). Therefore, in nursing practice, nurses should manipulate the surrounding environment during patient care so as to enhance the recovery process. Watson’s Theory of Human Caring affects the existential phase of nursing and emphasizes on holistic patient care (Sitzman & Watson, 2014). To this end, using this theory in nursing care behooves nurses to care about the patient’s body, mind, and spirit in order to maintain the healing process at an optimal level. Thus, applying the concepts of spirituality, trust, hope, caring, faith and love to nursing practice as dictated by Watson’s Theory of Human Caring helps satisfy the notion of human caring.
DeNisco and Baker (2016) observe that nurse practitioners establish an expertise in electing models and theories that are relevant and appropriate to their practice. Hence, the above-mentioned theories have capacities to incite behavioral change within a health care setting. Given that Watson’s theory focuses on issues related to patient care and even spiritual connection between a patient and a nurse, its application may influence the adoption of a model of care that transcends the patient-centered care (Sitzman & Watson, 2014). Thus, the application of Watson’s Theory of Human Caring may shift nurses’ behaviors from patient-centered care to human-to-human connection so as to improve the quality of patient care. In the same breadth, Florence Nightingale’s theory may influence nurses to focus on the environmental needs of a patient as part of care.
Nightingale’s environmental theory and Watson’s Theory of Human Caring have characteristic strengths and weaknesses. Regarding the former theory, its strengths include the improvement of the quality of care as has been demonstrated by reduced mortality rates when utilized. The wholesome values and principals of the theory continue to receive application in the education of modern nursing (McDonald, 2017). Lastly, the theorist’s five essential components concerning optimal healing that is light, cleanliness, efficient drainage, pure water and pure air continue to form a significant part of healing. However, certain cons such as the absence of proper procedures in handling extremely needy or dependent patients in the theory exist. Also, Nightingale’s assumption that diseases occur primarily due to miasma was disapproved by Pasteur in his famous work.
Watson’s Theory of Caring also has its pros and cons as evidenced by various scholarships on the matter. One of the theory’s benefits encompasses its positive influence on the nurse-patient interaction as well as practice for patients. Additionally, Sitzman and Watson (2014) postulate that the theory places a suffering patient within the context of the culture, the community, and the family and these are important mediators in the recovery process of a patient. Nevertheless, the theory neglects the patient’s biophysical needs and mainly focuses on their psychosocial needs. Such confinement limits health as it has a physiological need that requires to be addressed.
Studies have also revealed that nurse educators can integrate the two theories in their practice. Regarding Nightingale’s environmental theory, nurse educators can integrate the procedures of ensuring a clean setting environment in the curriculum. Thus, through various educational programs, nurse educators can teach their students about hygiene at the workplace and their role in disease acquisition and progression (McDonald, 2017). Watson’s Theory of Human Caring can also play a useful role in educational settings and academic programs. Nurse educators have the capacity to empower their students and enhance their psychosocial wellness via the caring theory. Therefore, advanced practice nurses such as nurse educators can utilize the two theories in various ways.
Porter-O’Grady and Malloch (2016) aver that the concepts of autonomy, beneficence and betrayal among others form the basis for making ethical decisions in medicine. However, an intricate relationship exists between nursing and ethics and as such, examination of the ethical dimension becomes important. The ethical consideration of the two theories with regards to caring may be rooted in the lifeworld-led care. Accordingly, even as nurses provide care to their patients, they need to acknowledge the lifeworld of the patient as well as have openness to the description of the patient’s experiences (Galvin & Todres, 2013). This implies that nurses need to have the willingness to listen to the meanings and connections from the patients as the lived lives. Therefore, the ethical aspects of caring from the two theories rest on the phenomenological understanding by nurses. However, even as that is the case, nurses also need to appreciate the value of human dignity in the provision of care (Parandeh, Khaghanizade, Mohammadi, & Mokhtari-Nouri, 2016). The issue of human dignity forms an important ethical foundation in Watson’s theory of caring because of its emphasis on human-to-human connection between the patient and the nurse. Thus, even as they strive to make a connection with the patient using the theory, nurses need to be aware of the need to maintain respect and exercise professionalism.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
Galvin, K., & Todres, L. (2013). Caring and well-being: A Lifeworld approach. , : Routledge.
