NR 510 Theory and the APN Role Discussion

According to Karnick (2014), nursing theory provides the ethics and beliefs that guide practice and help generate nursing knowledge. When nurses purposefully form their care around a particular theory, clinical practice takes place (Karnick, 2014). Karen should learn nursing theories because she will need the information to guide her care of the patient. Nursing theory is very important to APN practice because it provides nurses with the foundation and principles of the profession. The four main paradigms— person, health, environment, and nursing—that drive nursing theory aim to promote patient wellness. Also, learning nursing theory encourages critical thinking and suggests ways to relate the fundamentals of nursing to the actual practice of nursing (Karnick, 2014). Nursing theory is useful in many areas of nursing to include clinical, community health, legislative, administrative, educational, legal, etc. These theories provide invaluable knowledge that Karen can use to construct new knowledge. Nursing theory will teach Karen about the importance of evidence-based practice and how it relates to the decision-making process for patient care and patient values.

Karen’s concerns about the nursing theory being too broad should be addressed. While she is right, let’s put the reason why into context. As a new graduate nursing student, Karen will learn the theories are broad because there is more than one way to explain how to administer patient care or how to communicate with colleagues. There are multiple ways to display leadership and to educate oneself about new health processes, diseases, patient concerns, and all things dealing with nursing. Nursing theory is confusing at times because there are so many theories to learn. However, this should be viewed as a positive because it inspires a sharing of ideas and nursing practices. There is no singular way to provide the best patient care, and Karen can use many of the theories to enhance her clinical expertise. She can also compare nursing theories with current external clinical evidence and research to extract the most useful information to provide better patient care. The lack of agreement in the professional literature on nursing theory does not diminish the value of the theories nor does it make the theories irrelevant to practice. What the lack of agreement does is create dialogue and promote more evidence-based research. Karnick (2014) states eliminating nursing theory in the classroom will “degrade nursing as a viable profession.” The discipline of nursing needs these theories to guide effective patient care, or nursing will be just another set of actions or tasks that is not valued or needed by patients and their families (Karnick, 2014).

Reference:

Karnick, P. M. (2014). A case for nursing theory in practice. Nursing Science Quarterly, 27(2), 117. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/0894318414522711

The Theory of Modeling and Role-Modeling states nurses should care for each patient with an understanding and respect for the patient’s uniqueness (Currentnursing.com, 2018). This is the basis of Erickson’s theory, which focuses on the patient’s needs and what should be the core of clinical practice. To apply this theory to family practice, the role of the FNP is to facilitate care, nurture the wellness of the client, and to accept the patient’s need for autonomy. The five goals of the theory apply to the practice of nursing, as well as leading nursing organizations’ missions and purposes. One of the first theories that nurses learn is the Code of Ethics. When put into practice, the code is the ethical obligations and duties of every nurse (Judge-Ellis & Wilson, 2017). Erickson’s theory and the Code of Ethics align with each other because both state that nursing goals and interventions should be to build trust between the patient and the nurse, to promote the patient’s autonomy and privacy, and to set health goals that promote the client’s strengths and respects cultural practices. As FNPs engage in family practice, they must apply these values to provide the best care to families.

References:

Currentnursing.com. (2018). Modeling and role modeling theory. Retrieved from http://currentnursing.com/theory/modeling_and_role-modeling_theory.html

Judge-Ellis, T., & Wilson, T. R. (2017). Time and NP Practice: Naming, claiming, and explaining the role of nurse practitioners. The Journal for Nurse Practitioners, 13(9), 583-589. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2017.06.024

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Great insight on the correlation of Erickson’s theory, the theory of Modeling and Role-Modeling and nursing practice as an FNP. Might I add, not only with Erickson’s theory, but with many, if not all theories, will provide a way for Karen to develop and apply new knowledge for caring for her patients an an APN FNP. Nursing theories will provide a way for Karen to understand the importance of evidence-based practice in the APN role and also the correlation it has critically for her decision making ability while caring for individuals as the primary care provider. Karen should also understand that nursing theories are also essential as they utilized to expand and explain clinical interventions and decisions. While nursing theories are broad and there are many to learn, they all have a common connection of being develop to optimize patient care and outcome. Because Karen is just starting her new journey as a MSN graduate level student it will take her time to develop an appreciation and through understanding as to how theory are seen, utilized, and valued in today’s practice amongst APN FNP and other APNs.

