Introduction
A nursing theory is a framework developed to organize knowledge and define the discipline more clearly (Cowden & Cummings, 2012). The suppositions promote quality patient care and provide solutions to various problems in the nursing practice. The theories are used to resolve challenges in both educational, research, and administration settings. In addition, they are applied when directly helping patients.
In this paper, the author will analyze middle-range theories and their application in the nursing profession. The conjectures are more concrete and narrow compared to grand theories (Cowden & Cummings, 2012). The reason behind this is because they contain a limited number of variables and prepositions. In spite of this, they can be used to resolve a wide range of clinical research queries. There are a number of middle-range theories in the nursing discipline. One of the most commonly used includes Orlando’s supposition of the nursing process. Another one is Watson’s theory of human caring. There is also Peplau’s model of interpersonal relations.
In this paper, the author will discuss how middle-range theories can be used by leaders and managers in the nursing profession to improve patient satisfaction and care delivery. A number of problems and issues in nursing will be discussed. Under each problem, a strategy that can be used to resolve it will be provided. In addition, there will be an analysis of ethical concerns in the profession. Other aspects to be discussed include models of leadership needed to enhance staff engagement and how middle-range theories can be applied in community settings.
Analysis of Problems and Issues in Nursing and Strategies to Resolve them from the Perspectives of Middle-Range Nursing Theories
The Issue of Patient Satisfaction and Improved Care Delivery
In the healthcare field, nurses work their level best to promote patient satisfaction and improve the quality of care provided. In spite of these efforts, they face challenges that may negatively impact on their ability to offer quality services (Kalish & Lee, 2011). One strategy to deal with the problem involves the use of the theory of nursing process. In the framework, Orlando stresses on the need for a reciprocal nurse-patient relationship. To this end, the major goal of healthcare providers is to identify and meet the immediate needs of an ailing individual (Longo, 2010). However, before making decisions, the practitioner should determine the patient’s behaviors and need for help. In addition, nurses should offer their services to people within any setting.
One ethical issue related to the application of this strategy is the need to enhance patient involvement. The theory also encourages patients to participate in the nursing process. One way of doing this is by effectively communicating their needs in instances where they are not critically ill and can initiate a conversation. When nurses use this model, they gain more knowledge on how to deal with patients’ needs (Longo, 2010). As a result, they improve quality of care and patient satisfaction.
Recently Publicized Ethical and Legal Concern in Nursing Profession
Overview
Ethics entails doing the right thing and causing no harm. However, different nurses have their own definition of what is ethical. In the nursing field, care providers are faced with ethical problems that affect them and their patients (Kalish & Lee, 2011). In spite of the frequent nature of the cases, majority of them attract little attention or go unnoticed.
One recently publicized ethical and legal issue in the nursing field is the Stoughton elder abuse case. The case involved a 75 year old lady under the care of a registered nurse. The practitioner was Sandra Lucien-Calixte. The lady was kept in a frosty basement room in Palisades Circle. She had sores, was malnourished, and dehydrated (Erwin-Toth, Thompson & Davis, 2012). According to Stoughton Police reports, Sandra was a healthcare provider recognized by the Commonwealth of Massachusetts. She was an employee of the Spaudling Rehabilitation Hospital. The thermostat in the room was set at 51 degrees. The old woman’s bed sores were so severe to the extent that some of her bones were exposed (Erwin-Toth et al., 2012). Upon rescue, the victim was immediately taken to the ICU.
Analysis of the issue from the perspective of human caring and process discipline theory
Watson’s theory of human caring is based on various principles. They include a relational caring for both self and others. To this end, nurses are required to base their practice on moral, ethical, and philosophical foundations of love and values. In addition, they should employ a reflective approach when helping patients (Cowden & Cummings, 2012). Orlando’s theory stresses on the need for a nurse to meet the patient’s immediate needs. When a healthcare provider helps an ailing individual, the purpose of nursing is met (Longo, 2010).
A review of Sandra’s case from the two theories reveals that the practitioner violated the nursing code of ethics. She failed to offer her help to the old lady as was required. Despite of her knowledge of the victim’s predicament, she chose to keep the elderly lady in a poor state. The situation could not facilitate her recovery.
Administrative Concerns in Nursing Profession
The problem
Disruptive behaviors in the healthcare profession impact negatively on the safety of both patients and staff. The issue is a major challenge in the nursing field. However, most cases are never recognized or reported. Managers and leaders should develop initiatives to address the problem. Failure to deal with unruly behavior silently encourages and reinforces it (Longo, 2010).
One major administrative concern is nurse bullying by co-workers, such as managers. The predicament has remained a major issue in the field for decades. The conduct is both threatening and humiliating. In addition, it interferes with care provision. For example, in the United States, one out of every six employees suffers from bullying. Research studies by National Surveys indicate that approximately 27% to 85% of nurses report being bullied in the workplace. New employees are at higher risk compared to their established colleagues. About 90% of them have experienced some level of hostility from co-workers (Kalish & Lee, 2011).
Resolving the issue of nurse bullying by use of oppressed group behavior and human caring theories
Many theories have been used to explore behaviors in the nursing profession. The two models that can be used to address the problem of bullying are oppressed group behavior and human caring suppositions. The latter supports the development of authentic caring connections and relationships in the workplace (Cowden & Cummings, 2012). When employees have healthy associations, their performance improves. According to the oppressed group behavior theory, nurses are members of the exploited faction. They are unable to confront the oppressive system (Longo, 2010). As a result, the healthcare providers take out their frustrations on each other. An analysis of the problem from the perspective of the two theories reveals that nursing leaders should be at the forefront in ensuring the work environment is safe for all employees.
