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[Sample Paper #2 Using Four Heading Styles]Maintaining a Clear Focus in Nursing Practice [Name of the Assignment – only on title page]]Julie A. Student The University of Toledo College of NursingNursing 1000 – Introduction to Issues in Health CareDr. Anthony Deever[Faculty Name(s)]January 43, 2030[Date Turned In]Basing one’s practice on nursing theory provides the nurse with a clearly derived focus for her care and decision-making. Traditionally, nursing has focused on its very important role in helping people manage the effects of a medical diagnosis. Extensive learning about the medical diagnosis and its underlying pathophysiology can overshadow awareness of the unique role of nursing. Few nurses have been exposed to and have learned well the language of the discipline as expressed in its many nursing theories. Nursing care is not defined or prescribed by any other discipline.True Believers of Nursing TheoryOliver (1991) described a true believer of nursing theory as one who is fluent in a theory that guides her or his approach to nursing - whether for practice, research, or education. Choosing a Nursing TheorySelecting a theory requires one to understand its underlying philosophy and values. The theory needs to be congruent with one’s own personal philosophy. Some advocate shifting to the theory that best fits the care situation. Moving from theory to theory in practice seems extremely difficult, because of the investment required to learn one theory well. The theory becomes blended into how one thinks and makes decisions. Reasons a Nursing Theory may not FitWhen the theory does not fit the situation, it may be that the nurse has a limited understanding of the theory, a limited willingness to invest in learning the theory or a limited vision of its usefulness. Some theories are limited in their application, because they were developed for specific situations, such as one developed primarily to describe the nursing role in facilitating the maternal role with a newborn. That theory has little usefulness for describing or understanding other nursing situations.Selecting Among TheoriesShared concepts of the discipline. All of the nursing theories share some or all of the major concepts of the discipline reflected by the relationship among person, environment, health, and nursing. Valuing the nurse-patient relationship is universal within the discipline, and all stress the importance of understanding the patient’s perspective. If the patient’s perspective is not valued, one could argue that the nurse is not practicing within the disciplinary values and perspective. Different foci. Some theories focus on the patient’s perspective and goals as the major guiding force for how the nurse works with the patient to achieve health. The nurse’s expertise is shared as the patient is willing to accept it. Examples include those written by Watson, Parse, and Peplau. Other theories focus on working with the patient, but stress the nurse’s expert guidance more, such as: Orem, Roy and Neuman. One may choose a theory, because its emphasis fits the nurse’s philosophy or area of practice better than another. Rejecting Nursing TheoryMany nurses reject the use of nursing theory. Some learned one or more nursing theories, and others were never exposed. Some nurses reject nursing theory altogether, because they may be more comfortable practicing from whatever theory base without examining the underlying values. The effort to investigate and compare the philosophical basis of nursing theory and theories from other disciplines requires a major commitment that may not have any apparent reward. Unless each nurse discerns the distinct uniqueness one brings to healthcare beyond assisting the promotion of good medical outcomes, there is little incentive to delve in the theories of one’s own discipline. Discerning the Differences between Medicine and NursingSome nurses identify caring and medicine as two roles of nurses, viewing the task-oriented care that supports patients’ recovery from disease as the medical side of nursing. A task-oriented approach, however, denies the holistic foundation of nursing. Medicine has as its focus the diagnosis and cure of disease. Nursing focuses on the person’s response to his or her health state or disease to support one’s quality of life.Nursing Theory as a CompassNurses’ practice encompasses concepts and theories from many disciplines. How those are used can result in a tangled skein of yarn or an intricately woven work of art. That is the power of using nursing theory as one’s overriding guide to practice. It is like a touchstone or compass that keeps us returning to the purpose for all our actions on behalf of patients. Using Theories from Other Disciplines to Guide Nursing CareBecause nurses require learning from many supporting disciplines, they sometimes adopt the theories they learn as a guide for nursing care. Using theories from psychology (or pathophysiology) as a primary focus neglects nursing’s holistic focus, and care becomes directed by psychologists’ philosophy and discipline. Similarly, adopting educational theories without testing their applicability may result in ignoring important factors from practice that were not part of their development.Advanced Practice NursesAdvanced practice nurses must be clear about their roles in providing advanced nursing care, because they overlap traditional medical care, too. Advanced Practice Nurses who adopt the role of physician-substitutes lose their unique value as nurses. Even when diagnosing and treating illness, a nurse’s holistic perspective about patients should guide one to delve into the patient’s health concerns, the context in which that person lives, and result in a better understanding of what interventions will be acceptable and may work to promote health. That insight also can come from understanding the aggregate community from which the person comes.CaringSeveral nursing theories describe caring in some depth. For example, Watson emphasizes caring to the exclusion of other major concerns of nursing, because she believes that without the caring relationship with patients, the rest becomes dehumanizing. Quite a different theory, Orem’s self-care deficit nursing theory, includes a consideration of mature love, which overlaps some of Watson’s ideas. Orem identified components of mature love as: 1) care, 2) responsibility, 3) respect, and 4) knowledge (knowing the person). This underlying philosophical perspective of Orem’s theory is often overlooked.Integrated Holistic PracticeIf nurses accept that holistic care is foundational to nursing, then, regardless of the theory one uses, basic changes in practice will reflect this value. Charting will involve more than check-mark assessment detail to reflect mind, body, and spiritual aspects. Sometimes, nurses do not really reflect valuing or recognizing their holistic approach and the “art” that is part of the science on a daily basis, because it is rarely documented. Nursing students reflect this perspective when they do not recognize care that does not include technological skills. One instance involved a student who had spent at least two hours listening to and supporting a panic-stricken patient express her fear of up-coming surgery. The student discounted the importance of her caring as intervention.Skills and Communication as Part of Holistic PracticeHow one carries out the technologic part of nursing can also reflect one’s art as much as interpersonal communication. For example, an “Orem” nurse recognizes the importance of the requisites of both solitude and social interaction and normalcy as much as “air.” If using Roy’s theory, then charting would need to include all modes: physical, interdependence, role, and self-concept. The nurse may change emphasis, depending on the patient’s needs, rather than focus in-depth in all areas. Art and Competence in CareHow often do we remember that how one helped a patient get through a difficult procedure was the true art, not only one’s competence in carrying out a specific procedure? Competence refers to more than psychomotor skills. Technologies alone do not define the level of education needed, but the judgment and art with which they are applied. Theoretical knowledge identifies the purpose for carrying out the skill and puts it within the context of the whole warp and weave of nursing care. Perhaps that is what is so hard. The most important part of what nurses do is not visible!Some nurses identify a time when nurses only carried out what MD’s ordered, without question, assigning accountability to the physician. In Great Britain, Nightingale recognized the flaw in that thinking by removing nursing education from the control of hospitals. ReferencesOliver, N. R. (1991). True believers: A case for theory-based nursing practice. Nursing Administration Quarterly, 15(3), 37-43. ................
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