NUR 513 During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

Most nursing theories look at the patient as a whole person rather than simply an illness or injury. This approach is called a holistic or humanistic approach which helps foster mental and emotional health aside from physical health. (Paterson, Zderad,2014)

The Humanistic Nursing Theories was created by Josephine Paterson and Loretta Zderad. Humanistic nursing theories essentially nurture the idea that patients can grow in a healthy and productive manner. The humanistic theory focuses not just on the nurses’ medical and scientific background but also on the nurses’ ability to interact with patients. The humanistic theory emphasizes the

nurse-patient relationship wherein both the nurse and the patient influence the outcome of the nursing interventions. The purpose of this nursing theory is to show that the relationship between the nurse and patient can bring healing as much as the medical intervention. Unlike other theories that generalize the role of the patient, the humanistic model of nursing looks at the patient as a unique individual, and their situation is distinct from one another. This nursing approach has no formula or process to care for patients. Each patient is assessed and treated individually and on a case to cases basis. An example of a concept that needed full attention in the ICU is the introduction of palliative care early in the admission process. We are seeing that physicians will consult the involvement of the palliative care team in the middle or late stage of a patient’s intensive care admission. ICU nurses are proactive members of the ICU team. They are the first healthcare provider to sense if the patient will or will not make it out of the ICU. Often, palliative care consults are driven by the nurse’s desire to support not just the patient but their families. The established rapport of the ICU nurses with the families made it possible for the nurses to know the patient’s wishes in the event of an end of life or death. That’s when nurses will advocate for the introduction of palliative care. There is a misconception about the role of palliative care among patients and their family members. Palliative care is a branch of medicine that focuses on providing relief of symptoms of illness while optimizing the quality of life for patients and families. Research conducted by Fagundes Junior in 2021 showed that in a contemporary CICU registry, comfort measures preceded death in two-thirds of cases, frequently without palliative care team involvement.

The high utilization of advanced ICU therapies and delayed and lengthy discussions on comfort measures’ decisions prolong the patients’ and their families’ agony and suffering at the end of life. However, the research also highlights a budding possibility for an early consultation of a palliative care team in cardiac ICU settings to address these concerns. Fagundes et al, 2021). Remember that even at the end of life and death, the patient should be treated humanely and respectfully. Patients should be viewed as holistic beings needing nurturing and care even at the end of their lives. During the patient’s suffering, the palliative care team can provide emotional support and relief from pain through their prescribed interventions. The ICU team should also consult the psychiatric team to ease the patient’s anxiety and emotional distress. The best nursing theory to address the concern for the end of life is the theory formulated by Paterson and Zderad because patients are viewed as holistic beings needing attention addressing not just their physical but, most importantly, their emotional needs. Florence Nightingale Theory of holistic care is also applicable because her theory delve on the philosophy that the provision of care to patients are based on a mutual understanding of their physical, psychological, emotional, and spiritual dimensions.

(Wagner,Whaite, 2010).

Josephine E. Paterson,J.E., Loretta T. Zderad,L.T.(2014).Humanistic Nursing Theory: In Prezi. Retrieved from https://prezi.com/wluuzrylv3nz/humanistic-nursing-theory-josephine-paterson-and-loretta-zd/

Wagner, D.J., Whaite, B. (2010). An Exploration of the Nature of Caring Relationships in the Writings of Florence Nightingale. Journal of Holistic Nursing. 28(4):225-234. doi:10.1177/0898010110386609

Fagundes Junior, A., Berg, D., Bohula, E., Baird-Zars, V., Guo, J., Katz, J., Alviar, C., Van Diepen, S., & Morrow, D. (2021). Palliative care in cardiac intensive care units (CICUs): Insights from the Critical Care Cardiology Trials Network (CCCTN) registry. European Heart Journal. Acute Cardiovascular Care, 10(Supplement_1). https://doi.org/10.1093/ehjacc/zuab020.158

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My experience in the class has been exciting, with important information on advanced nursing practice. Before taking the course, I only anticipated a discussion of the differentadvanced nurse practitioner roles. However, I am glad that the program encompasses various aspects that strongly correlate with and influence all nurse practitioners. Having looked at global perspectives and practical nursing in the theories, I feel more informed about factors impacting advanced registered nurses’ practice scope. I also began the course anticipating intense research activities, having been informed about the evidence-based practices in MSN courses. The current research I have engaged in has been beneficial and continues to prepare me for my change agent and innovation roles. I look forward to week six, where I will learn more about the research process and correct any potential gaps.

Furthermore, the approach used to present the course, as highlighted in the syllabus, has encouraged me to be open-minded and flexible in learning about my future and related specialties from diverse angles. I also now appreciate feedback from everyone else since I believe that having a global and diverse perspective is critical in my current and future role. As Brau (2020) asserts, learning and understanding occur through interaction and experiences with the environment. Therefore, after interacting with the course, I look forward to bettering my contribution and reading approaches to maximize the topic resources in gaining new knowledge. Overall, I am excited that the course is as interesting as I anticipated. I enjoy all the week’s activities, and I will continue exerting more effort for a good score and heightened knowledge.

