NURS 513 Topic 5 DQ 2: SELECT ONE THEORY DISCUSSED DURING TOPICS 4 AND 5

Imogene M. King’s theory called Theory of Goal of Attainment applies to my future role of Public Health Nurse. This theory leads both the nurse and the patient to accomplish health goals on the patient’s behalf. “The theory focuses specifically on perceptions, communications, interactions, and transactions between nurses and clients as part of the process of mutual goal setting to achieve a state of health” (Balasi et al., 2020, p. 41). As a Public Health Nurse, this role allows for an awesome opportunity to reach the underprivileged to improve their health statuses. These individuals can also inform their families, friends, and neighbors about the advantageous chance at addressing current illnesses that they have been ignored. The patients that are currently present at the hospital for example are those with severe infections in their extremities. They now have to be treated with IV antibiotics and have wound care interventions performed once per shift. These groups of patients are usually those who have uncontrolled diabetes as well. In addition to education on their illnesses, this population needs to be taught how to care for their extremities in the future. Reaching this individual will create a relationship with this community by assisting the patient and will also create personal recommendations on where others who live or work alongside this individual to a Public Health Nurse. 

NURS 513 Topic 5 DQ 2: SELECT ONE THEORY DISCUSSED DURING TOPICS 4 AND 5

NURS 513 Topic 5 DQ 2: SELECT ONE THEORY DISCUSSED DURING TOPICS 4 AND 5

Topic 5 DQ 2

Select one theory discussed during Topics 4 and 5. Describe how this theory applies to your future role in advanced nursing practice (individuals, families, communities, and special populations)? Why or why not? Use examples from your current practice to illustrate differences or similarities.

Describe an ineffective leadership trait you have observed in your career. List some strategies you believe you will use as a future leader. Answers are voluntary but do count towards one of your three substantive posts for the week if you meet the 200-word minimum requirement

I am looking forward to hearing all of my classmates’ answers, as I know we have all unfortunately experienced an ineffective leader in one way or another. However, just as we discussed last week, as Florence Nightingale said, mistakes bring wisdom. So, optimistically we are able to learn from the errs of their ways and move forward on a better and more successful path. “Leaders create a culture of ownership and investment in the collective action of work, helping to build a community around the purposes of work and deepening the understanding of the relationship among individual work activities, the collective convergence of that effort, and its power to make a difference (Malloch, et al., 2019).” If a leader is unable to positively influence and encourage those around them, they may be “managing” and not “leading”.

An ineffective leader can quickly lead to distrust, and work failures. Specifically, an ineffective leadership trait that I have been exposed to in my career has been a leader or manager who is an over delegator. This person in particular was so far removed from bedside, which I believe made them uncomfortable, as they did not actually know what they were doing. In turn, this leader over delegated to cover up their ineptitude, instead of actually getting to the bottom of the problem themselves. This leader unfortunately did not build up credibility with the staff and was often not trusted even though the intent may have been good.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: SELECT ONE THEORY DISCUSSED DURING TOPICS 4 AND 5 NURS 513 

Malloch, K., Mangold, K., Porter-O Grady, T. & Weberg, D. (2019). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284146530

“In turn, this leader over delegated to cover up their ineptitude, instead of actually getting to the bottom of the problem themselves. This leader unfortunately did not build up credibility with the staff and was often not trusted even though the intent may have been good.”

This is not only wrong ethically but also very sad.

It’s sad when this post immediately reminds me of a previous nurse manager. One of the reasons I left my previous bedside nursing position was due to management. This manager was focused on herself and was not an advocate for the nurses who worked under her. She had no experience on our floor and did not advocate for safe nurse-patient ratios. We would be slammed, and she would come in to “help” and not have access to any of the medication rooms or know any of the processes we followed. It was very frustrating! I think as a leader it is important to know the processes and what work your team does and be able to assist in all aspects.

