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Theoretical Foundations of Nursing:
Nursing can be described as a science and practice that enlarges adaptive capabilities and improves the transformation of an individual and the environment. This profession focuses on promoting health, improving the quality of life, and facilitating dying with dignity. The nursing profession has certain theoretical foundations that govern the nurses in promoting adaptation for individuals and groups. These theoretical foundations include theories, theory integration, reflection, research and practice, and assimilation.
Grand Nursing Theory:
There are several grand nursing theories that were developed by various theorists including the Science of Unitary Human Beings by Martha Rogers, Sister Callista Roy's Adaptation Model, and Systems Model by Betty Neuman. Sister Callista Roy's Adaptation Model is based on the consideration of the human being as an open system. She argues that the system reacts to environmental stimuli via cognator and regulator coping techniques for individuals. On the other hand, the stabilizer and innovator control mechanisms are the means with which the system responds to environmental stimuli for groups (George, 2009).
Sister Callista Roy developed this grand nursing theory while she was a graduate student at the University of California -- Los Angeles. The major factor that prompted her to develop this theory was the challenge she received to build a conceptual nursing model by Dorothy Johnson in a seminar. During this process, she examined Harry Helson's adaptation theory and obtained concepts from Seyle and Lazarus. The development of the adaptation model was also influenced by her 17-year work with the faculty at St. Mary's College in Los Angeles, where it became the framework for a nursing-based integrated curriculum.
One of the central values and beliefs established by the theorist is that nursing focuses on transforming stimuli or fostering adaptive procedures to lead to adaptive behaviors. In essence, nursing practice focuses on promoting adaptation for individuals and groups throughout the four adaptive modes in order to improve health, enhance quality of life, and contribute to dying with dignity ("The Roy Adaptation Model," 2013). Secondly, this model presents an individual as a holistic adaptive system that constantly interacts with both the internal and external environments. As nursing focuses on promoting successful adaptation, the major responsibility of the human system is to maintain integrity when faced with environmental stimuli.
Roy's Adaptation Model is adequate and useful for nursing education since it incorporates the four metaparadigm concepts. Its use in nursing education is evident in its integration as a framework for nursing-based curriculum. The person metaparadigm is included in the model through its definition of the human system while environment is included through consideration of environmental stimuli. The concept also defines health and states the major goal of nursing practice in relation to individuals and groups. However, this model can be more useful in nursing practice because it enables the nurse to follow the six stages in the nursing process (Masters, 2011).
Nursing Theory and Recommendations for the Future of Nursing:
The Institute of Medicine recently published a report on the future of health care in the United States. One of the major concepts highlighted in the report is the critical role nurses will have in that future with regards to promoting safe, quality care, and coverage for every patient in the health care system ("IOM Recommendations," 2011). The basis for these recommendations includes the need for nurses to practice to the total extent of their education and training and need for improved education system to facilitate seamless academic progression.
The other factors are need for improved data collection and information infrastructure and fostering partnerships between nurses and other health care professionals.
Since nursing theory has usually played an important role in nursing practice, it will play a crucial role in supporting IOM recommendations for the future of nursing. However, the role of nursing theory in the future of nursing will require further theoretical development, which will be fueled with the needs of the population. Further theoretical development in the nursing field will also be characterized with attempts to meet the needs of patients from an interdisciplinary and integrative measure of perspective (Meleis, 1995, p.112). In order to support IOM recommendations, the nursing profession will be based on phenomenon-driven theories.
Nursing theory can support the future of nursing through focusing on three major areas, which are the basis for IOM recommendations i.e. education, research, and practice. Under education, nursing theory should offer a general emphasis for designing curriculum and directing curricular decision-making. In research, nursing theory should provide the basis for producing knowledge and new ideas, facilitate the identification of knowledge gaps in the field of study, and provide a systematic framework to identify study questions, interpret findings, and ratify nursing interventions ("Application of Theory in Nursing Process," 2012). Under practice, nursing theory should govern assessment and intervention of nursing care, develop the means to evaluate quality of nursing care, and provide a framework for data collection.
Middle Range Theories:
One of major middle range theories is Watson's Theory of Human Caring, which focuses on how nurses provide care to patients and the translation of that caring into improved health plans that promote the patients' well-being. Jean Watson states that people enter the profession because of the opportunity it provides to care about individuals. Based on Watson's Philosophy and Science of Caring, nursing practice is founded on caring and promotes improved health as compared to mere medical cure. Therefore, caring promotes growth since a caring environment accepts an individual as he/she is and works toward making he/she become better ("Jean Watson -- Nursing Theorist," 2011). Watson's development of the theory and philosophy is attributed to her rich history and background in the nursing field, which can be traced to graduation from Lewis Gale School of Nursing in 1961. She holds a Bachelor's Degree in Nursing, a Master's Degree in Psychiatric and Mental Health Nursing, and a Doctorate Degree in Educational Psychology and Counseling.
A good model case for applying Watson's theory is in delivery of care to older adults in order to promote successful aging. For instance, a 59-year-old patient has been admitted to a hospital for acute abdominal pain caused by excessive drinking. The patient asks for pain medications more often than other patients suffering from the same condition. In addition to requiring a higher level of analgesia, the patient is provided with more morphine dose due to conflicts with the physician.
The current measures and views of successful aging originate from the medical model and primarily focus on behavioral determinants of health (McCarthy, 2011, p.22). However, successful aging requires combination of biomedical and psychosocial perspectives, which can be achieved through caring. Watson's Theory of Caring can be used in this scenario to address the patient's biophysical, psychophysical, and psychosocial needs. This can be achieved through attentiveness, responsibility, competence, and responsiveness. It implies recognizing the patient's need, determining the scope and extent of care, developing effective intervention strategies, and evaluating whether the patient's caring needs are met (Lachman, 2012, p.114).
In an advanced nursing role, the application of the theory would follow the same procedure, which is similar to the scientific process i.e. assessment of the problem, development of a nursing care plan, implementation of the developed plan, and evaluation of the results. Notably, the assessment of the problem may involve formulating a hypothesis while the evaluation of results may contribute to formulation of another hypothesis. The strength of Watson's theory is that it helps to develop a generalized framework for practice that is applicable to various patients and situations. However, the theory is not useful in situations that need more structured approach to patient care.
Research and Practice:
While middle range theories are quite different from grand nursing theories, grand nursing theories provide the basis for some of the middle range theories like Self-Care Deficit. As compared to grand theories, middle range theories are more constrained though not as solid as situation-specific practice theories. In the past few years, these theories have attracted huge scientific interest because of their high levels of construction (Andershed & Olsson, 2009, p.598). However, there is need to continue examining and promoting the use of middle range theories in nursing research and practice.
One of the major reasons for ongoing evaluation and promoting the use of middle range theories is the fact that these theories have a high explanatory value in understanding varying phenomena and easy application in practice. Through assessing these theories, researchers will not only examine the relevance of the theories but they will also develop measurement tools and practical models. This will also enable assessment of the effectiveness of these theories and how they can guide nursing research and practice.
Secondly, these theories provide valuable management mechanisms to facts being evaluated by interdisciplinary teams. There is a huge need to continue using middle range theories in research and practice because they are beneficial to nurses and professionals from other disciplines with formulating common phenomena (Smith & Liehr, 2008). The use of these theories in research and practice elevates nurses' work through theory-guided practice. Thirdly,…[continue]
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