Nursing
Order Instructions:
Content
1. Introduction to the paper includes a few general statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice. For example, why would one pick a nursing theory to solve a practice problem? Would a grand, middle-range, or practice theory be best? Does the writer have any experience in using nursing theory this way? In addition, a brief one-paragraph summary of a specific nursing theory and information on the sections of the paper are provided. The selected nursing theory can be a grand theory, a middle-range theory, or a practice theory.
2. Description of the problem/issue for which strategies will be developed. The problem to be resolved must be in nursing leadership, nursing education, nursing informatics, or health policy. Scholarly evidence (in the form of a literature review) supporting the issue is included. The problem/issue could be local to one’s specific practice setting. For example, the setting might be a nursing unit, a nursing-education program, an informatics department, or a health-policy unit of a consulting firm. The problem/issue needs to be something that a nursing theory can impact, whether it solves the actual problem/issue or enables people affected by the problem/issue to deal with it. It is best if the problem/issue is from real life – something the writer of the paper has dealt with or is currently engaged in.
Some examples (these are fictitious examples)
a. A nursing unit has experienced rapid turnover of professional staff, including several nurse managers. A new nurse manager from outside of the nursing unit is appointed.
b. Informatics nurse specialists face a lot of resistance from all healthcare professionals to implementation of a computer-based order entry program. The implementation date will not be changed.
c. A nurse educator is assigned to take over a large class of undergraduate nursing students, with a mix of young adults and adults returning for a second degree. The subject is difficult, students have not been doing well, and frustration and tempers are impeding group work.
d. A health-policy nurse specialist works for a consulting firm that lobbies on behalf of many healthcare professions. Within the specialist’s work unit, there is much debate over the pros and cons of various policies being proposed for attention in the coming year.
3. Applying concepts and principles from the selected theory, one strategy for resolving the identified issue is described in depth. Details on how the theory would be applied are included (consider: who, what, when, where, and how). Rationales for the strategy as well as evidence from scholarly literature are included. One ethical and/or legal aspect of the strategy is discussed. Expected outcome(s) from implementing the strategy are proposed.
4. Concluding statements include new knowledge about applying nursing theory gained by writing the paper
Format and Special Instructions
1. Paper length: 6 pages minimum; 8 pages maximum, excluding title page and reference page. Points will be deducted for not meeting these requirements.
2. The textbook required for this course may not be used as a reference for this assignment.
3. A minimum of 3 scholarly references are used. References must be current – no older than 5 years, unless a valid rationale is provided. Consult with the course instructor about using an older source.
4. Title page, body of paper, and reference page(s) must be in APA format as presented in the 6th edition of the manual
5. Ideas and information from readings and other sources must be cited and cited correctly.
6. Grammar, spelling, punctuation, and citations are consistent with formal academic writing as presented in the 6th edition of the APA manual
SAMPLE ANSWER
Introduction
Barr and Welch (2012) suggest that leading change in health care has become more rampant among the nurse leadership. Strong leadership in partnership facilitates smooth transformational change. Nursing theory shape nurse practice in a myriad ways, and provides considerable positive impact. Nursing theory provides a framework, which support nursing practice and offers solutions to nursing ethical dilemmas, thereby ensuring delivery of quality care. Nursing theories assists the nurse discipline in the clarification of beliefs, goals, and values. This facilitates proper definition of the unique nurse contribution to the concept of care. In fact, nurse clinical practice standards are derived from the nursing theories. The nursing theory resolves challenges in educational, leadership and research as well as practice settings.
Depending on the health issue under investigation, there are three major types of nursing theory. Grand nursing theory is the broadest, but provides generalized propositions. This level of nursing theory reflects on the nurse practice, thereby offering very insightful solutions. Theories in this level include conceptual frameworks. The middle range theories scopes are narrower than Grand nursing theory. The importance of this level of nursing theory is that it acts a bridge between the grand nursing theory and nursing practice. The nursing practice theories have very limited scope. These theories are developed within a specific nursing practice. The nursing theories at this level offer intervention for nursing practice, and predict outcomes of nursing practice. The advantages of nursing theory will be demonstrated by Jean Watson’s theory (Clark, Zickar & Jex, 2013).
Identification of practice problem
The main issue in the health care facility I work at is staffing ratio. Literature indicates that nurse-staff ratio ensures quality of care. However, high turnover rates and reduced number of nurse graduates has been an ongoing challenge of nurse managers as well as administrators. Blignaut, Coetzee & Klopper (2013) argue that challenge is associated with negative patient outcome, reduced safety in work place and reduces patient satisfaction. The high turnover rates are attributable to nurse overwork, burnout, and fatigue. This affects nurse’s practice because the nurse lacks compassionate working.
