Abstract
As a discipline, Nursing is increasingly defining its own independent functions and contributions to health care. The Development and use of Nursing Theory provide autonomy in the practice of nursing in many ways. As nurses demonstrate that nursing does indeed make a difference and that nursing service are valuable, the discipline become more independent. Having a body of knowledge specific to the discipline allows members to be viewed by others as experts; this in turn gives nurses the authority to carry out actions. Today it has become even more necessary to demonstrate efficient, cost effective and high quality care with in the organized healthcare delivery system. By practicing theory based nursing combined with critical thinking skills, nurses are able not only to deliver care that meets those criteria but likewise to describe what it is they do. The major concepts employed in their administration of care serves as their model which will be the central theme of this research paper, in its aspect of finding out its impact towards the professional environment.
Introduction
Originally nurses were employed plainly for the role of taking care of the patient as prescribed by a physician. They were more perceived as first class maids which later evolved into the “biomedical model of nursing care which still strongly influences nursing practice today”. This biomedical model focuses heavily upon disease course such as pathophysiology and altered well being or homeostasis. It fails to identify the uniqueness of the person as well as the different reaction and impact of an altered well being to each person, which works well in the traditional manner of care. It focuses mainly on the treatment of disease, rather than the person’s psychological, socio-cultural, political, and spiritual and even the economic differences between individuals. The Biomedical Model then views a sick person similar to all the rest of the sick people, as having the same kind of illness. It fails to take account the ethnicity, religion, and culture of the sick individual. This is in contrast to the social model which places emphasis on changes that can be made in society and in people’s lifestyles to foster healthier population.
1. Describe a Clients Concern that is relevant to Nursing:
An example of a client’s concern that is relevant to nursing is the presence of a poor environment which becomes the culprit of the client’s communicable illness (Barritt. 1973. p.28). This is relevant to the nursing practice because the environment plays an important role in the management of the disease, in how the nurse makes use of the environment in the investigation of how the disease began and how it contributed to the illness of the patient. The environment will also determine the progress with which the client recuperates or recovers (Ibid. p.40). Managing the environment will become one major factor for the nurse to consider when planning for the course of action to employ. The client’s attitude towards the environment as well as his level of learning will now become an aspect for the nurse to intervene with (Gropper. 1990. pg. 32).
2. Describe three approaches to the above identified concerns using 3 nursing conceptual models
The three approaches to the environmental concern of the client can make use of Florence Nightingales’ model, Dorothea Orem’s model as well as that of Jean Watson. The central them of Florence nightingale in 1860 says that the overall wellness requires the meeting of the client’s personal needs through the manipulation of the environment, where a healthy environment is necessary for the client’s wellness. This clinical practice involved in the employment of this model addressed the concerns of the patient in the promotion of clean, well ventilated, temperate and sanitized environment along good diet, well lighted and free from noise (Connelly. 1987. pg.621). Dorothea Orem’s model on the other hand, advances self care as a human need whilst the deficits in self care such as poor hygiene and poor grooming is a concern that requires specific nursing actions (Hartweg. 1991). It purports Nursing as a human service where the nurse is designed to organize plan and implement interventions to provide or to manage self care actions for sustaining health or recovering from an illness or injury. The theory of Jean Watson of 1979 on the other hand, contains a concept whereby Nursing is concerned with the promotion and restoration of health. Most of all, Watson’s model emphasizes the prevention of illness as well as the caring for the sick. Clinical nursing care is holistic to promote humanism, health and quality of living (Watson. 1981. pg. 245). It also makes special emphasis on caring as universal and is practiced through interpersonal relationship.