I smiled at your post because it also took me awhile to develop an appreciation of nursing theories and to apply them to patient care. Applying theory to patient care is still challenging to nurses who have been in the field for awhile. Yet, I have learned there are many advantages to understanding various nursing theories. These theories serve as reminders or guides to what we should do as nurses. As nurses, it is important that we use critical thinking skills when applying nursing theory to real-world clinical application. Niederriter, Eyth, and Thoman (2017) propose that nursing instructors need to help students understand how nursing practice and patient outcomes differ when nursing theory is used. The role of nursing instructors is imperative because of the body of knowledge they have. If nursing students accept the academic guidance and clinical expertise of their instructors, they will grow into successful, productive nurses (Niederriter et al., 2017). When nursing instructors “intentionally” connect theories to nursing practice, nurses are empowered to make a difference to patients, families, and the health organization (Niederriter et al., 2017).

Reference:

Niederriter, J. E., Eyth, D., & Thoman, J. (2017). Nursing students’ perceptions on characteristics of an effective clinical instructor. Open Nursing, 3. Retrieved from https://doi.org/10.1177/2377960816685571

I think work Erikson’s is very important, yet classical model to look at when discussing how it relates to family practice. A nurse practitioner that specializes in family nurse practitioner practice, will have education that goes across the board. During clinical, one will do pediatrics, women’s health, adult and geriatric health. It is important to understand the psychological needs and accomplishments of each age group. Healthcare tries to now look into a patient as a holistic person and not just a person with signs and symptoms and a illness or disease to treat. When caring for a patient, one has to look at the patient mentally, physically, emotionally and even sometimes spiritually. For example with 45 to 65, according to Erickson, they are experiencing generative vs stagnation. People experience a need to create or nurture things that will outlast them, often having mentees or creating positive changes that will benefit other people. Success will equal to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. 65 and older will be experiencing ego integrity vs despair. This stage takes place after age 65 and involves reflecting on one’s life and either moving into feeling satisfied and happy with one’s life or feeling a deep sense of regret.Success at this stages leads to feelings of wisdom, while failure results in regret, bitterness, and despair. For a nurse or nurse practitioner will do a thorough assessment to examine all avenues of the patient. A patient who is 55 years old might be going thru depression because her only son is in jail and she might feel as though she failed her son. This might cause her to eat less, grow weaker and become non compliant with blood pressure medication. If the NP did not look into this, she would have missed this important factor and just aimlessly order different interventions without examining the psycho social aspect of it. One patient in a clinic who is 69 years old, is generally healthy for their age, happy, compliant with medications might have been satisfied with life, vs the 70 year old patient that did not work in a profession he/she wanted, divorced and has been lonely may be unhappy, unsatisfied and non compliant with medication. Often, nurses and nursing practice becomes busy with different task and interventions to do, however, it is still important to look at the patient holistically. (Dunkel & Harbke, 2017)

Reference:

Dunkel, C., & Harbke, C. (2017). A Review of Measures of Erikson’s Stages of Psychosocial Development: Evidence for a General Factor. Journal Of Adult Development, 24(1), 58-76. doi:10.1007/s10804-016-9247-4

I can honestly say that I had the same views as Karen, until I took the course. I found that the class was very informative, and has made nursing into the profession that it is today. There are many great theorists that have led us to the development of better treatments and caring than ever before. I feel that nursing is still evolving, and the rise of the different theories continuing. The future of nursing is being led by the different theories. Evidence based practice developed through the use of research studies and theories will lead the nurse into the future (n.a., 2018)

Through the development of theories, the way patients have been cared for has changed. Florence Nightingale adapted the environmental theory that encompassed the use environmental factors that aided in the health and condition of the patients. She addressed that the environmental factors such as ventilation, cleaning, lighting, heat, noise, odors, and feeding make a difference in the recovering process (Medeiros, Enders, & Lira, 2015). Since the beginning of this theory, things have drastically changed. We now have housekeeping that goes through the department at least once a day, we have “quiet hour” in the afternoons where paging is not allowed and the lights in the hallways are dimmed down, and staff is not allowed to wear strong scents. All of this changed after the theory became known.