I have worked along assistant managers and managers who knew the processes and how to take care of a patient from admit to discharge. In nursing this is essential in a leadership position. How can you know appropriate staffing, appropriate ratios, and what is going on if you have no experience in the job the nurses you oversee are doing. Other things I believe are important is open communication, advocating, and good listening skills. Being a leader doesn’t mean you stop listening. Those who work in the nitty gritty know what the issues are and are essential in improving processes. (word count: 220) 

My experience with my leadership so far has been mostly positive. There was one instance that I will never forget when this executive leader, who is supposed to hold one of the highest positions in the hospital, came to visit our unit during our morning huddles. We discussed the new staffing method the hospital is about to implement, known as the NHPPD (Nursing actual Hours Per Patient Day) method. Of course, questions about patient acuities came up. Our unit is known for caring for acute medical psyche geriatric patients and is the designated acute medical-surgical- COVID unit. Our concern, of course, is patient acuities.

The presenter did not answer many of our questions directly or clearly. Finally, the executive leader said, “If you are not happy with the staffing method, the door is open for you.” For us staff, it simply means shut up and suck it up, or you may be free to resign. I understand that being a leader is stressful, and you may not be able to please everybody, but still, you are being looked up to, and your knowledge, decisions, and attitude as a leader your subordinates are following as an inspiration. Patience is a virtue. A leader should be a force to calm down and bring balance. People look up to you for answers and solutions if there is an issue. Clearly, that leader did not show patience or compassion to her staff.

“I think as a leader it is important to know the processes and what work your team does and be able to assist in all aspects.”

So true!! At the organization where I work the Chief Nursing Officer (CNO) has never been a bedside nurse. She has always been in administration. I think it’s very easy to sit up in the high office and dictate all the things that nurses should be doing when you never had to perform them. Don’t get me wrong, I’m aware of the tedious schedule of the CNO but just a little more respect for the bedside nurse goes a long way. I understand hospitals are big on patient satisfaction scores, so they require the communication board to be updated, they require hourly rounding which I know helps to keep down call lights as well as anticipates the needs of the patients but if the patient to nurse ratio is 7:1 or 8:1 it’s extremely difficult to provide these patients with quality care.

Upper management constantly pushing discharges to get in new patients, inserting new procedures and policies for the nurse to fulfill but there is no manpower. Then the constant questioning about the why seems to me a bit patronizing. A patient is complaining about the quality of care they’re receiving but the counter is why wasn’t the board updated? I too think administrators need to have a rotation where they come and work on the floors so they can get a feel of what to do to help because how can they effectively advocate for positive change if they’ve never experienced the negative firsthand (What Does a CNO Do?, 2018).  

I am looking forward to hearing all of my classmates’ answers, as I know we have all unfortunately experienced an ineffective leader in one way or another. However, just as we discussed last week, as Florence Nightingale said, mistakes bring wisdom. So, optimistically we are able to learn from the errs of their ways and move forward on a better and more successful path. “Leaders create a culture of ownership and investment in the collective action of work, helping to build a community around the purposes of work and deepening the understanding of the relationship among individual work activities, the collective convergence of that effort, and its power to make a difference (Malloch, et al., 2019).” If a leader is unable to positively influence and encourage those around them, they may be “managing” and not “leading”.

An ineffective leader can quickly lead to distrust, and work failures. Specifically, an ineffective leadership trait that I have been exposed to in my career has been a leader or manager who is an over delegator. This person in particular was so far removed from bedside, which I believe made them uncomfortable, as they did not actually know what they were doing. In turn, this leader over delegated to cover up their ineptitude, instead of actually getting to the bottom of the problem themselves. This leader unfortunately did not build up credibility with the staff and was often not trusted even though the intent may have been good.

It’s sad when this post immediately reminds me of a previous nurse manager. One of the reasons I left my previous bedside nursing position was due to management. This manager was focused on herself and was not an advocate for the nurses who worked under her. She had no experience on our floor and did not advocate for safe nurse-patient ratios. We would be slammed, and she would come in to “help” and not have access to any of the medication rooms or know any of the processes we followed. It was very frustrating! I think as a leader it is important to know the processes and what work your team does and be able to assist in all aspects.