With Nightingale’s promotion of clean environment and Orem’s promotion of proper self care coupled with Watson’s holistic care are three approaches that are essential elements in the nurses’ creation of a care plan. One of the important roles of a nurse is the administration of a planned care designed and aimed to promote overall wellness and recovery. Thus the nurse will be able to implement interventions that will educate the patient on how to correct his/her environment to prevent illness, or what to do with the environment in order to alleviate illness. The nurse will likewise effectively instruct and teach clients on the importance of good hygiene as the primary means to prevent the acquisition of diseases and correct the practices of the client that causes him/her to be vulnerable to an illness. Should the patient be suffering from an illness, the nurse will then make use of these model to discuss the possible causes of the illness, and then implement a care plan that factors in interventions aimed not only for the illness aspect but at the same time, the promotion of social, psychological and physical well being (Walther. 1995.pg.99).
3. Suggest approaches that are congruent with the nursing models chosen
Approaches according to Orem’s model may include, teaching the client of the importance of regular hygienic practices such as good grooming, cutting the nails and frequent hand wash each time the patient uses the comfort room. Regular hand wash should also be emphasized since the bacteria’s portal of entry through the body primarily begins in the hands, therefore the patient must understand that while there may be normal bacteria/flora in the skin, the likelihood of increasing these bacteria become greater with the surfaces that the hands get in contact with, that when left unwashed may likewise contaminate the food held prior to putting it in the mouth. As for nightingale’s model, an approach may be reflected in emphasizing the importance of a well ventilated environment for patients with upper respiratory problems because the free flowing clean air will help the patient breath in clean air. By making use of nightingale’s model, the nurse may emphasize to a patient with gastro intestinal problem to keep his toilet and lavatory clean and well sanitized. It may also be utilized by telling the patient to keep clean and well washed utensils in order to avoid bacteria from entering the body though an infected spoon and fork or glass. The nurse may likewise instill the importance of a dust free room for patients suffering from asthma, as this will trigger an attack. Using Watson’s concept may assist the nurse in designing a plan of care for patient that promotes not only the physical healing but also the social and psychological and spiritual, where the nurse could plot out activities that involves counseling of patients suffering from poor self esteem secondary to the social impact of the illness, such as the social impact of tuberculosis that sometimes causes the patient to withdraw from other people. In here the nurse may implement activities that allows the patient to interact with other patients nearing the recovery phase of the same disease wherein they can share their experiences while in the earlier stage so that the affected patient will feel that everyone goes through these normal process. Educating the client of the nature, characteristics and prognosis of the disease will help client understand what is happening thus making acceptance and cooperation easier. Discussing the importance and relevance of medication will also help foster understanding and cooperation, thus requiring less monitoring of the nurse especially when the client is about to go on discharge.
4. Describe the implications of using the nursing models selected in practice
The major concepts of a chosen model or theory guides each step of the nursing process. The concepts serves as categories to guide the nurse in determining what information is relevant and should be collected to make assessments as well as nursing diagnosis. These concept, also suggests the appropriate types of nursing interventions and patient outcomes to be included in the care plan. This can also be relevant in conducting research to further examine scientific, observable and verifiable information necessary for the employment of systematic care techniques. These models, encompasses both research to improve the care of people in the clinical setting and also the broader study of people and the nursing profession, including studies of education, policy development, ethics and nursing history. Nurses should be concerned with the advancement of nursing as a profession, and the employment of these methods promotes the development of greater autonomy and strength. Nurses, depending on their level of education, conduct or participate in research to improve their efforts to deliver high quality and cost efficient care.
These models likewise are fundamental to the recognition of nursing as a profession. As an occupation, has existed since the beginning of human history. Many argue however that this profession is still in the infancy stage neglecting one essential element that differentiates the profession from an occupation, and this is the possession and existence of a distinct knowledge based proficiency. The ultimate goal of the use of these models is to expand the act of nursing and care to an overall method of promoting and maintaining health. I believe that these concepts are there to improve the act of nursing not only as a career or a profession, but most of all to make it a lifestyle.
