Course Description

This course will analyze major nursing theories and explore theories from related fields. This course will apply the knowledge of nursing theory to evidence-based practice in domains of clinical, research, leadership, management and education. Students in this course will explore in depth the core concepts of Jean Watson’s Caring Science Theory. The student will develop a personal theoretical framework for their practice of advanced practice nursing- clinical practice, education, or administration.

Course Learning Outcomes

Demonstrate ability to comprehend and critique components, structure and development of theories/models in nursing and related fields. (PLO 1,4,9 )

Analyze application of nursing theory in evidence-based practice and research literature. (PLO 1,7)

Synthesize nursing theories in the development of advanced practice nursing. (PLO 4,8,9)

Evaluate nursing theory and theoretical frameworks for advanced practice nursing. (PLO 9)

Demonstrate the ability to select an appropriate theory for a personal theory based philosophy of advanced nursing practice. (PLO 4,6,9)

     Caring for Carolina® Pamela Rudolph posted Jun 30, 2022 1:07 PM Magnet status is given to US hospitals who have earned the accreditation from the American Nurses Credentialing Center (ANCC). The designation is earned by satisfying certain standards for patient care and nursing quality. The ANCC status is given to less than 9% of US hospitals for constantly improving processes and procedures for the benefit of patients and families (UNC Hospitals' "Magnet" Status Renewed for Third Time, 2020). For hospitals having this designation, magnet status provides a roadmap for nursing excellence which benefits the entire organization (ANCC Magnet Recognition Program®, 2022).

     My employer, University of North Carolina (UNC) is an “integrated health care system owned by the State of North Carolina. It exists to further the teaching mission of UNC and to provide state-of-the-art patient care” (UNC Hospitals' "Magnet" Status Renewed for Third Time, 2020). I was excited to learn in my research that UNC received this designation for the third time in 2020, something that only 160 US hospitals have achieved. The hospital system has a nationally renowned research institution, the UNC School of Medicine along with its own Physicians Network and 10 hospitals which have consistently ranked among the best in the United States (UNC Hospitals' "Magnet" Status Renewed for Third Time, 2020). To achieve magnet status, UNC management is built of individuals holding a bachelor’s degree or higher and have proven a comprehensive understanding of the role of nursing and its effect on patients, families, the community and the interdisciplinary teams. One example of UNC’s innovation to high-quality care was the introduction of the evidenced-based initiative of the Physio-Control Lucas 3 Chest Compression System during the COVID-19 pandemic. This system provides the high-quality care that patients have come to expect while reducing the risk of exposure of COVID-19 to staff and patients.

     UNC has implemented Carolina Care, which utilizes the Relationship-based care and Swanson’s Caring Theory as the theoretical foundation for the delivery of care model. Nurses and employees are trained on this model, which is “an interdisciplinary and interdepartmental set of core behaviors and actions designed to provide a consistent, caring, highly positive patient experience. Patients become active participants in their own care and nurses learn to anticipate patient needs and address them as soon, or before they arise” (Caring for Carolina, 2022).

     Nursingworld.org, states that hospitals with the magnet designation have a proven "lower staff turnover rate, a higher level of job satisfaction, as well as excellent patient outcomes" (ANCC Magnet Recognition Program®, 2022). These hospitals also manage grievances appropriately. Although I really have enjoyed working with the staff and patients at my location, I am more appreciative of the work I and my fellow nurses, as well as leadership staff, have been doing to care for Carolina to continue to be North Carolina’s Magnet Hospital system.

References

ANCC Magnet Recognition Program(R) . (2022). Retrieved from Nursing World - American Nurses Credentialling Center: https://www.nursingworld.org/organizational-programs/magnet

Caring for Carolina. (2022). Retrieved from UNC Health - About Us: www.unchealthcare.org

UNC Hospitals' "Magnet" Status Renewed for Third Time. (2020, 09 28). Retrieved from UNC Health & UNC School of Medicine: https://news.unchealthcare.org/2020/09/UNC-hospitals-magnet-status-renewed-for-third-time/

     Abraham Maslow created his theory of needs based on two concepts: deficiency needs and growth needs based on his positive view of humans. Upon completing his research, he developed this hierarchy believing that people are motivated to achieve certain needs and that some needs are more important than others. He found that these needs were commonly met in an order that resulted in self-actualization. He initially found that these needs, on the hierarchy, needed to be fulfilled to meet higher growth needs. This hierarchy is a way of looking at and understanding human needs.