Witges & Scanlan, (2014) state that the staffing ratio has been associated with reduced patient and nurse safety. The availability of health as nurses who have had ample rest is important in providing quality and empathetic acer. However, most work places are described with innumerable stressors, which often result to disease or even injuries. The stressors occur in various forms such as, characteristics of the facility’s leadership, internal and external changes the organization. Some of these changes includes lean contracts, use of advance technology without refresher courses, increased population of older workforce and high number of aging population seeking care in the healthcare facility have been associated with reduced patient safety.
The hazardous working condition can impair nurse’s health. This includes health complications such as musco-skeletal disorders, infections, mental discomfort, cardiovascular diseases, and other complications such as neoplastic diseases. Working for longer shift affects nurse sleep pattern and gastro-intestinal system. This results to psychological response such as stress and depression. Long hour shifts also increases rate of exposure to harmful chemicals and infectious agents. Long hour working can increase smoking and alcohol consumption rate, and caffeine use with the aim of fighting fatigue (Blignaut, Coetzee & Klopper, 2013).
According to Lievens and Vlerick (2013), the traditional approach of addressing the nurse staffing issues has not been very successful. The paper suggests that by applying the theory of human caring will help solve this challenge. This is because the model points out on nursing leadership solutions, which can help the administrators and the healthcare management by guiding them on how to solve this issue amicably.
Proposition of Jean Watson’s theory
Thomas-Hawkins & Flynn (2015) study indicates that the main concepts of the Jean Human caring theory assume that the foundation of nursing and its essence resides in provision of care. According to this theory, quality care provision is enhanced through interpersonal interaction. The main and basic assumptions of the theory include the fact that caring is effectively practiced through interpersonal interaction. The theory suggests there are a set of carative factors, which increase patient satisfaction. The theory also suggests that effective care promotes health of the patient, family and the community at large. Additionally, the theory suggests that caring responses accept a person as what she is currently and what she may become in the future. The nursing theory concept suggest that a caring environment is important as it provides an opportunity for a person to choose the best care plan for themselves at any given point of care.
Witges and Scanlan (2014) research indicates that a caring leadership is more healthogenic, this makes caring an integral concept to nursing practice. The theory has ten carative factors including the establishment of humanistic-altruistic leadership system. This factor is mediated through experiences and exposures to various healthcare challenges. This factor is paramount for maturation of nurse leadership and management skills. This nursing theory suggests that an effective leadership is one that cultivates sensitivity to others and to oneself. The nurse leader must ensure that the nurses are more sensitive and authentic. Moreover, the nurses should be encouraged such that self-actualization and self-growth is sustained. This in turn ensures that those people the nurse interacts with are empowered, thereby promoting health.
Empowered nurses will ensure that they build a strong relationship through effective communication. Effective communications is associated with good work place rapport and strengthen the aspects of human caring. The theory outlines that a good leadership is characterized by empathy, congruence, and warmth. These feelings foster a caring relationship between healthcare facility management and their staff as it improves the organizations awareness. The human caring theory enables the nurse leader to solve problems following systematic scientific approach of problem solving. This is the only approach to control, predict and to find the best solution. The human caring science should always be neutral and objective. The human caring theory focuses on the learning-teaching process. This will help the nurse understand the situation better, enabling them have a cognitive plan (Clark, Zickar & Jex, 2013).
Blignaut, Coetzee, and Klopper (2013) argue that for quality delivery of services, the model suggests that nurse must work in a safe environment. Tis will help the nurse to offer supportive and protective care adequately. The human caring theory recommends that both the internal and external environments should be at equilibrium as both environment are interdependent. The model as is grounded in a hierarchy of human demands similar to that of Maslow’s, and each need or demand is as important as the principles of nursing. Therefore, to provide an optimal care, the needs should be valued and attended. Lastly, the model has some allowance for existence of phenomenological forces. Phenomenology in this case refers to the way people understand and value this i.e. people’s opinion. The model allows the integration of psychology in nursing leadership. This helps the nurse and the organization management to mediate the concept of holistic nursing practice, and identify the best approach, which will empower nurses, improve staff ratio, lower nurse workloads and strengthen the quality of care.
Application of Watson’s theory
Witges and Scanlan (2014) reveals that Nurse Leaders can use this theory to address nurse safety issues associated with reduced nurse-staff ratio. Using the ten caritas, the health care facility can address the issue of nurse staffing and by enable the staff engage in holistic nursing practices, and making the uses engage in self-care. Additionally, the organization can plan on policies, which will ensure nurses do no work for long hours. The organization leadership should ensure that the nurses have enough time to rest so that they can rejuvenate. Incorporating this theory into practice, provides a great impact to the work environment as well as positively impact on the nurse’s perception. The theory enables the nurses to incorporate a caring practice in their practice; caring to patients and to their health’s. This indicates that there is connectedness between nurse leadership, nurse and the patients.