References

Brau, B. (2020). Constructivism. The Students’ Guide to Learning Design and Research.

The nursing profession provides many areas in healthcare and patient care that one can practice in. Within the healthcare system, nurses make up the largest workforce but are still struggling with staffing shortages that create a threat to public health, the healthcare system and patient care. One area of suffering that is seeing the effects of the shortage is in nursing faculty. According to the American Association of Colleges of Nursing (2020), “Faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for professional registered nurses continues to grow; Budget constraints, an aging faculty, and increasing job competition from clinical sites have contributed to this crisis” (para. 1). This issue was highlighted during the start of the COVID-19 pandemic. In my home state of New York, we were hit hard by the outbreak which left many of our hospitals in chaos. Many of the nursing students I knew were expedited through their course if they were in their final semesters and funneled into hospitals because of the staffing shortages. Prior to the pandemic I do remember there were a few friends of mine who had to look for other online schools because the schools near them didn’t’ have enough classes as a result of not having enough nursing faculty to conduct those classes. Many of my nursing colleagues who are in education say that their class sizes have doubled as a result of understaffing and now with the need for more nurses, students are having a hard time enrolling in nursing courses because of classrooms being over capacity. This is a threat to health care as the shortage of faculty means less class rooms and courses being made available and longer waiting periods to enroll in courses. It was very difficult to find a nursing theory that would best solve this problem. The only theory I found that could work was the Middle Range Nursing Theory which is a type of nursing theory. “Middle-range theories get into more specific areas of nursing as opposed to grand theories; They can come from day-to-day nursing practice, research, or from theories of similar disciplines” (Western Governors University, 2021). This theory will allow the individual(s) to focus on the problem (nursing faculty shortages) and gather resources and information from various areas of research and experience to develop effective and efficient solutions and new approaches to nursing education such as more online learning versus being in the class room, financial incentives to recruit and retain nursing faculty.

References:

American Association of Colleges of Nursing (AACN). (2020). Nursing Faculty Shortage. https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage

Western Governors University (WGU). (2021). Understanding Nursing Theories. https://www.wgu.edu/blog/understanding-nursing-theories2109.html#close

My specialty is Nephrology Nursing, focused on outpatient dialysis. Our patients come in three times a week to have their dialysis treatment. Because of the nature of the procedure, we get to establish a longer standing nurse-patient relationship with our patients, as dialysis treatment is necessary to prolong life until a patient either gets a transplant, withdraws from dialysis, recovers kidney function, or they pass away. We get to know our patients better, so applying Hildegard Peplau’s Interpersonal Relations Theory would be very beneficial for our setting.

Peplau’s Interpersonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. The model emphasized the need for a partnership between and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders. The subconcepts enumerated under this theory including the nurse acting as a stranger offering the client the same acceptance and courtesy as any other stranger, being a resource person, teacher or educator, leader, counselor, and technical expert, are all roles that are very relevant to what we do in the dialysis outpatient setting. (Gonzalo, 2021)

The development of patient’s trust in the care team is crucial to our role in outpatient dialysis. This is earned over time as the patients get to know their care team and vice versa by the care team becoming more familiar with patients’ preferences, their tolerance for dialysis treatment, their behaviors and attitude, culture and beliefs. We have quality outcomes that need to be met that we use to measure the quality of care provided to our patients. One of the more challenging quality outcomes to achieve is fluid management. The patient listening and following through with the care team’s health education focused on fluid control is very important. This is an example where Peplau’s theory of interpersonal relationship proves to be a beneficial guide when formulating a care plan.

References:

Gonzalo, A., (2021). Hildegard Peplau: Interpersonal relations theory. Nurselabs. https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/

Central line-associated bloodstream infections (CLABSI) are a primary problem in PCU. CLABSI was considered nosocomial-acquired, most of the time happened after the second day of admission. When a patient is admitted to ICU will place in a central line that benefits the patient, such as fluid resuscitation, blood draw, CVP, dialysis, multiple gtt, and chemotherapy. However, when their clinical presentation gets better will transfer to PCU. This is when our bedside nurses find the central line has not been correctly taken care of and tested positive for CLABSI.

The theory of Bureaucratic Caring by Marilyn Anne Ray can be applied to our current problem in PCU to protect our patients from CLABSI. The concept of her theory is empowering nurses to make the change between units for care patients holistically. The theory focused on the economic and political aspects. (Smith, 2019, P. 460) Our hospital has developed a vascular access committee, in which each unit has at least three staff become a member of the committee. This committee’s goal is to reduce CLABSI and improve services and quality of patient care. The committee is strengthening the accountability of staff by instituting more stringent compliance processes to prevent CLABSI. One thing that works for PCU is building consistency in educating staff for compliance with dressing care. As we know, the Centers for Medicare and Medicaid service (CMS) are no longer reimbursed for the cost of nosocomial-acquired infections such as CLABSI. Preventing CLABSI will be financially beneficial for hospitals.

