[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 Nursing
Nursing 1000 – Introduction to Issues in Health Care
Dr. Anthony Deever
[Faculty Name(s)]
January 43, 2030
[Date Turned In]
Student 1
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 Theory
Oliver (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 Theory
Selecting 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 Fit
When 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
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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 Theories
Shared 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 Theory
Many 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
Student 3
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 Nursing
Some 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 Compass
Nurses’ 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 Care
Because 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
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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.
Student 5
Advanced Practice Nurses
Advanced 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.
Caring
Several 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 Practice
If 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
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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 upcoming surgery. The student discounted the importance of her caring as
intervention.
Skills and Communication as Part of Holistic Practice
How 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 indepth in all areas.
Art and Competence in Care
How 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
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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.
Student 8
References
Oliver, N. R. (1991). True believers: A case for theory-based nursing practice.
Nursing Administration Quarterly, 15(3), 37-43.