Applications of Concepts from Caring Science

Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence. Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two. Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate. Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses. This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured. Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex. If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B). Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents. Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion. Present your outcome in an APA formatted paper that meets the University’s standards for a written assignment.Applications of Concepts from Caring Science

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Application of Concepts from Caring Science

The concepts presented in nursing theories are usually the leading pillars that direct nursing practice. All good evidence-based interventions that are undertaken by nurses in the line of caring for patients are supposed to have proper theoretical underpinnings. These are provided by conceptual frameworks that can only be found in nursing theories. Conceptual frameworks therefore provide a base upon which sound evidence-based practice or EBP can be built. Like a lighthouse at sea to a ship; the concepts in a nursing theory guide, direct, and steer practice around pitfalls and obstructions that may render the interventions ineffective and inefficacious. Nursing theories fall into three main categories, with each differentiated according to the level of abstraction in the theory in terms of its concepts. According to Wayne (2020), all nursing theories will be (i) a grand theory (ii) a mid-range theory, or (iii) a practice-level theory. Among the three, it is grand theories that are the most abstract whereas practice-level theories are the least abstract. Practice-level theories are easy to understand, direct to the point, narrow in scope, and very specific. Mid-range theories fall in-between and are arguably the largest category of nursing theories (Risjord, 2018). Some well-known and most often quoted nursing theorists are Florence Nightingale with the Environmental Theory, Madeleine Leininger with the Transcultural Nursing (TCN) Theory, Dorothea Orem with the Self-Care Deficit Theory (SCDT), and Jean Watson with the Theory of Human Caring (Alharbi & Baker, 2020; Gonzalo, 2019a; Gonzalo, 2019b; Pajnkihar et al., 2017; Borji et al., 2017). The purpose of this paper is to discuss how theoretical concepts can be applied to nursing practice with regard to the clinical practice problem of patient falls among the elderly in a rehabilitation center. Special attention will be given to the application of Jean Watson’s Theory of Human Caring.Applications of Concepts from Caring Science

An Outcome of Nursing Practice that Can be Improved

The outcome of nursing practice that will be the subject of this paper is the rate of patent falls in the elderly patient population that is 65 years old and above. This is a measurable outcome that represents a need for quality improvement (QI) in the healthcare setting in which it is found. Patient falls in the elderly is such an important quality issue that the Center for Medicare and Medicaid services (CMS) as payers stopped reimbursing providers for care provided to patient fall victims (AHRQ, 2018; Fehlberg et al., 2017). There is overwhelming evidence from peer-reviewed scholarly literature that supports the notion that accidental patient falls are indeed a significant clinical practice problem in nursing as a profession. According to Kojima et al. (2015), elderly patients in healthcare settings such as rehabilitation centers are at an ever-present risk of suffering unintentional falls. This is due to the fact that they are frail, suffer from various comorbidities that bring about various levels of disability, and also often have cognitive deficits due to neurocognitive disorders. The current incidence of patient falls in the US stands between 3.3 and 11.5 falls per 1,000 patient days. The falls cause injuries such as fractures but also concussions and even death (Kenny et al., 2017). Venema et al. (2019) state that the national benchmark for patient falls stands at 3.44 falls per 1,000 patient days.

A Clinical Nursing Theory

Within the context of the clinical problem of accidental patient falls in the elderly patient population discussed above, a clinical theory in the form of concept A | Proposition | concept B can be created. In this way, therefore, the concept-proposition-concept theory will have the following components:

• Concept A: Patients who are aged from 65 years going upwards are frail. Their bodies have undergone physiological deterioration and now they are susceptible to adverse health outcomes from different directions. They also suffer from many comorbid physical conditions as a function of their old age. These conditions include cardiovascular disease (CVD), type II diabetes mellitus, hypertension, and multiple sclerosis amongst others. Apart from these physical conditions, persons in this age group of 65 years and above also suffer from mental illness that places them at even greater risk of adverse health outcomes such as injuries from falls. Of particular concern here are the neurocognitive disorders such as dementia (major neurocognitive disorder or NCD) and Alzheimer’s disease. The neurocognitive disorders are marked by cognitive impairment including memory loss, disorientation, and disordered speech. With these kinds of symptoms, the elderly 65 year-old will easily wake up from the bed without a purpose and injure themselves as they fall while leaving the bed. Measurement of this concept in research occurs through descriptive statistics in tabulation of demographic data.
• Concept B: Assessment of the risk of fall among patients reveals that patients who are senior citizens and aged 65 years and above are at the highest risk of suffering accidental falls in any healthcare setup. This is especially true with healthcare settings that have high numbers of these elderly patients such as a rehabilitation center or a nursing home. This risk assessment is done by using evidence-based tools such as the Morse Fall Scale (Falcão et al., 2019). Applications of Concepts from Caring Science Patients in this demographic category suffer various degrees of injury when they fall victim to accidental falls in a healthcare setting. The injuries add to their frailty and may eventually lead to their death due to complications such as intracerebral hemorrhage after a concussion and a stroke or thromboembolic myocardial infarction (MI). The measurement of this concept in research uses evidence-based risk assessment tools such as the Morse Fall Scale.
• Proposition: there is a positive correlation between concept A and concept B above. Concept A is directly responsible for concept B and the relationship is that of direct causality. The risk of accidental falls is a direct function of advanced age and its associated problems such as frailty and comorbidities. In research terms, the independent variable in this case is age above 65 years. On the other hand, the dependent variable is the occurrence of an episode of accidental fall within the context of a healthcare facility. The independent variable is a constant and cannot be change. However, the dependent variable is the observed characteristic that may or may not occur depending on a variety of factors. Evidence-based fall prevention interventions seek to prevent the occurrence of the dependent variable.