McDonald, L. (2017). Florence nightingale, nursing, and health care today. New York, NY: Springer Publishing Company.
Parandeh, A., Khaghanizade, M., Mohammadi, E., & Mokhtari-Nouri, J. (2016). Nurses’ human dignity in education and practice: An integrated literature review. Iranian journal of nursing and midwifery research, 21(1), 1-8.
Porter-O’Grady, T. & Malloch, K. (2016). Becoming a professional nurse. ( 2nd ed.), Leadership in nursing practice: Changing the landscape of healthcare Burlington, MA: Jones and Bartlett Learning.
Sitzman, K., & Watson, J. (2014). Caring science, mindful practice: Implementing Watson’s human caring theory. New York, NY: Springer Publishing Company.
Topic 5 DQ 1
During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice. Consider an area in your specialty that you believe needs improvement. Which nursing theories could you apply to this problem? Why is this the best theory?
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Solution to Topic 5 DQ 1
Research reveals that the home care nursing experiences consequential shortage in the number of registered nurses. In the United States, the Department of Labor statistics projects that the shortage will become a crisis as the demand for home nurses will outpace the supply in the next 10-15 years (Seo & Spetz, 2013). As a consequence of the shortage, the quality of care in home nursing agencies and productivity of the available nurses receive a significant battering. Studies attribute these to the fact that the RN shortage prevents the agencies from undertaking certain procedures such as patient admission and the removal of central venous catheter, since the law bars LPNs/LVNs from performing them. The absence of RN nurses makes the agencies ineffective since Porter-O’Grady and Malloch (2016) assert that an effective care delivery system ensures that the needs of patients are paired with competent caregivers. Therefore, there is an urgent need to stem the shortage of RN nurses by instituting strategies that will allow for recruiting and retaining nurses to fill these vacancies. In addition, evidence reveals that the usage of longer-term travelling and short-term daily through temporary employment agencies may plug the shortage.
According to DeNisco and Baker (2016), theory-based practice of nursing has gained fundamental application in the field and it could be employed to solve certain issues. Various researchers have extrapolated the application of theory-based practice into matters such as addressing nursing shortage. In the present situation, the usage of Watson’s Theory of Human Care could help improve the issue of nursing shortage. Evidence-based practice has demonstrated that high attrition rates of RNs could form a fundamental reason for the existence of nursing shortages in home settings. Nevertheless, that RN nurses leave their work is contradictory to the central tenet of nursing, which is rooted in caring. The utilization of Watson’s Theory of Human Caring, which emphasizes on holistic caring that transcends the traditional boundaries of patient-centered care to the human-to-human interaction may positively influence the decision of these nurses (Durgun & Okumus, 2017). Thus, Watson’s theory is the best since it taps into the central objective of nursing to ensure that nurses remain faithful to the call.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
Durgun Ozan, Y., & Okumu?, H. (2017). Effects of Nursing Care Based on Watson’s Theory of Human Caring on Anxiety, Distress, And Coping, When Infertility Treatment Fails: A Randomized Controlled Trial. Journal of caring sciences, 6(2), 95-109. doi:10.15171/jcs.2017.010
Porter-O’Grady, T. & Malloch, K. (2016). Becoming a professional nurse. ( 2nd ed.), Leadership in nursing practice: Changing the lanscape of healthcare Burlington, MA: Jones and Bartlett Learning.
Seo, S., & Spetz, J. (2013). Demand for Temporary Agency Nurses and Nursing Shortages. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 216–228. https://doi.org/10.1177/0046958013516583
Topic 5 DQ 2
Select one theory discussed during Topics 4 and 5. Does application of this theory differ based on the population focus (individuals, families, communities, and special populations)?
Why or why not?
Use examples from your current practice to illustrate differences or similarities.