Nursing Leadership and Staff Engagement
Leadership is another major issue in the nursing profession. It is noted that the style adopted by administrators has impacts on both employees and patients. Poor management affects the morale of employees. It also increases turnover rates and reduces productivity. As result, the quality of care is unsatisfactory (Longo, 2010).
Democratic leadership can be adopted as a strategy to address this concern. The model encourages all employees to take part in the decision making and goal setting process (Cameron, Harbison, Lambert & Dickson, 2012). Before making decisions, a nursing manager gathers information, ideas, and feedback from employees. However, the final decision is made by the leader. Democratic managerial approach also facilitates professional and personal development among nurses. In addition, the employees acquire some level of autonomy. The model motivates them to take initiative and make contributions to matters related to their profession (Cameron et al., 2012).
Using Nursing Intellectual Capital Theory to Deal with Staffing Issues
Staffing is a major administrative matter that nursing managers need to address. Registered nurses acknowledge that enrollment is a major concern (Kalish & Lee, 2011). The problem affects both patients and healthcare providers. Studies reveal that there is a link between nurse-to-patient ratio and quality of care.
The concepts found in nursing intellectual capital theory help in the understanding of work environment (Cowden & Cummings, 2012). It encourages the development of strong inter-relationships among all aspects of the healthcare setting. They include staffing levels, managers’ support for all employees, and recruitment of registered nurses. Application of this theory by managers has numerous benefits. They include reduced medical errors, decrease in mortality rates, and improved patient satisfaction. In addition, nurse fatigue is reduced.
Early Discharge before Adequate Education on Ostomy Care
In North America, over 70,000 patients undergo ostomy surgery annually (Erwin-Toth et al., 2012). The operation can be conducted at any age. It can also be permanent or temporary. The procedure is necessitated by such ailments as cancer and congenital. The intervention affects patients in different ways. For example, they experience changes in bowel routine, sexuality, and social activities. Under the care of nurses, ostomy patients are taught on how to cope with the condition once they are discharged. However, not all patients undergo the entire training process.
To help reduce cases of early discharge, nurses can employ Peplau’s theory of interpersonal relations. The supposition provides a framework for patient training. It stresses on the need for a healthy nurse-client relationship. The therapeutic correlation allows a healthcare provider to provide the information needed to understand the diagnosis and treatment plan (Cowden & Cummings, 2012). Through this, the patient is able to undergo the required recovery process. In addition, they regain their normal state of independence and enjoy quality life.
Application of Middle-Range Theories in Third World Countries’ Community Settings
Nursing at the community level in developing nations has both advantages and limitations. Challenges emanate from the poor working and living conditions in certain parts of the countries (Cameron et al., 2012). In addition, some locals are hostile and unwelcoming towards foreigners.
Concepts from nursing theories offer a wide range of benefits to healthcare providers when working in different places. Nurses get important information that enables them to develop strong relationships with patients from varying backgrounds. They also gain the capability to work with the communities by taking the necessary steps to acknowledge prevailing morals and beliefs (Kalish & Lee, 2011). In addition, healthcare providers acquire more knowledge to help them devise plans on how to help patients in the worst affected areas. Consequently, the practitioners end up improving the peoples’ quality of life.
Using Clinical Systems Improvement Theory to Enhance Flow of Patients in Hospital Settings
Waits, delays, and cancellations have become a daily routine in healthcare settings. Flow involves the movement of information, patients, and equipment between staff in different departments. Hospital areas that are faced with the problem include emergency department, intensive care unit, and operating rooms (Kalish & Lee, 2011). The sections are regarded as bottlenecks because they are non-interchangeable resources.
A middle-range theory that can be applied to optimize patient flow is clinical systems improvement (CSI) model. The framework is an evidence based procedure management for healthcare. It brings together knowledge from psychology, systems engineering, and other fields to improve service delivery (Cowden & Cummings, 2012). In addition, the model uses tools and information acquired from other theories. Such models include lean thinking, theory of constraints, and Six Sigma. By effectively applying CSI, healthcare centers can reduce delays and get rid of activities that do not aid in patient care.
Conclusion
In the process of writing this paper, the author acquired new knowledge about nursing theories and their application in the profession. For example, the author realized that nursing is an ever changing and complex discipline. In spite of these transformations, the dedication of nurses to their work continues to change for the better. The professionals have managed to excel by upholding ethical standards and maintaining best practices. In addition, by giving nurses a sense of identity, the wide range of theories in the profession can help patients and leaders in the field to understand the importance of their work. The diverse middle-range nursing theories play a key role in helping healthcare providers improve delivery of patient care.
References
Cameron, S., Harbison, J., Lambert, V., & Dickson, C. (2012). Exploring leadership in community nursing teams. Journal of Advanced Nursing, 78(7), 1469-1481.
Cowden, T., & Cummings, G. (2012). Nursing theory and concept development: A theoretical model of clinical nurses’ intentions to stay in their current positions. Journal of Advanced Nursing, 68(7), 1646-1657.
Erwin-Toth, P., Thompson, S., & Davis, J. (2012). Factors impacting the quality of life of people with an ostomy in North America: Results from the dialogue study. Journal of Wound, Ostomy, and Continence Nursing, 39(4), 417-422.
Kalish, B., & Lee, K. (2011). Nurse staffing levels and teamwork: A cross-sectional study of patient care units in acute care hospitals. Journal of Nursing Scholarship, 43(1), 82-88.
Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15(1), 3.