NR 501 Week 7: Nursing Theory Applied to Research

Thanks for responding to my post. I just believe that as a nurse caring is part of our duty to make sure the patient is well taken care of. This includes being there throughout every step of the healing process even if that means offering self and just being there from admission to discharge or transition to other living arrangements. Sometimes this is all the patient needs. As I stated above, do not appear to be in a rush and listen without interrupting. Patients feel if you are in a rush, there is no need to tell you the whole truth about what is going on with them. There must be a common ground, communication and active listening, that accompanies the growth of a relationship which can only produce positive outcomes for our patients as well as our team members. 

     There are several caring theories that all have one goal in mind: caring for the patient and their mental capacity. This is key in taking a patient’s concerns serious enough that one is willing to look out for the others’ best interests instead of their own. Carper’s Art of Nursing theory (1978) is described as expressions of the nurse’s perception of what is significant in the individual patient’s behavior, as well as performance of nursing actions in an artful manner. This theory involves three concepts: respect, responsibility and empathy, which are all a part of a nurse’s daily duty to all patients. Actualization of these values clearly is essential for high quality nursing care (Alligood & Fawcett, 2017). As an advanced practice nurse, it is imperative that top priority is given to the care of patients.

     Also, another theory that comes to mind is that of Virginia Henderson’s Need Theory. This theory also signifies the importance of getting to know the patient from the first encounter and continue to assess and identify needs that may be relevant to the patient’s health status. Discharging can be dependent upon what the patient needs versus what they do not need to go home. Henderson called her definition of nursing her “concept” and emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed (Ahtisham & Jacoline, 2015). The goal is to assist the patient into being as independent as possible. With her focus on individual care, Henderson stated that the nurse’s role is to assist patients to achieve activities that maintain health, to recover or to achieve peaceful death (Ahtisham & Jacoline, 2015). Caring and the art of nursing go hand in hand and effective nursing care is key to the health and well-being of our patients.

References

In NR 500, you explored an area of interest related to your selected specialty track. You then identified an issue/concern related to that area of interest. Select a nursing theory that can be applied to resolving the issue/concern. In your initial response, address the following:
• How the selected nursing theory is relevant to your area of interest
• A brief description of the issue/concern
• How the selected nursing theory can be used to guide the resolution of the issue/concern

Include an example from the literature or your own experience to illustrate your points. Remember to include at least one outside scholarly source.

I am currently pursuing the track of Family Nurse Practitioner and the area I am interested in is the cervical cancer screening (Pap smear). I consider the self-care deficit nursing theory, which is also know as The Orem’s Model of nursing, valuable in nursing practice and therefore I will apply it to the issue of cervical cancer prevention. This theory can be used in many areas of nursing practice. The self-care deficit nursing theory is a grand nursing theory that was established by Dorothea Orem, which extrapolates from the totality paradigm based on human beings being able to adapt to one’s environment.

NR 501 Week 8: Course Reflection and Future Application

An area of interest which I believe is important to the Family nurse practitioner track comprises the screening and recommendations for pap smear in the female population. Pap smear or cervical cytology is mainly associated with the purpose of screening for cervical cancer in women. Pap smear is important since it can detect high-grade variations in cervical cells. If undetected, cervical cells can modify to cancer cells which may bring fatal consequences to affected women. American Cancer Society recommendations that women

NR 501 Week 7 Nursing Theory Applied to Research

should adhere to the guidelines to assist in early detection of cervical cancer. As an FNP, I am aware of how important is to follow all screening protocol and recommendations for a pap smear screening test. According to Weng et al. (2015) evidence-based practice encourages nurses to seek answers concerning ways to improve practice and thus can open nurses’ eyes to all the ways to improve patient outcomes. Evidence-based projects have been used as imperative ladders to evaluate the competence of nurses and can be used to drive quality and safety of care. While applying these scientifically proven practices there will be enhanced patient health outcomes, there will be also greater decrease of unnecessary procedures and complications that may risk the patient health status. Evidence-based practice encourages health care providers to seek responses.

According to Evsen & Gülsen (2013) self-care theory incorporates self-care, self-agency, and therapeutic self-care demand, as well as self-care requirements. Self-care is assumed by persons to improve life, and well-being. Self-care requirements are actions needed to preserve the level of well-being or health. Self-care agency is recognized as the power of persons to direct self-care, and it reflects a person’s capacity. Self-care has components reflecting the importance of skills, attitudes and knowledge. Also, self-care agency is influenced by the environment.

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The Orem’s Model of nursing is relevant in the area I have selected because the main focus in primary care should be preventing actions and empowering the possible affected population, in this case women to take responsibility for their own health outcome. It is of paramount importance to influence women through health education, so they will have the will to prevent cervical cancer or treated promptly and prevent serious complications that may affect their health status or even provoke death. If we as Family nurse practitioner’s base cancer screening actions on Orem’s theory, and use the point of view that all women once they have the right tool to make informed decisions such as proper health education on cervical cancer screening and prevention, they will have the power to care for themselves accordingly. In Primary care, I believe prevention is the tool to keep our population healthy and free of diseases.