Karen must need to be present in the class to learn how theory has brought the profession to what it is today. Theory is extremely important, and will continue to be important as healthcare is ever changing, and will not be stopping anytime soon.

Medeiros, A, Enders, B, & Lira, A. (2015). The Florence Nightingale’s environmental theory: A critical analysis. Scientific Electronic Library Online, 19(3). doi: https://dx.doi.org/10.5935/1414-8145.20150069 (Links to an external site.)

n.a. (2018). The practicality of nursing theory in the future. Nurse Journal. Retrieved from https://nursejournal.org (Links to an external site.)

I would tell Karen that I disagree with her statement that nursing theory isn’t useful for APN practice. I would remind Karen that APN’s may have advanced skills and knowledge, however, they are still nurses whom can still utilize various nursing theories into their practice as an APN. In fact, some theories may have even more impact as an APN.

Nurse practitioners are exceptional health-care professionals whom have a combination of clinical experience and additional graduate education. Nurse practitioners are educated in both medical skills and nursing theory, the ability to diagnose, order and interpret diagnostic tests, perform specific procedures, as well as prescribe both medications and treatment plans (The nurse practitioner, 2017). Although the focus of the NP is considered clinical by nature, it also incorporates research, leadership, and theory. While based on the basic principles of primary health care, nurse practitioners work with individual patients, groups, families, diverse populations and communities, therefore must be able to process and incorporate the beliefs and preferences of these individuals to be able to properly make decisions within the plan of care. Nurse practitioners deliver comprehensive care to patients of all ages, doing so by utilizing disease prevention, health promotion, illness management, as well as palliative care. Nurse practitioners also offer new knowledge based from evidence-based practice and research studies and provide leadership (The nurse practitioner, 2017). I would implore Karen to reconsider her statement, and consider some of the theories in which the nursing field was founded upon, many of which we utilize everyday during bedside care, which do not end simply due to advancing education and skill set.

The nurse practitioner. (2017). The Canadian Nurse, 113(2), 8-9.

I feel nursing programs can help students see how the role of nursing theory plays in day to day care by providing example for the students to learn from. I think when a student is taught a particular theory, then followed up with a direct example of the theory, then is becomes easier for the student to apply and make the connections. I think it is generally easier to learn about topics when examples and rationales are provided and applied. For example, as nursing students we all learned about Maslow’s hierarchy of needs. Maslow’s hierarchy of needs is most commonly viewed as a pyramid shape where the most basic human needs are the “foundation” at the base of the pyramid, once these needs are met, then more advanced needs may then be achieved by progressing toward the top of the pyramid in ascending order. The pyramid is laid out as follows:

Physiological- the most basic physical needs are the foundation of the pyramid. These are the basic needs that all humans require for survival, such as air, water, food, sleep and warmth. One cannot ascend to the next level of the pyramid until these basic needs, which are instinctive to humans, are first met.

Safety- this includes shelter, living in a safe environment, access to healthcare

Belongingness- love, affection, social interaction, intimate relationships.

Esteem needs- feelings of accomplishment and personal worth

Self- actualization- the highest level of the pyramid- autonomy, self-fulfillment, achieving full potential of skills, talent, and abilities. People whom reach this level are concerned with personal growth, and cannot be accomplished unless the previous levels have been achieved (Mennella & Holle, 2017).

This is once of the less complicated theories to teach nursing students, as it is easily understood that as humans, our most basic needs come first, such as air (breathing status, airway, etc), water (proper hydration), food, shelter, etc. These are all basic needs we all need, therefore we pay quite a bit of attention to these needs as nurses with our patients.