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Solution to Topic 5 DQ 2
Watson’s Theory of Human Caring plays an important role in the restoration of a patient’s health. However, questions have been asked regarding its application based on the focus population. According to studies and my clinical experience, no significant differences exist in the application of the theory on varied populations. As a home health nursing interacting with both children from newborns to 20 years and adults from 21 years of age, I have noticed that the application of the theory is uniform across the population spectrum. Indeed, the philosophical and theoretical underpinnings of the theory can guide the nurse to prepare appropriate interventions concerning a condition. During my home care nursing experiences, the Watson’s Theory of Human Caring has received significant application ranging from children with specific conditions to patients belonging to the special populations in a manner consistent with DeNisco and Baker’s (2016) postulations regarding application of theory-based practice in nursing. During the usage of this theory, one thing has been a constant-the operationalization of the 10 carative factors which forms the basis of the interventions supported by the theory. The caring process using this model requires nurses to have knowledge concerning human behavior inclusive of mind-body spirit, the patient’s responses, limitations, and strengths, as well as knowledge concerning how to comfort, and proffer empathy and compassion (Sitzman & Watson, 2016). All these aspects are taken into consideration irrespective of whether the patient is an individual, belongs to a family, communities or special populations.
In the recent past, the application of Watson’s Theory of Human Caring has integrated notions of caring, intentionally, and consciousness. According to Watson (2018), these healing modalities can be integrated into direct patient/family care further giving credence to the versatility of the model. In fact, using the theory, nurse educators emphasize to nurses the significance of human-to-human interaction and the need to create a proper spiritual, mental, societal and physical environment during the application of the theory. All these factors are fundamental in the healing process and as such, they can be applied to an individual, family, community, and special needs populations.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the
profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
Sitzman, K., & Watson, J. (2014). Caring science, mindful practice: Implementing Watson’s human caring theory. New York, NY: Springer Publishing Company.
Watson, J. (2018). Unitary caring science: Philosophy and Praxis of nursing. Louisville, CO: University Press of Colorado.
Topic 6 DQ 1
Review the evidence-based practice project ideas you described in Topic 5 DQ 1. Based on your initial ideas, what types of scholarly nursing research (such as quantitative or qualitative research, peer-reviewed resources, etc.) would be required to further investigate the issue? Identify the criteria you would use to evaluate the appropriateness of the research. Why is it important to select research that meets these criteria?
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Solution to Topic 6 DQ 2
According to DeNisco and Baker (2016), health care professionals including students need to acquaint themselves with the skills for effective literature search and the utilization of formal rules to critically examine the evidence. The formal rules herein refer to the presentation of knowledge from literature and the art of giving credit to the author of a cited work. To this end, when I discover that my classmate has inappropriately cited or refused to cite works from authors in their PICO statement, the next course of action would be to make them realize the grave academic sin that they will be committing. Thus, I will first of all ensure that the classmate understands the impact of that error of omission on the originality of the work that they will be presenting. According to EBP dictates, the originality of a research work is determined by the presence of appropriately cited author names and year and in some cases page numbers depending on the adopted format (Macrina, 2014). In addition to originality, I will also discuss with the classmate the role of citation with regards to offering evidence or support to the ideas he will be presenting in his PICO assignment. Through this, I will highlight to him the need to make the readers of the work realize that he had made serious and proper research through properly citing his sources and acknowledging the authors thereof hence avoiding plagiarism.
Also, the commission of the above-mentioned errors by the colleague will have credibility and integrity ramifications on involved persons, the institution and the profession. In an era whereby evidence-based practice has been introduced to nursing, it behooves lecturers and students to ensure that they understand the nitty-gritties of the same. So, that the classmate did not appropriately quote and also refused to quite sources may negatively reflect on our nursing class. The concerned people may thus be viewed as lacking academic integrity and credibility hence their works cannot be trusted (In Bretag, 2015). Further, the university and the profession may also suffer negatively. A student producing plagiarized work may insinuate that the university does not produce graduates who meet professional expectations and that the profession does not have well-educated staff who can offer quality care modelled around ethical practices.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
In Bretag, T. (2015). Handbook of academic integrity. Singapore : Springer Singapore
Macrina, F. L. (2014). Scientific integrity: Text and cases in responsible conduct of research. Washington, D.C: American society for microbiology.