     This hierarchy is commonly shown in a pyramid, with the most important need – the largest – at the bottom. The first four of the five levels are considered deficiency needs, those that motivate people when unmet, and become stronger when they are denied. For instance, a hungry person will become hungrier if he does not eat. If he is only slightly hungry, he might choose to have only one slice of pizza. However, if the same person waits until he is famished, he might choose to eat several slices.

     The final stage of growth, self-actualization, according to Maslow’s original theory, could never be met until the four stages below were met. The bottom four (or first four) levels were described in the following terms:

Physiological – air, food, water, shelter, sleep, clothing, warmth, reproduction

Safety/security – personal security, employment, resources, health, property

Love/belonging – friendship, intimacy, family, sense of connection

Esteem – respect, self-esteem, status, recognition, strength and freedom

These are the deficiency needs and according to Maslow, must be met – in order – to reach the 5th level of self-actualization, which is described as the desire to become the most that one can be (McLeod, 2022).

     Since Maslow originally wrote this theory, there have been questions regarding its accuracy. He later realized that this hierarchy is not a constant, and people can and do move not in a unilateral direction but can move up and down the hierarchy during different times in their lives. Certain life experiences such as relationship separation, death of a family member, or loss of a job can cause a person to revisit some or all the levels (McLeod, 2022).

     He also realized that people do not necessarily have to even reach a particular level to reach a period of self-actualization. Although he understood that everyone has the desire and are (usually) capable of moving up the hierarchy, there are some that have reached self-actualization without even touching the other needs. Consider the lives of Rembrandt, Van Gogh and even Mother Teresa, who was capable of love and the feeling of belonging. Each of these lived in extreme poverty, constantly living for others, and reached a period of self-actualization without fulfilling their basic needs.

     Since Maslow’s original theory, two additional levels of were added to the bottom portion of the pyramid. Both cognitive (knowledge and understanding, curiosity) and aesthetic needs (appreciation for beauty, search for balance, form) were included in 1970. Maslow positive view of humans may not be realistic for today when considering everyday realities such as violence, mental illness, and physical restrictions.

References

McLeod, S. A. (2022, April 04). Maslow's Hierarchy of Needs. Retrieved from Simply Psychology: www.simplypsychology.org/maslow/html

Personal theory: Anticipating patient needs reduces call light interruptions and improves patient safety

Pamela Rudolph

posted Jul 10, 2022 12:21 AM

     Patients often find themselves with a loss of control in hospital rooms. These are often strange places, with strange equipment, with strange people in and out at various times of day. They aren’t feeling right, they aren’t thinking right. Nursing staff often find themselves with a loss of control, too. They face staffing shortages, and increased patient ratios, competing priorities along with increased patient acuity. When added together, both scenarios make for a busy call light system (Laura Stokowski, 2022).

     The typical hospital unit begins its day with a nurse/nurse or CNA/CNA hand-off report. These reports are generally (but not always) done at the bedside and are to include conversations with and about the patient and their individual needs. Then, throughout the day, patients are visited by the staff hourly to determine if they have any needs. As each patient is different, with a different set of needs, it is important to help the patient determine what they might need. Pain control, bathroom or bedpan, a drink, food, a noisy machine, a cold air-conditioning system, or even a fluffed pillow or straightened blanket. Sometimes these are referred to as ‘the 4P’s of rounding’, which refers to assessing pain, position, personal needs and personal belongings. The list of anticipated needs is endless. But what if we don’t ask the patient/family their needs? What if we don’t anticipate what they might need? The answer is not always simple. Some patients will be on the call light every few minutes just thinking of things they want, just so someone will be in the room. Some patients are confused and may not understand how to use a call light and they’ll try to get up from bed to go to the bathroom or even get up to turn on a light, not knowing where they are. And some patients may not be able to get up or reach the call light. These scenarios, when not anticipated, equate to decreased patient satisfaction scores, lower Medicare reimbursement dollars, and more importantly – patient safety.

     When the sound of the call bell emanates through the nursing station, it alone causes undue stress on already stressed nurses. So, what can be done about this stress? Anticipating what the patient needs. Anticipating when the IV fluids are going to run out. Anticipating when pain medication may be requested. Anticipating temperature fluctuation. Nursing staff must be certain to respond to alarms on beds and medical pumps quickly. Falls continue to be a problem among US hospitals, and injuries from these falls decreases Medicare reimbursement dollars. According to The Joint Commission, hundreds of thousands of patients fall each year in healthcare facilities. And of those patients, 30%-35% sustain injuries (Critical Access Hosptial 2022: National Patient Safety Goals, 2022).