According to MacGill (2017) the focus of women’s health is reproductive health and the prevention and treatment of diseases that are specific to women. Women’s health nurse practitioners (WHNP) provide healthcare to women across the lifespan. WHNP work with patients at the onset of puberty through their advanced years and provide healthcare, prevention of disease, and services aimed at promoting health. Women’s health nurse practitioners (WHNP) is a specialty track that is important since it follows the entire lifespan of women’s health, addresses the many different health issues that are unique to women, provides both acute and chronic care as well as counseling and preventive services. It is necessary for women to receive education on the need for the Pap smear which is a screening test.

According to Korfage et al. (2012) the Pap smear detects changes in cervical cells before they change to cancer cells and therefore it is imperative that all women should commence cervical cancer screening at age 21. The Pap smear test should be done every 3 years for women aged 21 to 29 years. Pap smears should not be performed on women under the age of 21 or women who have previously had hysterectomy for non-cancer disease. The Pap test entails extraction of the cervical cells and then testing them under the microscope. Majority of patients set to undergo a Pap smear test feel ashamed, pain, inconvenience and nervousness during the screening procedure. This area of interest is very important as it enables providers to determine the presence of cervical cancer before onset.

According to Rasul et al. (2015) the four main themes that are relevant to a Pap smear include conflict, belief, awareness about cervical cancer screening, and socio-cultural factors. Patients are mostly at conflict regarding whether to take a Pap smear or not and most patients are hesitant to take the test. Beliefs include health related beliefs and cervical-cancer related beliefs. Beliefs are imperative elements of decision-making. Appropriate awareness is necessary to promote the willingness of individuals to take a Pap smear. Socio-cultural include supportive family, spirituality, role of mass media among others, which all influence the decision to take a Pap smear test.

According to Frellick (2015) the updates by American Colleague of Gynecologist (ACOG) recommends changes in screening and prevention of cervical cancer. These recommendations include the role of screening with human papillomavirus (HPV) testing alone. Cytology testing should be encouraged for women aged 21 to 29 years. Screening with Pap smear alone every 3 years is acceptable according the guidance by ACOG. ACOG recommends against annual testing. The American College of Obstetricians and Gynecologists (ACOG) recommends cytology testing alone every 3 years for women aged 21 to 29 years. Co testing with cytology and HPV testing every 5 years is recommended for women aged 30 to 65 years. The solution to promote women’s health and prevent cervical cancer, is for societies that deal with women’s health to revise their full set of guidelines and promote coverage

I think the selected theory, Orem’s Model of nursing may be used to guide the resolution of empowering women regarding the need and importance of the Pap smear, through the provision of health education geared towards the elimination of certain beliefs, socio-cultural factors and increase consciousness of the importance of Pap smear and all consequences that may take place health wise, if there is not cervical cancer screening and prevention. Therefore, it is of crucial importance to get the involvement and receive support from family and the media.

I can recall an example from my personal experience as registered nurse. While I was working in a clinic as an RN, we were attending to a patient who was 38 years old, who was diagnosed with Cervical intraepithelial neoplasia (CIN III), unfortunately due to a mixture myths and misconceptions on Pap smear. She thought Pap smear was done to detect STD and she argued she had only one sexual partner, so she did not need to have this test done. After provided information, this patient finally consented to have the Pap smear done and this was the result we found. If the Orem’s Model of nursing had been used, this patient would have had the proper information to make the right decision on time to prevent many complications affecting her health as well as her finances. The importance of health education plays a key role in patients like this one in this example to make informed decisions regarding their health status and she would definitely have been empowered to have self-care in order to improve and maintain life, and well-being.

Reference

Evsen, N., & Gülsen, E. (2013). The Prevention and Reduction of Postpartum Complications: Orem’s Model. Nursing Science Quarterly, 26(4), 360-364. DOI: 10.1177/0894318413500402.

Frellick, M. (2015). Updated guideline on cervical cancer screening issued by ACOG. Retrieved from https://www.medscape.com/viewarticle/856431 (Links to an external site.)

Korfage, I. J., van Ballegooijen, M., Wauben, B., Looman, C. W. N., Habbema, J. D. F., & Essink‐Bot, M. L. (2012). Having a Pap smear, quality of life before and after cervical screening: a questionnaire study. BJOG: An International Journal of Obstetrics & Gynaecology, 119(8), 936-944.

MacGill, M. (2017). Gynecologists: What do they do and what should I expect? Retrieved from https://www.medicalnewstoday.com/articles/288354.php (Links to an external site.)