The clinical nursing theory created for this scenario is therefore that advanced age over 65 years is an independent risk factor for accidental falls.

A Comparison of the Created Clinical Nursing Theory with Watson’s Theory of Human Caring

The Theory of Human Caring by Jean Watson states that caring for the needy generates mutual benefit and creates a therapeutic bond between nurse and patient. It enables the potentiation of the nurse’s innate capabilities. On this, the major concepts in Watson’s theory that are pertinent to nurses include (Alharbi & Baker, 2020; Providence, 2020; Pajnkihar et al., 2017):

1. Selfless caring for others who need our help with the aim of restoring wellbeing
2. Playing the role of change agent and patient advocacy in a healing environment that is therapeutic

• Fostering the therapeutic nurse-patient relationship necessary for wellbeing and healing

1. Having faith in spirituality and the concept of miracles or divine intervention.

The proposition in Watson’s Theory of Human Caring is that caring is a necessity to the nursing profession. It is a moral obligation of one human being attempting to preserve and protect human dignity, wholeness, and wellbeing (Pajnkihar et al., 2017). This proposition is comparable to the one in the created clinical nursing theory above in that the evidence-based interventions for fall prevention are determined and implemented from patient advocacy and moral obligation point of view. Intentional hourly rounding by nurses, nurse training to effectively identify at-risk patients, and the use of intelligent bedside alarms (Linehan & Linehan, 2018; Leone & Adams, 2015) are all interventions for reducing the rate of patient falls that aim at preserving wellbeing and restoring dignity. This is congruent with the proposition advanced by Watson’s Theory of Human Caring.

Of the ten Caritas processes in Watson’s Theory of Human Caring, the one that matches concept ‘A’ above in the clinical nursing theory created is the creation of a healing environment that is respectful to the human body (Providence, 2020). Concept ‘A’ above states that the human body undergoes normal deterioration as one ages. This makes the older person frail and susceptible to adverse health outcomes. For this reason, the healing environment must be respectful to these aged patents that are 65 years and older. For instance, there should be no staircases in the rehabilitation center for older persons. Floors should not be slippery just as beds should be low. These will be attributes of a healing environment respectful of the human body.Applications of Concepts from Caring Science

Looking at the comparison made above and the congruency achieved between the concepts and propositions, the conclusion that can be drawn is that Watson’s Theory of Human Caring is a practical and applicable mid-range nursing theory that is compatible with many clinical nursing theories or models and practice situations. In the example and scenario above, the clinical nursing theory created for the accidental patient falls context fits perfectly well with the mid-range theory of Human Caring by Jean Watson.

Discoveries Made and Their Impact on the Nursing Profession

During the readings for this paper, many discoveries have been made by the author. All of these relate to nursing as a profession and its practice in caring for the patient. The first discovery is that there are many mid-range nursing theories that guide nursing practice. As professional nursing practice had developed over the years, so has the body of nursing theories available for use in guiding practice. From Florence Nightingale as the first nursing theorist, there have been numerous other nurse theorists who have followed in her footsteps to participate in building the body of nursing knowledge as we know it today. Some of these theorists have been mentioned in the introduction to this paper and one of them is Jean Watson. The impact of this discovery to the nursing profession is immense. It is that evidence-based practice (EBP) in nursing as a profession must be guided always by verified nursing theoretical concepts.

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            The other discovery was that the nursing interventions that are underpinned by concepts from proven nursing theories are what are usually referred to as evidence-based practice or EBP. That is practice that makes use of only those interventions that have proven efficacy in resolving what they are intended to resolve. They are not interventions that are undertaken just as a matter of course. They have rationale and this rationale is drawn from the conceptual underpinnings drawn from the mother theories such as the mid-range theory of Human Caring seen in this paper’s example. Lastly, an important discovery made also is that nursing is not just a profession but also a calling. In other words, nursing is more than just a profession. This has been evidenced by a reading of the 10 Caritas processes as defined by Jean Watson. The nurse is expected to be selfless, caring, and a patient advocate. Hey are supposed to put their interests aside and place the wellbeing of the patient above everything else. Of the discovered questions above, the one that requires further research is the one that states that nursing theories guide nursing practice. Further research is needed to determine whether grand theories, mid-range theories, and practice-level theories all guide nursing practice with the same levels of detail and practicality.Applications of Concepts from Caring Science

Conclusion

Nursing theories are important components of the profession of nursing. They guide practice and enable the implementation of evidence-based practice modalities. An example of a clinical problem that may be solved by using a clinical nursing theory is that of accidental patient falls. This paper has analyzed this problem and come up with a theory that has been compared to the concepts and proposition in the mid-range theory of Human Caring by Jean Watson. The two have been found to be congruent and compatible; with just a few lessons learnt that also have an impact in nursing practice.

References

Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

Alharbi, K.N., & Baker, O.G., (2020). Jean Watson’s middle range Theory of Human Caring: A critique. International Journal of Advanced Multidisciplinary Scientific Research, 3(1), 1-14. https://doi.org/10.31426/ijamsr.2020.3.1.3011

Borji, M., Otaghi, M. & Kazembeigi, S. (2017). The impact of Orem’s self-care model on the quality of life in patients with type II diabetes. Biomedical & Pharmacology Journal, 10(1), 213-220, http://dx.doi.org/10.13005/bpj/1100

Falcão, R.M.M., Costa, K.N.F.M., Fernandes, M.G.M., Pontes, M.L.F., Vasconcelos, J.M.B., & Oliveira, J.S. (2019). Risk of falls in hospitalized elderly people. Revista Gaúcha de Enfermagem, 40(e20180266), 1-8. http://dx.doi.org/10.1590/1983-1447.2019.20180266

Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036

Applications of Concepts from Caring Science