I have worked along assistant managers and managers who knew the processes and how to take care of a patient from admit to discharge. In nursing this is essential in a leadership position. How can you know appropriate staffing, appropriate ratios, and what is going on if you have no experience in the job the nurses you oversee are doing. Other things I believe are important is open communication, advocating, and good listening skills. Being a leader doesn’t mean you stop listening. Those who work in the nitty gritty know what the issues are and are essential in improving processes. (word count: 220) 

My experience with my leadership so far has been mostly positive. There was one instance that I will never forget when this executive leader, who is supposed to hold one of the highest positions in the hospital, came to visit our unit during our morning huddles. We discussed the new staffing method the hospital is about to implement, known as the NHPPD (Nursing actual Hours Per Patient Day) method. Of course, questions about patient acuities came up. Our unit is known for caring for acute medical psyche geriatric patients and is the designated acute medical-surgical- COVID unit. Our concern, of course, is patient acuities.

The presenter did not answer many of our questions directly or clearly. Finally, the executive leader said, “If you are not happy with the staffing method, the door is open for you.” For us staff, it simply means shut up and suck it up, or you may be free to resign. I understand that being a leader is stressful, and you may not be able to please everybody, but still, you are being looked up to, and your knowledge, decisions, and attitude as a leader your subordinates are following as an inspiration. Patience is a virtue. A leader should be a force to calm down and bring balance. People look up to you for answers and solutions if there is an issue. Clearly, that leader did not show patience or compassion to her staff.

So true!! At the organization where I work the Chief Nursing Officer (CNO) has never been a bedside nurse. She has always been in administration. I think it’s very easy to sit up in the high office and dictate all the things that nurses should be doing when you never had to perform them. Don’t get me wrong, I’m aware of the tedious schedule of the CNO but just a little more respect for the bedside nurse goes a long way. I understand hospitals are big on patient satisfaction scores, so they require the communication board to be updated, they require hourly rounding which I know helps to keep down call lights as well as anticipates the needs of the patients but if the patient to nurse ratio is 7:1 or 8:1 it’s extremely difficult to provide these patients with quality care.

Upper management constantly pushing discharges to get in new patients, inserting new procedures and policies for the nurse to fulfill but there is no manpower. Then the constant questioning about the why seems to me a bit patronizing. A patient is complaining about the quality of care they’re receiving but the counter is why wasn’t the board updated? I too think administrators need to have a rotation where they come and work on the floors so they can get a feel of what to do to help because how can they effectively advocate for positive change if they’ve never experienced the negative firsthand (What Does a CNO Do?, 2018).  

Many interactions demonstrate the relevance of goal attainment theory in the current practice as acute care nurses provide care to individuals, families, communities, and populations. Regularly, elderly adults seek acute care services due to their reduced independence stemming from chronic diseases and reduced mobility (Abdi et al., 2019). In response, nurses engage these patients and relevant family members in setting mutual goals and Nurses work as they acquire more skills to enable them to serve patients better in the future. As applied in the current practice, nursing theories will be instrumental in the success of future roles in advanced nursing practice. They will be crucial since self-care, the environment, and patient engagement will remain valuable for effective, holistic, and satisfactory care.

Among many theories, Imogene King’s theory of goal attainment applies to my future role as an acute and geriatric care nurse. King’s theory is established on the tenet that the care process is transactional and that the patients should be active participants in goal setting and accomplishment. If differently stated, the nurse and the patient should communicate information, set mutual goals, and act appropriately to achieve the set goals (Adib-Hajbaghery & Tahmouresi, 2018). The implication is that the desired goals are achieved through mutual perceptions and each participant playing their part as required. As Adib-Hajbaghery and Tahmouresi (2018) further mentioned, the nurse’s role is to care for the patient while initiating appropriate actions to enable patients to developing the treatment plan. As Kneuertz et al. (2020) noted, patient engagement improves adherence to medication, which is witnessed among this unique patient group when the nursing process is transactional. A similar approach to care will be instrumental in the future as acute care practitioners seek innovative ways of improving health among patients and populations.

