NR 501 Week 4: Connection Between Theory and Advanced Clinical Practice

Nightingales environmental theory shows how providing a holistic approach to patients by using the four metaparadigms of nursing can benefit the patients care (Sayani, 2017). According to Nightingale, nursing is a separate entity in medicine and nurses play a vital role in the care of both the patient and their environment (Sayani, 2017). Nursing is a trusted profession because of Nightingale. She laid the foundation, through theory, for nurses to give exceptional care. This care does not just include the medicine we give, but the way we care for patients. While it is easy to look at a patient in their chart and see their medical history and their diagnosis, nurses look deeper. We speak with the patient, we learn about them, we go out of our way to make them feel comfortable, and we alter their environment to benefit them. To nurses, it is all about the patient and their well-being. Whether it be giving them medications, talking with them about their family, or making sure they have fresh linen, all of these factors affect the patients’ health and well-being. 

As Nightingale states, nursing is a separate entity. We use the metaparadigm that is found in theory to look at other facts such as environment, the patient, their health, and the nursing care we are providing. These four concepts make up the care that nurses given to patients, as they are all interconnected. We as nurses use these concepts to better the patient and better ourselves. Nurses form interpersonal relationships with their patients by using theory. Nurses communicate with their patients, form bonds with them, and develop a trusting relationship by giving competent, holistic, theory driven care that encompasses not only the patient, but their environment as well. 

NR 501 Week 4: Connection Between Theory and Advanced Clinical Practice

NR 501 Week 4: Connection Between Theory and Advanced Clinical Practice

Nursing theory has an important role in clinical practice. Theory has been recognized as the tool to making our practice a “rational knowledge based science” (Mao, 2015, p. 13). I feel that many people feel that theory has no place in clinical practice because of the abstract ideas and terminology that is involved. Mao (2015) gives the example of the nurse practitioner who’s main focus is curing rather than caring, while most theory is centered in caring as the primary nursing goal. “Currently, there is an explosion on the number of nursing theories, but not the usage of nursing theory” (Mao, 2015, p. 13).
        However, I feel that theory is at the base of clinical practice. Every intervention that we perform as nurses is based in theory. You may not actively think to yourself, “today I am applying Orem’s theory of Self Care to my practice,” but you are still educating your new onset diabetic patient on insulin administration. I think that taking time to understand and simplify theory would make it easier to use it to improve clinical practice. For example, Martha Rogers’ theory the Science of Unitary Human Beings sounds pretty abstract when you read about it. It talks about energy fields and uses big words like resonance and helicy (Rahim, 2016). However, at its core the theory is just talking about the patient and their relationship to their environment. The patient and their environment are two things that are constantly interacting with one another and affecting one another (Rahim, 2016). We apply this idea to nursing all of the time. We are taught in nursing school to look at our patients holistically and assess all of the factors that could be affecting their health.  When I receive a patient I am constantly assessing their family dynamic. I am thinking about what their home situation is like and what help they will need at discharge. I am taking into account the hospital environment and its affect on them. Finally, I am taking into account their illness and how it is affecting their reaction to the hospital environment. At no point in my day am I going to think to myself that I am applying Mary Rogers’ theory, but I am applying it because my training as a nurse was based upon it. I think that the argument that theory does not apply to real life practice exists just because there needs to be an effort to simplify it and realize that it is already occurring in our everyday practice. 

References

Mao, A. (2015). The gap of nursing theory and nursing practice: is it too wide to bridge? Macau Journal of Nursing, 14(1), 13-20. Retrieved from http://web.b.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/detail/detail?vid=31&sid=fd5498a1-42f5-4660-88a2-6b5fee7ebaaf%40sessionmgr120&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=ccm&AN=113930388 (Links to an external site.)

Rahim, L. (2016). Comparison between two nursing theories: Rogers and Leddy. Journal on Nursing, 6(1), 1-5. Retrieved from http://web.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/detail/detail?vid=3&sid=472994c4-62a3-42ca-94e5-95386a361761%40sessionmgr4006&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=116359098&db=ccm

I agree with your perspective and discussion, theory is applied daily to every nursing action and procedure. We as nurses carry out nursing actions and procedures with the purpose of assisting patients in the recovery of health and or maintain a good health status with these theories as foundation. As you well explained we do not stop to think which theory we are applying, we just use then routinely and apply them as evidence base practice. Now to have current information on evidence based information we need to keep up to date with current and recent clinical practice research, one of the ways to do so, is by participating in clinical research or continuing education workshops.

Evidence based practice is the current development in nursing practice that dictates excellence when carrying out a specific nursing action and or procedure, that promises assurance of optimal patient healthcare outcomes. A study undertaken by McKeon and McKeon (2015), define evidence based practice as the process in which clinical practice and nursing data are standardized into clinical decision-making. Once the application and utilization of clinical experience are used jointly with the most up to date information and best evidence available, nurses are able to provide and enhanced care for their patients and families.

We can relate to Dorothea Orem’s self-care nursing theory, which is one of the grand nursing theories. This theory has emphasized that the client’s capacity to accomplish life-sustaining activities are indispensable to the patient’s well-being (Wong, Ip, Chio & Lam, 2015).

According to Wong, Ip, Chio & Lam (2015) an individual begins and does self-care to preserve life, healthy functioning, and well-being. This individual must achieve selfcare intervention which is influenced by basic predisposing factors such as age, sex, developmental state, environmental factors, family system factors, sociocultural factors, health state, pattern of living, healthcare system factors and availability of resources. The patient’s capability to achieve or involve in self-care may be affected by  the abovenamed predisposing factors and therefore these self-care activities might need to be modified by the type of activity or even the quantity of these self-care activities.  

