Integration of Nursing Theories into Practice Essay
Integration of Nursing Theories into Practice Essay
Nursing theories are useful in the practice of nursing. I have been applying the interpersonal theory, as it defines the relationship between patients and nurses that evolves through identification, orientation, resolution, and exploitation. Interaction with the patients is a priority for me because I always seek to understand their problems so that it becomes easy to assist them. Moreover, trans-cultural nursing requires the provision of care in line with the cultural beliefs, values, and practices (Reed & Shearer, 2012). I always recognize the fact that care is the basis of nursing, as well as the distinctive, dominant, and unifying feature. Caring helps patients to become well, and this is the essence of offering culture-specific care. Integration of Nursing Theories into Practice Essay.
Patients should be encouraged to be independent to assist them during the recovery process. Need theory emphasizes the desire to increase the patient’s independence to enhance the healing progress after discharge (Reed & Shearer, 2012). As a nurse, I have a duty to help the sick in carrying out activities that contribute to their recovery or wellbeing. The aid is aimed at helping patients to gain their independence as fast as possible. Furthermore, a nurse has to be at the service of the patients so that they are offered quality health care.
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Nursing theory offers nurses with a viewpoint on how to consider the client’s situatioans. Therefore, it becomes simple to plan and implement health care proactively and purposefully. Planning helps nurses to practice systematically, which make them efficient, possess better control of patient outcomes, and communicate with the patients regularly (Reed & Shearer, 2012). Novice to Expert theory has proven to be effective in nursing profession because it guides on the levels of proficiency that nurses have to go through before qualifying as an expert. One starts as a novice, followed by an advanced learner, competent, proficient, and finally as a specialist.
References
Reed, P., & Shearer, N. (2012). Perspectives on nursing theory. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
This may be related to an increasing number of international nurse scholar exchanges in nursing academia; (e) “integration to practice” where nurses attempt to integrate theory into practice in their clinical practice. Occasionally two or more theories were combined to explain a particular practice setting phenomenon; and finally (f) “selective evolution” where most of the research noted related to the four grand theories: Neuman’s system model, Orem’s self-care theory, Rogers’ history of unitary human
Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry. Integration of Nursing Theories into Practice Essay.
Florence nightingale’s often quoted beliefs “that nature alone heals” and the role of nursing is to put the patient in the best environment for the natural reparative process to occur date back to the ancient Greek philosophers including Aristotle, Hippocrates, and Plato, whose writings Nightingale studied as a young adult.1 While nursing theorists have nearly unanimously recognized optimizing the environment for patients as an essential element of nursing care, there has been considerably less emphasis on the importance of the nursing work environment for nurses to be able to provide optimal care. More than 25 years ago, the seminal work of Chandler2 “The Relationship of Nursing Work Environment to Empowerment and Powerless” was grounded in Martha Rogers’ theoretical work on integrality or the continuous interaction of humans and the environment. Over the past few decades, the importance of the nursing practice environment has been explored through various research methods but is largely in the domain of health services researchers, who are exploring ways to reduce turnover and burnout among nurses and improve health outcomes for patients. The unique contribution of nursing science to advancing health research and changing norms of health care is stymied by the unfamiliarity or discomfort that many nurses associate with nursing theory, and the general tendency to ground nursing research in biomedical, sociological, or psychological frameworks.
Integrality reflects the oneness and unity or wholeness of humans and their environment.Integration of Nursing Theories into Practice Essay. In nursing practice, integrality involves the realization that the observer is integral to what he or she is observing. The focus is on collaboration (including our patients), coevolution of knowledge and patterns of health, and unitary thinking that does not reject objective analysis but recognizes its limits.3 In the context of nursing practice, a nurse’s way of being with patients is the pattern or form of the nurse’s care (including clinical judgment). How this way of being or care is expressed and perceived or received is a reflection of the interior and exterior environments of both the nurse and the patient, which will be discussed later in this article.