5. Describe 3 benefits gained from examining practice concerns and a nursing model
As definitions of nursing have expanded to describe more clearly the roles of nurses, much attention has been attributed to nursing as a professional discipline as it uses existing and new knowledge to solve problems creatively and meet human needs with in the ever changing boundaries. Nursing is recognized increasingly as a profession based on the criteria which includes, a well defined body of specific and unique knowledge; strong service orientation; recognized authority by a professional group; code of ethics; professional organization that sets standards; on going research and autonomy. Nursing involves specialized skills and application of knowledge based on education that has both theoretical and clinical practice components. Nurses uphold the standards set forth by the professional organizations and follow an established code of ethics. Nursing focuses on the human response to actual or potential health problems and is increasingly focused on the wellness aspect; an area of caring that encompasses a unique knowledge and abilities. This is also increasingly recognized as scholarly, with academic qualifications, research and publications specific to nursing accepted and respected widely.
Nursing interventions are likewise based on evidence based practice based on research and not intuition. Although nurses have conducted and published research, only recently has the importance of using scientific evidence to develop guidelines for nursing care been recognized. By identifying and analyzing the best available scientific evidence, nurses steadily develops further guidelines for clinical practice which are useful nationally at the same time internationally.
It also increases the availability of healthcare which provides community based setting, thus involving the community in general making health care not only a business for the health provider but of the entire community in general. These community based settings includes the presence of community clinics, out patient department and institutes in the likes of nursing homes or home for the aged or orphanages. The impetus of these changes are largely due to the implementation of a system of managed care to control and monitor health care service to minimize cost.
The third impact would be on decreasing the length of stay in the hospital, though the patients require in house/hospital care, their length of stay is thus increased because of this nursing models. This trend affects nursing in several ways as nurses are employed in the hospital setting so they must be equipped with ample knowledge and skills to provide often complicated illness which necessitates nurses to provide broad aspect of care to very ill patients (Watson. 2000. p.6). But if such illness is managed properly in the least amount of expenditures on the part of the client, then there is a win/win situation wherein the achievement of cost efficient health care is successful (Watson. 1979). If the nurse is effective in educating the patient about the proper methods of preventing an illness, the chances for the patient to go back for another hospital stay incases of recurrence is lesser, which means that the patient is able to practice autonomy in implement what has been learned. The process of preventive care is thus a shared liability between the nurse and the patient.
In conclusion, the concept based nursing models are among the framework that makes nursing an essential aspect of healthcare provision. This is because these concepts caters not just of the illness nature, not just of the disease itself, but rather it looks at both the human and the disease and integrates both in managing its effect. Without these models, perhaps nursing would not be able to evolve into a holistic method of care, because each theory defines and structure what the word nursing should be all about. It not only defines the act of caring but it standardizes the act into series of process which are useful in promoting wellness.
Reference Page
Barritt. E.R.(1973). Florence Nightingales values and modern
nursing education. Nursing Forums 12(1), 7-47.
Connelly, C.E. (1987). Self Care Deficit and the Chronically ill
patients. Nursing Clinics of North America, 22, 621-629.
Gropper, E.I. (1990). Florence Nightingale: Nursing First
Environmental Theorist. Nursing Forum, 25(3), 30-33.
Hartweg, D.L.(1991). Dorothea Orem: Self Care Deficit Theory.
Newbury Park. CA: Sage Publications Inc.
Orem, D. E. (1995). Nursing: Concepts of Practice. 5th Edition.
St. Louis: Mosby.
Walther, R. D. (1995). Primary Partnership: A blended Model for
Patient Care in the Psychiatric Unit. Journal of the American Psychiatric Nurses Association, 1 (3) 97-101
Watson, J. (1981). The lost art of nursing. Nursing Forum.
20(3), 244-249
Watson, J. (1979). Nursing: The Philosophy and Science of
Caring. Boston: Little Brown.
Watson, J. (2000). Leading via caring-healing: The Four Fold way
toward Transformative Leadership. Nursing Administration Quarterly, 25(1), 1-6