Other theories that can be directly taught and applied to nursing students are Watson’s Caring theory, Ray’s adaptation Model, or the Health Promotion Model, as these theories are somewhat more basic and able to be directly applied with our role as nurses, Any of the simpler theories can be taught with somewhat of ease, when given distinctive examples in which the nursing students can apply. I feel using these methods would help students understand and make the connections of how these theories are used in day to day care of patients.

Mennella, H. A., & Holle, M. O. (2017). Maslow’s Hierarchy of Needs. CINAHL Nursing Guide.

You wrote a great post and explained very well how APN theories help them prepare for the clinical knowledge, daily stills and leadership. Theories are woven into the various nursing parts, however, they may seem invisible at times. Nursing undergraduate and graduate programs spend a great deal of time teaching and emphasizing how the clinical is incorporated with the theory – which is what makes the nursing profession unique.

The art of nursing is a combination of abstract and scientific knowledge. Working as a nurse, it is easy to absorb the reasons behind using protocols for patients’ clinical presentations using the medical model theory with ease. However, if the patients do not present with classic signs and symptoms, the often we have a more challenging time explaining the ‘why’ for the interventions chosen. I believe nursing theory (ies) answers the ‘why’ and ‘how’ of such interventions. There does not need to be complete consensus on a chosen theory, there are several theories from which to choose from. This is important because one theory is not a proper fit for all persons for various reasons.

The key to promoting evidence-based nursing practice is to expose nursing students to various nursing theories and their applications throughout the curriculum (DeNisco & Barker, 2015). This would help them gain a greater understanding and transfer this knowledge to facilitated understanding of the data collected (whether clinical assessments and/or other types of research) and in turn create evidence-based interventions that will promote patients’ well being. This viewpoint of processing knowledge gets transferred to the role of an APN. If theory was not integrated into their role, they would follow the medical model!

Reference:

DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from https://bookshelf.vitalsource.com

I thoroughly enjoyed reading your post! I love how you described the importance of nursing theories to practice. I don’t know that it could have been stated any better! I honestly think that most providers know the importance of nursing theory until they have gone through multiple courses. After taking the course, I believe that nursing has improved from nursing theories, and will continue to evolve due to nursing theories. You hit the nail on the head when you describe the roles that nurse practitioners use nursing theories for, which include disease prevention, health promotion, illness management, and palliative care. I mentioned in one of my posts earlier that we provide more holistic cares than other entities, which I believe comes from the studies of nursing theories. There are many theories that I incorporate into my everyday duties, and I strongly feel that as a nurse practitioner, there will be even more that I will use. I’m sure that there are more theories that are in process now that will also change the way that we practice.

When I first started school to become a FNP, I also believed theory was not important and I learned quickly once starting my Theory course I was incorrect. I believe Karen will feel the same way after starting her course.

We are fortunate as nurses to have had many nursing theorists who have helped steer nursing into its own entity and given it its own identity separate from physicians. With caring being one of the primary components of nursing, and unmeasurable, it is important to have theories to explain and help nurses and others understand the importance of what the basis and future of nursing is (Colley, 2003). It is particularly important to know where nursing is headed as the roles of the APN are continuing to evolve and expand.

Holistic care is the commonality among all APN’s regardless of their speciality. When working with an APN whether as a patient, colleague, floor, nurse, or anyone else they encounter it is apparent through their “relationship centered care”(Hagedorn &Quinn, 2004). Regardless of what they work on APN’s look at the whole picture which is pertinent when diagnosing and caring for patients or developing an educational plan for new graduate nurses practitioners to better understand an area in which they are struggling with.

Colley, S. (2003). Nursing theory: its importance to practice. Nursing Standard, 17(46), 33-37.

Hagedorn,S.,Quinn, A,(2004). Theory-Based Nurse Practitioner Practice: Caring in Action. Topics in Advanced Practice Nursing eJournal

Karen voiced a strong opinion, however there are several challenging oppositions to her statement. From the inception of nursing, the profession uses interdisciplinary and disciplinary theories and modules to help guide advanced nurses to providing effective quality care and create an autonomous profession. The variation of theories that exist can help practitioners guide how they choose to model their practice and interactions with patients and peers.