NURS 513 Topic 5 DQ 2: SELECT ONE THEORY DISCUSSED DURING TOPICS 4 AND 5 References

Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1), 1-15. https://doi.org/10.1186/s12877-019-1189-9

Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141-144. doi: 10.4103/2322-1488.235636

Kneuertz, P. J., Jagadesh, N., Perkins, A., Fitzgerald, M., Moffatt-Bruce, S. D., Merritt, R. E., & D’Souza, D. M. (2020). Improving patient engagement, adherence, and satisfaction in lung cancer surgery with implementation of a mobile device platform for patient reported outcomes. Journal of Thoracic Disease, 12(11), 6883–6891. https://doi.org/10.21037/jtd.2020.01.23

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. 

Re: Topic 5 DQ 2 

One of the theories I discussed last week was Orem’s Self-care Deficit Theory. Orem’s theory promotes the idea of patient independence over self-care with the ultimate goal of overcoming human limitations to self-care (Current Nursing, 2020). By focusing on a person’s ability to perform self-care, maintain health and overall wellbeing, this empowers the individual to take responsibility for their health or the health of others (Shah, et. al, 2013). This theory can be highly individualized from patient to patient, or patient’s families, so the application of this theory can differ greatly based on population focus. For example, this theory would be applied differently between adult and pediatric populations based on age and developmental stages. In pediatrics, this theory would likely be heavily geared towards parent support and educations in performing cares. Additionally, this theory can great vary based on specific illness or disease state. For example, I work in a pediatric cardiovascular ICU where the patient’s defect, arrhythmia, or ailment greatly determines their self-care needs.

A neonate with a congenital heart defect that is not yet fully repaired may have an oxygen requirement or tube feeding support. In this case, much more teaching would be geared towards the parent’s ability to use/manipulate these new medical devices. On this same unit, I may also take care of an adolescent patient who just had a mechanical valve replacement. Initially post op, this patient may require full or partial cares, and these deficits would change as the patient status improves and once again becomes independent. This same patient may also require teaching involving anticoagulant therapy; many adolescents have the physical and mental capacity to administer their own medications, so teaching and support would be given in this case. 

Ultimately, how Orem’s Self-Care Deficit Theory is applied to a population focus is highly variable from situation to situation because deficits can be adaptable and dynamic in nature.  

References 

Current Nursing. (2020, March 12). Nursing theories: Open access articles on nursing theories and models. https://currentnursing.com/nursing_theory/self_care_deficit_theory.html 

Shah, M., Abdullah, A., & Khan, H. (2013). Compare and contrast of grand theories: Orem’s self-care deficit theory and Roy’s adaptation model. International Journal of Science and Research. https://www.ijsr.net/archive/v4i1/SUB15564.pdf 

Orem’s theory promotes patient independence over self-care. The theory believes that patient autonomy enables the overcoming of human limitations to self-care.  Self-care differs among patients due to their complications and personalities (Younas, 2017). Tailoring patient care based on their needs increases accuracy and service reliability. Tailoring patient services create individualized care. Therefore, Orem’s theory application differs based on the population’s character. The adult patients due to their age and nature of complication they may want unique medical care compared to the young population (Fernandes et al., 2018). Adult patients due to their age they are pre-exposed to various health problems. Orem’s theory flexibility allows nurses to adjust their nursing care based on the condition. The ultimate goal of Orem’s theory is to facilitate self-care. Successful self-care is individualized nursing care that considers patient’s needs. Teaching nurses on understanding patient’s needs is an integral activity towards integrating Orem’s theory. Creating an enabling environment allows patient to disclose their concerns improving healthcare services.       

References 

Fernandes, S., Silva, A., Barbas, L., Ferreira, R., Fonseca, C., & Fernandes, M. A. (2019, September). Theoretical contributions from Orem to self-care in Rehabilitation Nursing. In International Workshop on Gerontechnology (pp. 163-173). Springer, Cham.  

Younas, A. (2017). A foundational analysis of dorothea orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23. 