Topic 6 DQ 2
Imagine the following scenario: You are taking the evidence-based practice course and one of your classmates shares an EBP project draft with you. You notice that some of the research has not been cited correctly or even at all. When you approach your classmate, the response is that “no one will notice and it is not a big deal anyway.” What are your next steps in speaking with your classmate? Consider how this could reflect on the credibility and integrity of the individuals involved, the University, and the profession.
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Solution to Topic 6 DQ 2
According to DeNisco and Baker (2016), health care professionals including students need to acquaint themselves with the skills for effective literature search and the utilization of formal rules to critically examine the evidence. The formal rules herein refer to the presentation of knowledge from literature and the art of giving credit to the author of a cited work. To this end, when I discover that my classmate has inappropriately cited or refused to cite works from authors in their PICO statement, the next course of action would be to make them realize the grave academic sin that they will be committing. Thus, I will first of all ensure that the classmate understands the impact of that error of omission on the originality of the work that they will be presenting. According to EBP dictates, the originality of a research work is determined by the presence of appropriately cited author names and year and in some cases page numbers depending on the adopted format (Macrina, 2014). In addition to originality, I will also discuss with the classmate the role of citation with regards to offering evidence or support to the ideas he will be presenting in his PICO assignment. Through this, I will highlight to him the need to make the readers of the work realize that he had made serious and proper research through properly citing his sources and acknowledging the authors thereof hence avoiding plagiarism.
Also, the commission of the above-mentioned errors by the colleague will have credibility and integrity ramifications on involved persons, the institution and the profession. In an era whereby evidence-based practice has been introduced to nursing, it behooves lecturers and students to ensure that they understand the nitty-gritties of the same. So, that the classmate did not appropriately quote and also refused to quite sources may negatively reflect on our nursing class. The concerned people may thus be viewed as lacking academic integrity and credibility hence their works cannot be trusted (In Bretag, 2015). Further, the university and the profession may also suffer negatively. A student producing plagiarized work may insinuate that the university does not produce graduates who meet professional expectations and that the profession does not have well-educated staff who can offer quality care modelled around ethical practices.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
In Bretag, T. (2015). Handbook of academic integrity. Singapore : Springer Singapore
Macrina, F. L. (2014). Scientific integrity: Text and cases in responsible conduct of research. Washington, D.C: American society for microbiology.
Topic 7 DQ 1
Describe the steps of the evidence-based research process and the importance of using them. In the initial stages of an EBP project, where do nurses in your specialty go to locate sources of information that help them to determine whether or not a practice problem is appropriate for an evidence-based practice change proposal. Include two specific sources on information in your discussion.
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Solution to Topic 7 DQ 1
Practice-based profession like nursing requires to utilize the best latest evidence when undertaking an evidence-based project. The evidence-based process contains several steps from available literature. According to DeNisco and Baker (2016) “the EBP process encompasses inquiring about an issue, formulating the clinical question via the PICO format, acquiring the best current evidence, conducting critical appraisal of evidence, and finally incorporating the synthesis of the evidence with patient preferences and values” (p. 489). Other researchers have divided the process into what they call the 6As of EPB process encompassing: Asses, Ask, Acquire, Appraise, Apply, and Audit. In the first step, a nurse will identify and describe a practice-based problem as well as determine the rationale for the same (In Dang et al., 2018). The nurse will then formulate PICO questions on the matter using a template. Afterwards, the nurse will conduct a literature search by utilizing ideal databases as well as keywords from the PICO question and use an evidence table to critically appraise the evidence from literature (Grove, Gray, & Burns, 2015). Lastly, the nurse will write their project protocol and then implement it after stating the outcomes, consequences, data-collection sources, design of the project and collecting IRB approval.
At my place of work, the agency has subscribed to CINAHL Plus with Full Text and the Agency for Healthcare Research and Quality (AHRQ). These two databases serve as important sources of information for nurses at the agency. Thus, in the initial stages of the evidence-based project, these two databases is where we go to acquire relevant literature.
References
DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.
Grove, S. K., Gray, J., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier.
In Dang, D., In Dearholt, S., Sigma Theta Tau International., & Johns Hopkins University. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines. Indianapolis, IN : Sigma Theta Tau International.