Karen’s criticism is not alone. The nursing field has battled defiance in dealing with theory due to its ambiguous nature and lack of conformity on theory. Karen’s comment lends itself to the reality that many nursing theories lack concrete preciseness that is relevant to everyday clinical application. While theories may provide an umbrella of quality of care, they are not applied in daily use by the nurses (DeNisco & Barker, 2015). Theories are often cited as abstract and subject to various interpretations (DeNisco & Barker, 2015). Additionally, there are so many theories – conceptual models, grand theories, systems theory, developmental theories, metaparadigm models. This list is long and confusing at times as to which theory is acceptable to today’s time, to today’s needs. As a nurse, it is hard to decipher and challenging when the reality of our work is managed by corporations and insurance companies.

However, despite Karen’s comment, nursing theories do add to cognitive structure that helps guild the professional nurse with professional knowledge. From the inception of nursing, theory models have help nursing to understand their goals and activities to help guide the patient towards recovery. For example, Orem’s self-care model helps nursing to uniquely tailor a persons self-care needs, Orlando’s model explained how the relationship between a nurse and patient can effect outcomes, Leininger’s model explained how nursing needs to be culturally competent and aware and how this affects patient health. While theory concepts may seem abstract and not medically concrete, there is great value in how the abstract plays into people health (Aggleton & Chalmers 1986). This is how nursing is unique. It is not based solely on the medical factual knowledge that is proven, that is for medical doctors. Nursing has the blessing of going beyond this scope and exploring what cannot always be proven indefinitely. Nursing can improve health by forming relationships, acknowledging cultural differences and needs, identifying patterns and organization, the family and society. This is what nursing is, a combination of the real and abstract. Karen needs further enlightenment into the reality of what theory is and how it can change people’s health. Nursing is always out to explore this because human being by nature are not always defined. Not one theory fits all. That is why we must adapt to the appropriate theory for guidance that fits our needs as nurses as well as the patients. As an APN, Karen will be able to adapt theories that fit her needs as a provider and what the patient needs so that the optimum health can be achieved. It will provide her guidance on how and why to treat a patient.

Reference:

Aggleton, P.J., & Chalmers, H. (1986). Nursing models and the nursing process. Bassingstoke, UK: Macmillan.

DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from https://bookshelf.vitalsource.com

Karen is not correct in her assessment about learning nursing theories.They are broad but useful because they recognize and classify the general body of knowledge a particular profession is based on, which when placed in the context of nursing provides nurses with a sense of identity. Karen is inspired to learn all about her field of nursing, and if studied closely, specific nursing theories provide a structure from which Karen can draw her inspiration. Karen undoubtedly has many questions about what the CNP role and the laws guiding practice. Reading nursing theories will provide Karen with those answers. She will have a better understanding of her purpose and role in the healthcare setting and lives of patients as a CNP. These past nursing and health theorists have taken time to share their experiences and put them in a format that when applied can help nurses and nursing leaders make their own unique contributions to the profession and to the wellness of their patients. The goal of nursing academics and theorists is to motivate nursing to progress and expand. Knowledge development is one of the cornerstones of learning that promotes the “evolution” of nursing and that has created specializations within the field (Colley, 2017). Nursing theories also guide practice and education (Colley, 2017). Nurses like to deal in facts, so they do not accept change easily. Nursing theories are expert opinions on why certain practices should be implemented and to which patient populations. The future of nursing healthcare is now, as nurses are no longer to expected to know about “all things nursing.” Nursing theories help form specialty distinctions in nursing practice and define what nursing is and should be (Colley, 2017). They are very useful to describe the beliefs, values, and goals of the nursing profession and the knowledge and skills needed to practice in the field (Colley, 2017).

Reference

Colley, S. (2017). Nursing theory: Its importance to practice. Nursing standard, 17(46), 33-37. Retrieved from DOI: 10.7748/ns2003.07.17.46.33.c3425

NR 510 Theory and the APN Role Discussion