     Hospitalized patients will require assistance with certain needs. If the staff will take the extra time to anticipate what the needs will be during their rounds, asking questions such as, “what else can I do for you while I am here?” or “how is the room temperature for you right now?”, instead of open ended questions (i.e. “do you have to go to the bathroom?” or “do you need water?”) and knowing that the IV fluids that were just hung will run out in a specific amount of time, the nurse and nursing staff can eliminate many of the unfavorable, stressful call light bells and prove to be effective patient care advocates.

References

Audrey Burgener, B. M. (2017, July). Enhancing communication to improve patient safety and to increase patient satisfaction. The Healthcare Manager, 36(3), 238-243. doi:10.1097/HCM

Critical Access Hosptial 2022: National Patient Safety Goals. (2022). Retrieved from The Joint Commission Center for Transforming Healthcare: https://www.jointcommission.org/-/media/TJC/documents/standards/national-patient-safety-goals/critical-access-hospital-national-patient-safety-goals/

Montie, M., Shuman, C., Galinato, J., Patak, L., Anderson, C., & Titler, M. (2017). Conduits to care: call lights and patient perception of communication. Journal of Multidisciplinary Heathcare(10), 359-366. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609800

Rasmussen, T. R. (2022). An Enhanced Purposeful Hourly Rounding Program: Impact of Proactive Toileting on Rates of Falls and Injurious Falls (Order No. 29061491). Available from Publicly Available Content Database. (2660467972). https://usu.idm.oclc.org/login?url=https://www.proquest.com/dissertations-theses/enhanced-purposeful-hourly-rounding-program/docview/2660467972/se-2

Stokowski, L. (2022). Ring for the nurse! Improving call light management. Retrieved from Medscape: https://www.medscape.org/viewarticle/570242_4

Ain't it Grand! The Theory of Human Caring

Pamela Rudolph

posted Jul 15, 2022 12:02 AM

     Jean Watson’s grand Theory of Human Caring is one that helps bring a central focus to nursing. As it is broad in scope, its’ concepts and propositions can be used in any nursing situations where people are regarded as human beings and patients are aided in achieving holistic harmony through caring (Utley, Henry, & Smith, 2018). This grand theory is often considered a central concept in nursing program philosophy. One of Watson’s middle range concepts is a core concept of nursing. It is more concrete in that it focuses on the caring of a nurse toward a patient. This concept is based on the patient’s achievement of knowledge, respect and care for oneself results in self-healing, but also includes individuals, families, groups and communities. This caring process promotes health, prevents illness and restores health promotion. This concept, while being broad in the spectrum of health care and specific to nursing, it is not specific to a particular group of patients or illness. It is holistic, and looks to provide health promotion through mind, body and spirit. It understands the patient as a person, which promotes sharing of life experiences and understanding the patient’s health needs. This theory also includes caring for one’s self. The grand theory, the Theory of Human Caring, is a framework of moral, ethical and philosophical for middle range theories of caring that is specific to nursing and patient health restoration.

Reference

Utley, R., Henry, K., & Smith, L. (2018). Frameworks for Advanced Nursing Practice and Research. New York: Springer.

Middle range theory as a framework to relieve opioid induced constipation

Pamela Rudolph

posted Jul 16, 2022 11:11 PM

     In her book, Notes on Nursing, Florence Nightingale wrote, “The most important lesson that can be given to the nurse is to teach them what to observe” (Nightingale, 1859). How do we know if a patient is better if we were not with him or her? It is impossible for a nurse to know everything about a patient if he or she cannot communicate. We must depend on documentation and verification from staff, for what we don’t know can be detrimental to the patient’s condition.

One condition that may be difficult to remedy is opioid induced constipation (OIC). Approximately 40% – 60% of patients without a cancer diagnosis are affected by OIC during and after hospitalization. It can happen immediately upon starting an opioid or happen gradually. Once it has developed the process to relieve OIC is slow and does not always result in optimal relief. Because of this, it is important not only for the nurse but the patient to know and communicate their daily bowel regimen. Patients educated on the use of laxatives while taking opioids will have more effective bowel movements and better medication absorption.