The ideas presented here represent the culmination of 8 years of inquiry regarding the central question: What is the essence and experience of nursing?4 The essential elements of the nursing meta-paradigm (nursing, environment, human being, and health) are redefined with implications for nursing research, practice, and education. While this work is grounded in contemporary integral philosophy, the findings are consistent with the Unitary Transformative Caring paradigm and articulate a clear foundation of the core elements of nursing that can be used to ground nursing education, research, and practice.5–10
PHILOSOPHICAL APPROACH AND EVOLUTION OF IDEAS
The philosophical inquiry approach used was grounded in contemporary integral theory and utilized an approach termed integral methodological pluralism, which aims to include all perspectives on an area of study.11,12 Similar to Kim’s nursing epistemology,* the organizational heuristic utilized in integral theory considers, at a minimum, the individual-interior realm of self and consciousness, the individual-exterior realm of the organism and language, the collective-interior realm of culture or worldview, and the collective-exterior realm of social systems and structures.13 The limitation of this method is that when there is not a solid understanding of the unitary or holonic nature of reality, the methodology can serve to further fragment rather than achieve coherence between paradigms. In addition, there can be a tendency to force data or knowledge to fit into the framework of the integral model.14 It is essential to recognize that the boundaries within the model, between categories, are “not a barrier but an interface, or region where 2 worlds are not just differentiated but joined.”14(p29)
The integral approach (as articulated by Wilber and many others) provides something deeper than a categorical framework within which to neatly organize one’s untidy reality: it suggests a certain attitude for how one can approach knowing, conceptualizing, and theorizing. Integration of Nursing Theories into Practice Essay. It suggests not so much what is true about the world but how people can work together to discover what is most true, just, and useful in a particular context (ie, it includes an epistemology as well as an ontology).15(p104)
My journey to answering the question “What is the essence and experience of nursing?” began with my participation in the 2003 Nurse Manifest emancipatory study of nurses’ perceptions of practicing nursing.6 Not surprisingly, the dominant theme was the primacy of the nurse-patient relationship, specifically teaching, caring, and mutual growth. The most interesting finding was how closely the work environment, including workplace culture, staffing, and availability of resources seemed to correlate with nurses’ perceptions of what it was like to practice nursing.16
This led me to extensive reading and reflection on the various theories and conceptual models of nursing, with particular attention to nursing meta-language, specifically the concepts of human being, environment, health, nursing, and caring. The second project consisted of unfolding and enfolding the core concepts of nursing, using the integral model as a lens, resulting in the enactment of an integral philosophy and meta-definition of nursing as “situated caring shaped by interior and exterior environments.”17 The ideas in that article were extensively discussed with mentors, peers, and colleagues during a 1-year period prior to publication, and I have continued to integrate additional perspectives and refine the ideas over the past 4 years. Integration of Nursing Theories into Practice Essay.Sources of knowledge or evidence include narratives of nursing practice from focus groups of nurses, a philosophical analysis of theories of nursing from the past 150 years, an analysis of the 50 US state nursing practice acts,18 international perspectives on nursing theory, and additional nursing publications including the American Association of Colleges of Nursing’s Essentials of Baccalaureate Education and the American Nurses Association (ANA) Scope and Standards of Nursing Practice.19–23Also included is the recently revised Scope and Standards of Nursing Practice, which now explicitly includes a standard for environmental health as a core competency of all registered nurses.24 It is important to note that the ANA defines environmental health as: “Aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychological problems in the environment.”24(p65)
Most recently, I have shifted my research to explore the relationship between nurses’ perceptions of the characteristics and quality of their work environments, and outcomes for nurses and patients through advanced health services research methods; performing secondary data analyses of large, linked databases. While there is criticism of the emphasis on evidence-based findings to justify what we know is true from other forms of inquiry or knowledge, the work of my quantitative-minded colleagues in this area provides the “evidence” needed by policy makers to make changes that improve nurse-patient staffing ratios and implement financial incentives to improve nursing care and care environments in acute and long-term care settings.25–28
Effecting major change in health care requires engagement of policymakers, health care administrators, patients and their families, nurses of all levels of education, our colleagues in other professions, and the media and society at large. What I aim to present here is an updated synthesis of the very basic definitions and relationship between the central concepts of nursing that should resonate with all nurses. Integration of Nursing Theories into Practice Essay. Since these ideas were first shared in print, the quadratic figures have been redrawn, now bounded by a circle (symbolizing wholeness and unity). Integral theory, like unitary science, maintains that the basic unit of analysis is not the atom, or the molecule, or the mathematical unit, or the interpretive perspective, or the cognitive pattern, or the historical event, or the spiritual revelation. For integral theory the unit of analysis, its basic point of explanation, analysis, reference, and “measurement” is the holon.29(p7)
When speaking of a human being, the unitary or whole person is the holon, or whole part—a part of a whole family, culture, community, or other collective. In addition, the thoughts and beliefs of a human being are part of their inner environment and, when interacting with another human being, can impact the external environment of another, and ultimately that person’s inner environment, which, in turn, is part of their whole self.