Strategy Rationale
Nurse safety is an integral component in any health care facility; however, the concept is overlooked. There are limited resources on the role of nurse leadership in enhancing staffing ratios. With the shortages of nurses in the country, it is high time that for leadership to explore other options such as the adoption of new technology such as robotics, telehealth, use of sensors in beds, motion sensors and thermos-sensors to help the nurse in delivering their services. Other options such as employing of unregistered nurses as staff assistance, more volunteers, and interns could be other options, which can be applied to reduce nurse workloads (Blignaut, Coetzee & Klopper, 2013).
According to Clark, Zickar & Jex, (2013) the strategy intends to reform the healthcare facility policies and protocols, which acts as barriers to improving, nurse safety through increasing nurse-staff ratio and reducing overworking the nurses. The exact model, which will be applied in this strategy, is Continuous Quality Model commonly referred to as FOCUS-PDSA. The Strategy rationale includes searching and seeking the underlying concept, which cause high turnover rates and increased workloads for the employees. This includes exploring options of integrating computerized health care devices such as Tele-health concept. Organization committee comprising of relevant stakeholders will be formed. These people (including nurses, managers, head of departments and community representatives) will preside over the barriers and facilitators of working; analyze the discrepancies and to establish the most effective interventions.
Expected outcome
The evaluation of the expected outcome will be done after one year. However, this should not be limited within this time because interventions outcomes may take a while before they are realized. The expected outcome includes improved and safe working environment. The nurses should not act for long hours. The turnover rate should decrease as well as the number of work injury or ailment related complication. The benefits of improving working environment for the nurses are manifested through increased quality of care. This includes reduced number of hospital acquired infections, hospital falls and postoperative infections. This is because the nurses will be in a position to deliver quality care, with minimal confusion or error. Relaxed and nurses with adequate rests manifest proper communication and interpersonal skills. This implies that there will be a reduction in medical errors, improved quality of life, and patient’s satisfaction.
The main challenges with this nursing theory is that it does not rely on the conventional mechanism of ensuring that only qualified people are employed, which are still being applied in most of the healthcare facility. Additionally, the theory lacks mechanisms to motivate nurse work force to ensure that they are retained. This implies that the theory is somewhat too abstract that the leaders may become reluctant to integrate into practice (Blignaut, Coetzee & Klopper, 2013; Witges & Scanlan, 2014).
Conclusion
Nurse staffing and nurse safety is a major issue, which need to be addressed. For a long time, these challenges have been solved using shortsighted interventions such as additional incentives and recruitment bonuses. These interventions solve the problems temporarily, and introduce fiscal difficulties to the organization. This calls for the integration of nursing theory to address this issue more amicably, through practical interventions. This implies that the nurse leaders must be involved, and must apply nursing theory to identify the underlying mechanism. The nursing theory should be applied when exploring available options. It should also be applied when making long-term changes that will shape the health care facility in to a safer environment for both the service user and service provider. Using theoretical framework, the nursing leadership as well as organizations will record higher employee retention rate, and simultaneously improve the quality of care and patients outcome.
Reference list
Barr, J., & Welch, A. (2012). Keeping nurse researchers safe: workplace health and safety issues. Journal Of Advanced Nursing, 68(7), 1538-1545. doi:10.1111/j.1365-2648.2012.05942.x
Blignaut, A., Coetzee, S., & Klopper, H. (2013). Nurse qualifications and perceptions of patient safety and quality of care in South Africa. Nurs Health Sci, 16(2), 224-231. doi:10.1111/nhs.12091
Clark, O., Zickar, M., & Jex, S. (2013). Role Definition as a Moderator of the Relationship Between Safety Climate and Organizational Citizenship Behavior Among Hospital Nurses. J Bus Psychol, 29(1), 101-110. doi:10.1007/s10869-013-9302-0
Lievens, I., & Vlerick, P. (2013). Transformational leadership and safety performance among nurses: the mediating role of knowledge-related job characteristics. J Adv Nurs, 70(3), 651-661. doi:10.1111/jan.12229
Thomas-Hawkins, C., & Flynn, L. (2015). Patient Safety Culture and Nurse-Reported Adverse Events in Outpatient Hemodialysis Units. Res Theory Nurs Prac, 29(1), 53-65. doi:10.1891/1541-6577.29.1.53
Witges, K., & Scanlan, J. (2014). Understanding the Role of the Nurse Manager: The Full-Range Leadership Theory Perspective. Nurse Leader, 12(6), 67-70. doi:10.1016/j.mnl.2014.02.007
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