The theory that knowledge of the use of laxatives with opioids will result in improved bowel results and proper absorption can be proven with accurate documentation. The nurse already documents the use of the opioid. The physician is aware and looks to this documentation to determine effectiveness of the medication on the patient’s bowel regimen. The physician would start the patient on a laxative with the opioid to prevent OIC. The nurse must have the knowledge that these medications must be given together (not necessarily at the same time). The nurse must also educate the patient on this regimen and its importance upon discharge from the hospital to prevent readmission for OIC, as it may cause nausea, vomiting, bloat, straining as well as a decrease in emptying of pancreatic juice and bile which then causes delayed digestion. Accurate documentation from all staff caring for the patient is necessary to substantiate the effectiveness of the medications which provides the framework for this middle range theory.

References

Nightingale, F. (1859). Notes on Nursing. New York: 2003 edition published by Barnes & Noble, Inc.

Sizar, O., Genova, R., & Gupta, M. (2021). Opioid Use Constipation. Treasure Island: StatPearls, LLC.

Two theorists, two theories, one result - patient care

Pamela Rudolph

posted Jul 24, 2022 9:44 AM

Jean Watson’s Theory of Human Caring and Caritas Processes is one based, of course, on caring. Caring of the mind, body, and soul. It is a holistic method for caring of the patient. Yet it is said to be philosophical and a moral and ethical foundation for professional nursing. Her theory promotes health and a patient’s satisfaction of certain needs. What constitutes a caring nature can also be seen in Florence Nightingale’s environment theory. While she does not refer to the term ‘care’ within the context of her writings, she describes nursing as a calling, a dedication, a sacrifice while serving as a reputable caregiver. That nursing is an art and science, one that promotes the health of the patient through maintaining the patient’s environment. She is quoted as saying, “Put the patient in the best condition for nature to act upon him” (Nightingale, 1859).

Both Watson’s and Nightingale’s theories can be misunderstood based solely on their concept titles. The theory of caring and the theory of environment are focused on the true meaning of caring. Watson emphasized that, “it is possible to read, study, learn about and even teach and research the caring theory, but to truly ‘get it’ one has to personally experience it” (Nursing Theories - Jean Watson's Philosophy of Nursing, 2020). She too realizes the confusion her concepts may cause someone not familiar with her caritas processes. It isn’t until one delves into the depths of each of the theories do they get the true meaning and are better able to provide the best nursing care to their patients.

References

Nightingale, F. (1859). Notes on Nursing. New York: 2003 edition published by Barnes & Noble, Inc.

Nursing Theories - Jean Watson's Philosophy of Nursing. (2020, 10 26). Retrieved from Current Nursing: https://currentnursing.com/nursing_theory/

Personal theory in motion

Pamela Rudolph

posted Jul 30, 2022 7:52 PM

Nursing theories create help create evidence-based practice. These theories help build a foundation for standards of practice and competencies of the profession. Nursing theories provide perspectives that nurses develop from their experiences, values, beliefs, and education. To create evidence-based practice, nursing theories must follow the C-T-E model. Information about the problem must be identified and gathered; a hypothesis needs to be created; a plan of care must be generated (Utley, Henry, & Smith, 2018). Concepts must be planned, tested, analyzed, and put into clinical practice. The theory then can be used alone or used in conjunction with other concepts and theories.

My personal theory that ‘anticipating patient needs reduces call light interruptions’ is about improving patient care while also decreasing staff interruption and stress which in turn could increase job satisfaction and decrease burnout. Anticipating patient needs (concept A) can be taught as part of a shift huddle on a regular basis. Frequent huddles are important due to the change in patient needs. Tracking reasons for calls (some hospital call systems have buttons for each need but that may not be accurate) and collaborating with nursing staff to determine the patient’s needs for a specific time, staff can work with patients to anticipate basic needs with each purposeful round. Reducing (proposition) call light interruptions (concept B) can be evaluated by reviewing call light reports, both before and after the training and testing the theory (Utley, Henry, & Smith, 2018). Anticipating patient needs to reduce avoidable interruptions, to help reduce stress and burnout, or improve job satisfaction is the responsibility of everyone on the unit to participate.

Reference

Utley, R., Henry, K., & Smith, L. (2018). Frameworks for Advanced Nursing Practice and Research: Philosophies, Theories, Models, and Taxonomies. New York: Springer.