This is especially true in health care situations where there is a cross-cultural clash between health beliefs. For example, a patient who believes in a hot-cold system, associates the properties of “hot” or “cold” with all food, medicine, and “disease.” For the patient, this is an objective truth. To illustrate, a public health campaign to encourage boiling drinking water in a rural area of Peru failed because the local, traditional belief was that boiled water (even after it had cooled) had the property of “hot” and was beneficial only in times of certain illness states that are “cold” and therefore the local population would not drink previously boiled water as a preventative measure.30 In this case, it is important to note that while the hot-cold belief system would be considered part of the cultural knowledge (lower-left quadrant) or intersubjective perspective in the mind of the nurse, it is important to recognize that in the patient’s worldview, the hot-cold system is as objective as germ theory is in the biomedical worldview. Integration of Nursing Theories into Practice Essay. As such, boundaries in the quadratic figures used on the following pages are often fluid, and “in all cases a boundary is not a barrier but an interface, or region where two worlds are not just differentiated but joined.”14(p29)
PHILOSOPHICAL PROPOSITIONS
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Nursing is caring situated in space, place, and time, shaped by the internal and external environments of both the nurse and the patient/client. These environments include
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the individual’s state of mind, intention, and personal beliefs (including personal philosophy of nursing);
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their level of relevant skill, training, and experience;
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societal and professional norms, values, and worldview;
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the practice environment, embedded in social, political, and economic systems (or resources, in the broadest sense).
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Nursing impacts the health of individuals, families, groups, and populations through situated caring (or the lack of). Because of the integral (unitary) nature of human beings, physical, mental, or spiritual aspects of health may be impacted by care (or lack of care) in any dimension of their experience. For example, physical health symptoms may be impacted by psychological, spiritual, environmental, social, and cultural conditions or events. Integration of Nursing Theories into Practice Essay.
NURSING IS SITUATED CARING
The word situated, as used in the nursing literature, means to put in context and describes the circumstances surrounding something, in this case, nursing. An integral view of nursing contextualizes the multiple pathways through which nurses receive their education or training. The various lines of development in nursing (communication, clinical competence, ethics, professional behavior) do not, by definition, proceed at an equal rate and may or may not correlate with a nurse’s highest level of education or stage of practice (academic degree, novice to expert). This conceptual model of nursing situates the different levels of nursing and types of nursing within the context of the profession as a whole. By identifying the primary orientation of an individual, organization, or culture toward a core concept such as human being or health, nursing students and practicing nurses can learn to justify and document their caring actions and intentions in a manner that will be understood by their colleagues in other disciplines and reimbursed by insurance or health financing systems.
Situated caring in nursing means that what caring “is” depends on where you are (time, space, culture) as well as one’s level of development (eg, training and experience; psychological development; moral-ethical development) and the context of the situation (disaster, high-pressure situation, routine business, relaxed, etc).Integration of Nursing Theories into Practice Essay. A nursing encounter encompasses all these factors as well as both our patient’s perspective and our own perspective (regarding health, illness, disease, death, etc). The concept of “nursing” or “situated caring” is illustrated in Figure 1.
Nursing/situated caring.
When viewed through the lens of the Right-Hand quadrants, nursing is technical actions and physical behavior. When nursing is viewed through the lens of the Left-Hand quadrants, nursing is the caring thought, feeling, and intention behind the action. These are not two different types of nursing for without caring our work would merely be tasks that could be performed by machines. On the flip side, without action our most caring intention is little more than silent prayer.17(p89)
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(Note: The quadratic figures accompanying each of the core concepts are used for illustrative (rather than prescriptive) purposes. By definition, the relevant knowledge and information for any situation are context dependent and what is considered objective in one situation or context may be considered a personal or cultural belief in another context.) Integration of Nursing Theories into Practice Essay.
SHAPED BY THE INTERNAL AND EXTERNAL ENVIRONMENTS
Caring is situated in space and place as well as purpose and focus. Tanner31 writes about “noticing” as a function of the nurse’s expectations and experience, vision of excellent practice, values, workplace culture, and environment. Similarly, my research points to the importance of the internal and external environments of both the nurse and the patient/client. These environments include the individual’s state of mind, intention and personal beliefs (including personal philosophy of nursing or what nurses “do”); their level of relevant skill, training, and experience relevant to the care situation; societal and professional norms, values, and worldviews; and the practice environment, embedded in social, political, and economic systems, also referring to available resources, which might be a competent nursing assistant, working refrigerator to store perishable medication, or reliable transportation.Integration of Nursing Theories into Practice Essay. Figure 2 presents an integrative perspective on the concept of environment and a framework to explore the holonic nature of our environment or kosmos. Kosmos refers to the entire universe in all its many dimensions: physical, emotional, mental, and spiritual. From an integral or unitary worldview, aspects of the inner environment cannot be separated from the external environment, and thoughts, beliefs, and cultural norms impact how we perceive our external environment. For example, individual or collective paranoia can impact how a government response to a health problem (such as a disease outbreak) is perceived. Integration of Nursing Theories into Practice Essay.