Reference: Smith, M. (2019). Nursing Theories and Nursing Practice (5th ed.). F. A. Davis Company

Nurse leadership is crucial for the success of the healthcare sector. It is a complex concept since nurses enter into leadership roles for diverse purposes. Unfortunately, clinical nurse leaders face challenges due to the impact of leadership roles. Thew(2018) highlights that a critical challenge that should be addressed is innovative technology. We are currently in a fast-paced world that requires a prompt response to market changes. A clinical nurse leader oversees other nurses’ work, coordinating patient care, and implementing new internal policies. Thus, they need to organize continuing education for nurses for them to be up to date with technological changes. However, keeping up with the technological changes is a complex task given the procedures involved, limited resources, and limited time.

Clinical nurse leaders must show improved efforts in the transition and keeping up with innovative technological changes. They are trusted as change agents; thus, they need to organize swift and orderly ways to keep abreast of significant changes. A theory that can guide nurse leaders in making effective change decisions is the innovation diffusion theory. According to Udodand Wagner (2018), the theory by Rogers asserts that an individual assesses an innovation and decides whether to reject or accept it. The theory’s first phase comprises knowledge, where one is introduced to the new idea. The second stage is persuasion, where an individual gathers information about the innovation.

The third stage involves a decision where the leader compares the pros and cons of the change. The two last steps include implementation and confirmation to continue applying the innovation. Roger’s theory is the best because even if change does not become successful, it could be reassessed later in a more appropriate form and opportune time (Udod & Wagner, 2018). Thus, a clinical nurse leader has the perfect opportunity to assess innovative decisions and make the best decisions for quality patient care.

References

Thew, J. (2018, January 28). Top 5 Nursing Leadership Issues for 2019. https://www.healthleadersmedia.com/nursing/top-5-nurse-leadership-issues-2019

Udod, S., & Wagner, J. (2018). Common change theories and application to different nursing situations. Leadership and influencing change in nursing.

Nurse leaders should communicate in an effective manner to reduce rates of medication administration errors. Reducing and preventing medication errors remains a key aspect for improving safety and limiting the adverse drug events among patients. Medication errors entails the failure of providers to keenly follow the five “rights” of medication administration; right patient, right medication, right time, right dosage, and the right route. The Joint Commission asserts that nurses are responsible for the administration of medications to patients and require to nurture the right perception about causes of errors and the need to develop appropriate interventions to mitigate their occurrence (Schroers et al., 2021). Nurse leaders must collaborate with nurses to develop right approaches to mitigate medication errors and reduce adverse events in any setting.

MacDowell et al. (2021) assert that efforts, including the use of new technologies and streamlining of processes, have not effectively addressed the issue as medication errors remain prevalent. The study opines that the median error rates ranged from 8% to 25% during the administration of medications. The implication is that leaders must use existing theoretical models like Watson’s caring model to reduce and mitigate the occurrence of these events. In their study, Gunawan et al. (2022) assert that Watson’s human caring theory is essential in nursing administration, including medication administration processes as it allows nurses to concentrate and have personal touch to the process without any interruptions.

The model entails ten carative factors that promote better integration and communication among nurses, especially during handover at the shift transition and modeling a healing attitude. Further, Watson’s theory helps nurses to listen to patients, sees the individual behind the disease, pay attention to what they are doing during the moment and enhances their learning. Through Watson’s theory, nurses understand their main purpose is to help people to heal and give them comfort (Gunawan et al., 2022). This theory is essential for nurses to reduce medication administration errors and enhance patient safety and quality of care.

References

Gunawan, J., Aungsuroch, Y., Watson, J., & Marzilli, C. (2022). Nursing Administration:

Watson’s Theory of Human Caring. Nursing Science Quarterly, 35(2), 235-243. https://doi.org/10.1177/089431842110705

Mac Dowell, P. Cabri, A. & Davis, M. (2021). Medication Administration Errors. Patient Safety

Network. https://psnet.ahrq.gov/primer/medication-administration-errors

Schroers, G., Ross, J. G., & Moriarty, H. (2021). Nurses’ perceived causes of medication

administration errors: a qualitative systematic review. The Joint Commission Journal on Quality and Patient Safety, 47(1), 38-53. DOI: https://doi.org/10.1016/j.jcjq.2020.09.010

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NUR 513 During This Program, You Will Complete An Evidence-Based Practice Project Addressing A Problem, Issue, Or Concern In Your Specialty Area Of Professional Practice