Rasul, V. H., Cheraghi, M. A., & Moqadam, Z. B. (2015). Influencing factors on cervical cancer screening from the Kurdish women’s perspective: A qualitative study. Journal of medicine and life, 8(2), 47.

Weng, Y. H., Chen, C., Kuo, K. N., Yang, C. Y., Lo, H. L., Chen, K. H., & Chiu, Y. W. (2015). Implementation of Evidence‐Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan. Worldviews on Evidence‐Based Nursing, 12(1), 22-30.

Encountering patients daily and identifying their needs is a daily routine. By treating everyone according to their needs, the nurse can assess them and identify what is needed for the person to be restored to their state of normal health. As a patient that is in a medical facility, discharging them at the right time is an important task. Discharging patients is an area of interest in being a Family Nurse Practitioner (FNP). The Family Nurse Practitioner (FNP) can diagnose and provides treatments to patients with a variety of illnesses. The FNP can continually provide care to patients in various health care settings. Also, the Family Nurse Practitioner provides patient education regarding diagnosis, treatments and preventative care. This role is challenging, and the advanced practice nurse must possess the clinical expertise to be successful in this advanced nurse role. A Family Nurse Practitioner can lead this change for quality care as well as advance a culture of excellence through lifelong learning. By building and leading collaborative interprofessional care teams this can result in a better outcome for patients.

Advanced practice nurses play a key role in providing education to patients; especially discharge education because a patient’s home treatment is dependent upon discharge instructions that are given to them. Discharge education is crucial in preventing problems and hospital readmissions. This is primarily due to inadequate communication, poor coordination with case management and healthcare providers and unassessed problems patient had that were not addressed properly. For example, there is a 54-year-old female with newly diagnosed hypertension. She was admitted because her blood pressure reached 220/110. She had been going to a physician at a local clinic and her readings were always high. He would ask if she had any questions but seemed like he was always in a hurry to leave so she would always she had no questions. He prescribed two medications for her to take but did not explain what and when to take them to her; told her the pharmacist would go over the medicine with her. At this point is where education must be incorporated while she is inpatient. Without the proper patient education, the patient will likely be readmitted. So, the right education at the right time can prevent an episode like this. Encourage patient to ask questions. This also helps the advanced practice nurse assess how well the person understands the information/instructions. As an advanced clinical practice nurse, don’t appear to be in a rush, expect questions and allow time for answering them, avoid closed-ended questions, listen without interrupting and encourage family to get involved. Also, the teach-back technique is the simplest method that can bridge any gaps in communication between the nurse and patient.

The Joint Commission recommends a multifaceted approach to prevent readmissions that includes explanations of discharge instructions, self-care, and ongoing or emergency care; inventory of outpatient resources/referrals; medication reconciliation; and understandable instructions for the patient and family (Schyre, 2009). A patient-individualized approach noting preferred language, culture, and the patient’s health literacy level is also recommended. Failure to provide complete discharge instructions can result in non-adherence to patient treatment regimens and lack of essential follow-up, the most commonly identified reasons for readmissions. As many as 79% of readmissions are considered preventable and a direct result of uncoordinated care (Feigenbaum et al., 2012). Readmissions can be avoided if the correct assessment is performed on patients to see if they are ready for transition to home or other long- term care arrangements. Theory is important for reasoning, thinking, decision-making, and supporting excellence in practice. The central philosophy of Dorothea Orem’s self-care deficit nursing theory “is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they’re able” (Younas, 2017).

Dorothea Orem’s Self Care theory is a method that can be utilized and is relevant to advanced nursing practice to determine the readiness of the patient for discharge. Dorothea Orem’s theory is a conceptual model that provides a structure for critical thinking in the nursing process. This theory can assist in identifying self-care deficits as well as assess the patient’s ability to care for themselves. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles (Younas, 2017). Identification of a patient’s ability to perform self-care will help the nurse prepare patient for discharge. Anyone who cannot care for themselves and requires help with activities of daily living (ADLs) has a self-care deficit and is in need for outside resources if discharge is approaching. FNPs and healthcare members must possess the competency to know if the patient is ready for discharge. This can present a challenge if staff is not fully aware of what is required.

Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system (Younas, 2017). The theory of self-care includes self-care, which is the practice of activities that an individual initiate and performs on his or her own behalf to maintain life, health, and well-being. Then there’s self-care agency, which is a human ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources. Finally, there is therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites. All these concepts can be applied to assessing the patient’s motivation for discharge, their level of health literacy and their knowledge of their condition and how to maintain it.

References

Schyre, P. M. (2009). The importance of discharge planning. The Joint Commission. http://www.commonwealthfund.org/-/media/Files/Resources/2009/Reducing%20Readmiss (Links to an external site.).

Feigenbaum, P., Neuwirth, E., Trowbridge, L., et al. (2012). Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals. Med Care, 50(1), 599-605.

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. http://doi.org/10.1891/1078-4535.23.1.13 (Links to an external site.)