References

McKeon, P. O., & Medina McKeon, J. M. (2015). Evidence-based practice or practice-based evidence: what’s in a name?. International Journal of Athletic Therapy & Training, 20(4), 1-4. DOI: 1-4 http://dx.doi.org/10.1123/ijatt.2015-0055 (Links to an external site.) Retrieved from http://eds.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=2cef8dbd-7ff5-4058-835a-c39989924269%40sessionmgr4006 (Links to an external site.)

Wong, C. L., Ip, W. Y., Choi, K. C., & Lam, L. W. (2015). Examining self-care behaviors and their associated factors among adolescent girls with dysmenorrhea: an application of orem’s self-care deficit nursing theory. Journal Of Nursing Scholarship, 47(3), 219-227. doi:10.1111/jnu.12134

Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1678728778?accountid=147674 (Links to an external site.)

I feel that clinical nursing practice needs nursing theory. Nursing is both an art and a science and practice based on theory will ensure that practice includes the art of caring as well as the science of best evidence. Middle-range theories are considered more applicable to practice than grand theories though there is not consensus on which theories are middle range. Grand theories can be too abstract to be readily applied to practice. Middle-range theories are well suited to be applied to practice. Middle-range theories “explain, or predict phenomena and they are explicit and testable” (McEwen & Mills, 2015. Pp. 214). Middle-range theories have general, easily understood ideas that address the metaparadigms of nursing, are testable, and can be applied practice across settings. Practice level theories on the other end of the spectrum from grand theories are situation specific, testable, address a single concept and are applicable to a narrow practice situation.

I identify with Jean Watson’s caritas theory but find it daunting when considering practice application. Watson considers her theory to be both a grand and middle-range theory. Perhaps with practice I could find more ease with practice application of her theory rather than using it to frame care broadly. In this light I find Swanson’s theory of caring and healing to be relevant to my practice goal of providing caring nursing to empower patients to achieve best health. I also feel it is easier to apply directly to practice than Watson’s theory as it is less ambiguous and broad, yet it remains broad enough to be applied to many practice settings and scenarios.

In the theory of caring there are five processes to caring: knowing, being with, doing for, enabling, and maintaining belief. An obese, 10 year old male lives a sedentary life, going from school to after school care where the child chooses indoor sedentary play rather than outdoor physical activity due to a dislike of the heat. The child is brought home by a parent and the family eats dinner and then the child completes homework and goes to bed. This child and his family desire to increase his physical activity lack knowledge to set goals and create a plan. The patient and mother present to the family nurse practitioner (FNP) at a primary care practice where the patient has been seen since infancy. The FNP has developed a therapeutic relationship with the patient and his mother and they are comfortable discussing the patient’s obesity and sedentary lifestyle with the FNP.

The knowing component of caring is met by understanding obesity from the perspective of the patient and his mother taking into consideration their family values and Puerto Rican culture. The being with component of caring is met by the FNP being authentically present during the visit. The doing for component of caring is met when the FNP shares best evidence regarding physical activity recommendations for children and safe methods for engaging in physical activity. The FNP searched for best evidence that the patient and mother did not have access to or perhaps understanding and training to complete. They had a desire to gain knowledge and understanding but not the resources to gain that understanding without the FNP. The enabling component of caring is met when the FNP allows the patient and his mother to set goal and choose the methods of best fit to achieve those physical activity goals, and measure activity. The maintaining belief component of caring is met when the FNP encourages achievable goals and schedules follow up visits to monitor progress toward set goals and emotionally supports the patient and his mother encouraging them as they increase the patient’s physical activity (Swanson, 1991). The FNP has engaged in caring practice based on Swanson’s theory and this practice will support the positive lifestyle change the patient and his mother will make.

References

McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Swanson, K. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166.

Participation for MSN

Threaded Discussion Guiding Principles

The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

Participation Guidelines

Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.

Grading Rubric Guidelines

Performance Category	10	9	8	4	0
ScholarlinessDemonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisionsEvaluates literature resources to develop a comprehensive analysis or synthesis.Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.Evaluates information from source(s) to develop a coherent analysis or synthesis.Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) without any interpretation/evaluation.The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge -Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.Applies concepts to personal experience in their professional setting and or relevant application to real lifeInteractions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifeDoes not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.Posts are superficial and do not reflect an understanding of the lesson contentDoes not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignoredNo discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive DialogueReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.(5 points possible per graded thread)	Exceeds minimum post requirementsReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.Replies to a post posed by faculty and to a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate daysReplies to a question posed by a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days.The main post is not made by the Wednesday deadlineDoes not reply to a question posed by a peer or faculty	Has only one post for the weekDiscussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the threadNo connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APANote: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.Points deducted for improper grammar, syntax and APA style of writing.The source of information is the APA Manual 6th Edition	2-3 errors in APA format.Written responses have 2-3 grammatical, spelling, and punctuation errors.Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format.Writing responses have 4-5 grammatical, spelling and punctuation errors.Writing style is somewhat focused.	6-7 errors in APA format.Writing responses have 6-7 grammatical, spelling and punctuation errors.Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format.Writing responses have 8-10 grammatical, spelling and punctuation errors.Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format.Written responses have more than 10 grammatical, spelling and punctuation errors.Writing style does not facilitate communication.The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirementsper discussion thread	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirementper discussion thread	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.