Re: Topic 5 DQ 2 

In Topic 4, I have mentioned the Environmental theory by Florence Nightingale in one of the discussions. This theory is not based on a specific population focus. This can be applied to every individual, families, communities, with no other special populations specified. The reason for this is that the theory is concerned on a person’s health in relation to its environment and the impact of the environment upon them (Gonzalo, 2021). Every person, young or old, has a variety of environmental factors that can be detrimental to their health. However, a person’s environment may also constantly change, temporary or permanent, depending on the circumstance. 

The difference that would be observed in this theory would depend on the environmental factors affecting that population focus. An example is when I volunteered for a medical mission before and performed health assessments on families who lived near a mangrove, many of them reported GI symptoms or have history of gastrointestinal-related illnesses (e.g., diarrhea, vomiting, stomach pain). It was reported that the water from the mangrove had somehow entered through a leaked pipe, causing them to consume unclean water. It affected both children and adults. On the other hand, another family that I conducted health assessments on that did not live near the mangrove, exhibited no symptoms, and were all perfectly healthy. The idea here is that these families had different environmental conditions, which led to two different outcomes. 

In order for APNs to incorporate this theory into practice, as Nightingale described it, the nursing process should include gathering of information and assessing the information on its relevancy (Tourville & Ingalls, 2003). Also, it is essential that nurses in an inpatient setting be able to provide an environment that fosters healing. Though some of the environmental factors can not be controlled, it is imperative for nurses to take the initiative in configuring the environmental settings appropriate for the gradual restoration of the patient’s health (Gonzalo, 2021). In my future practice, with emphasis in healthcare quality, one of my major goals is to ensure that I implement policies and procedures that promote environmental safety. 

                                                          References 

Tourville, C., & Ingalls, K. (2003). The living tree of nursing theories. Nursing Forum, 38(3), 21-30, 36. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1111/j.0029-6473.2003.t01-1-00021.x 

Gonzalo, A. (2021). Florence nightingale: Environmental theory. Nurselabs. https://nurseslabs.com/florence-nightingales-environmental-theory/ 

I agree with you that environmental factors impact people regardless of their age.  Nurses attend to different patients with different medical needs.  Environment affects the medical intervention. The environmental theory insists that healthcare facilities should be clean and suitable to facilitate patient’s recovery (Fernandes & Silva, 2020).  Unfortunately, the environment might change due to various environmental occurrences. A clean environment, water, and proper lighting are environmental factors that facilitate smooth patient’s recovery. Some patients may not prioritize clean water since they are used to drinking untreated water. Therefore, these patients may want other environmental factors that will enable them to be comfortable. Prioritizing environmental factors when attending to patients (Sayani, 2017). Nightingale’s theory dictates that the APNs should gather crucial environmental information before integrating the environmental theory. Obtaining the information allows healthcare providers to understand patients’ environmental needs.  The inability to understand the patient and the environment that enable the patient’s recovery paralyzes the nurses’ efforts to improve healthcare quality.    

References 

Fernandes, A. G. O., & Silva, T. D. C. R. D. (2020). War against the COVID-19 pandemic: reflection in light of Florence Nightingale’s nursing theory. Revista Brasileira de Enfermagem, 73.  

Sayani, A. H. (2017). Nightingale’s Theory and its Application to Pediatric Nursing Care. i-Manager’s Journal on Nursing, 7(2), 38.  

Re: Topic 5 DQ 2 

Virginia Henderson is a theorist that emphasizes the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. “Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the patient and how nursing can assist in meeting those needs. The four major concepts addressed in the theory are the individual, the environment, health, and nursing. Hendersons theory does not differ from the application when it comes to individuals, families, communities, and special populations. An example that can be applied to Hendersons theory is the elderly population. They may require assistance to achieve health and independence, or assistance to achieve a peaceful death. For the individual, mind and body are inseparable and interrelated, and the individual considers the biological, psychological, sociological, and spiritual components. This theory presents the patient as a sum of parts with biophysical needs rather than as a type of client or consumer” (Nursing theory, 2020). 

In the elderly population education is a major factor when it comes to medications. Teaching the patient how to properly take or administer medications can benefit them in many ways in turn lowering death rates. The environment plays a major role as well, because it determines how the patient can adapt to their surroundings. Henderso