Verbal communication

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#1774710 Topic: PICO(T) Evidence Review 1: Evidence Search

Number of Pages: 7 (Double Spaced)

Number of sources: 1

Writing Style: APA

Type of document: Research Paper

Academic Level:Master

Category:   Nursing

Order Instructions at 1774710.txt

Running head: PICOT EVIDENCE REVIEW 1

PICOT EVIDENCE REVIEW 2

Appendix A

PRISMA Diagram

( Identification ) ( Additional records identified through other sources (n = 4 ) ) ( Records identified through database searching (n = 7 ) )

( Records after duplicates removed (n = 3 ) )

( Screening )

( Full-text articles assessed for eligibility (n = 3 ) ) ( Records excluded (n = 3 ) ) ( Records screened (n = 8 ) ) ( Full-text articles excluded, with reasons (n = 5 ) )

( Eligibility )

( Studies included in qualitative synthesis (n =1 ) )

( Studies included in quantitative synthesis (meta-analysis ) (n = 2 ) ) ( Included )

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Practical Use Of Theory

Practical Use Of Theory

All the information needed for the paper is attached. Paper is about the 2 questions bellow. please stay on topic and use information given.

Read the 10 Caritas Processes™ on the Watson Caring Science Institute website which further elaborate on the carative factors listed in Box 8-4: Watson’s 10 Carative Factors located on p. 183 of Theoretical Basis for Nursing.

Write a 250-word message in which you:

1-Reflect upon the caritas and address how these compare to your practice with patients and families, and relationships with other nurses and health care professionals. 

2-Identify how you would use this theory to change your relationships with patients and others.

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Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note  Chronic Conditions (15 Points)

Pick any Chronic Disease from Weeks 6-10

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Follow the MRU Soap Note Rubric as a guide

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement
Please use one of the templates provided to format your soap note. Keep these templates for future clinical rotations.

SAMPLE Block format Soap Note   Template.docx

Sample Soap Note Template.docx

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment: 

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

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Developing an Advocacy Campaign

Application Assignment 2: Part 2 – Developing an Advocacy Campaign

To prepare:

Review Chapter 3 of Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

In the first assignment( HEALTH ADVOCACY CAMPAIGN DOCUMENT ATTACHED BELLOW), you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first paper.

Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.

Consider how you could influence legislators or other policymakers to enact the policy you propose.

Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.

To complete:

Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:

Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.

Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.

Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.

Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.

Paste the rubric at the end of your paper.

NOTE: CHECK THE DOCUMENT: HEALTH ADVOCACY CAMPAIGN, AND BOOK ATTACHED BELLOW,

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Grand Nursing Theories

INSTRUCITONS

The purpose of this assignment is to draft and submit a comprehensive and complete rough draft of your Nursing Theory Comparison paper in APA format. Your rough draft should include all of the research paper elements of a final draft, which are listed below. This will give you an opportunity for feedback from your instructor before you submit your final draft during week 7.

Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory.

·       After studying and analyzing the approved theory, write about this theory, including an overview of the theory and specific examples of how it could be applied in your own clinical setting.

Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 10 and 11), select a middle-range theory.

·       After studying and analyzing the approved theory, write about this theory, including an overview of the theory and specific examples of how it could be applied in your own clinical setting.

The following should be included:

1.     An introduction, including an overview of both selected nursing theories

2.     Background of the theories

3.     Philosophical underpinnings of the theories

4.     Major assumptions, concepts, and relationships

5.     Clinical applications/usefulness/value to extending nursing science testability

6.     Comparison of the use of both theories in nursing practice

7.     Specific examples of how both theories could be applied in your specific clinical setting

8.     Parsimony

9.     Conclusion/summary

10.   References: Use the course text and a minimum of three additional sources, listed in APA format

The paper should be 8–10 pages long and based on instructor-approved theories. It should be typed in Times New Roman with 12-point font, and double-spaced with 1″ margins. APA format must be used, including a properly formatted cover page, in-text citations, and a reference list. The proper use of headings in APA format is also required.

CHAPTER 6: Overview of Grand Nursing Theories

Evelyn M. Wills

Janet Turner works as a nurse on a postsurgical, cardiovascular floor. Because she desires a broader view of nursing knowledge and wants to become a clinical specialist or family nurse practitioner, she recently began an online RN to BSN degree program that would prepare her to enter a master’s degree program in nursing. The requirements for a course entitled “Scholarly Foundations of Nursing Practice” led Janet to become familiar with some of the many nursing theories. From her readings, she learned about a number of ways to classify theories: grand theory, conceptual model, middle range theory, practice theory, borrowed theory, interactive–integrative model, totality paradigm, and simultaneous action paradigm. She came to the conclusion that there is no cohesion among authors of nursing theory and even wondered what relation theory had to what she was doing in her critical care nursing practice.

Janet’s theory course was delivered through online distance learning methods. To express her frustration and to try to understand the material, she consulted with her theory professor via the Web-based live chat room that was part of the course. The entire class eventually logged on to the chat and a long discussion resulted in which students shared their frustration with these new and abstract ideas. The instructor, a teacher who had come from an RN to BSN program herself, shared with them that frustration and confusion were the normal feelings one had when learning these abstractions. She presented them with several interesting ways to conceptualize grand nursing theories. The chat broke up with the agreement that each student would review the assigned readings again and return to next week’s live chat ready to discuss their findings.

Theories evolved from several schools of philosophical thought and differing scientific traditions. To better understand the theories, Janet looked for ways to group or categorize them based on similarities of perspective. As she studied theories based on similar perspectives, she was able to read and analyze the theories more effectively, and to select three that she intended to examine further.

In Chapter 2, the reader was introduced to grand nursing theories and given a brief historical overview of their development. Fawcett and DeSanto-Madeya (2013) distinguish between conceptual models and grand theories, and this chapter discusses that differentiation in an effort to assist nursing students to understand the material. According to Fawcett and DeSanto-Madeya (2013), conceptual models are broad formulations of philosophy that are based on an attempt to include the whole of nursing reality as the scholar understands it. The concepts and propositions are abstract and not likely to be testable in fact. Grand nursing theories, by contrast, may be derived from conceptual models and are the most complex and widest in scope of the levels of theory; they attempt to explain broad issues within the discipline. Grand theories are composed of relatively abstract concepts and propositions that are less abstract than those of conceptual models (p. 15) and may not be directly amenable to testing (Butts, 2011; Fawcett & DeSanto-Madeya, 2013; Higgins & Moore, 2000). They were developed through thoughtful and insightful appraisal of existing ideas as opposed to empirical research and may provide the basis for scholars to produce innovative middle range or practice theories (Figure 6-1).

FIGURE 6-1: Relationship of conceptual model, theory, and hypotheses.

The grand nursing theories guide research and assist scholars to integrate the results of numerous diverse investigations so that the findings may be applied to education, practice, further research, and administration. Eun-Ok and Chang (2012), in their review of literature, found support for the idea that grand theories have an important place in nursing, for example, in research and clinical practice. They also found that theorists are further refining concepts and theories. They stated that theories are “essential for our discipline at multiple levels” (p. 162). Eun-Ok and Chang (2012) also noted that the grand theories provide a background of philosophical reasoning that allows nurse scientists to develop organizing principles for research or practice, sometimes referred to as middle range theory (middle range theories will be discussed in Chapters 10 and 11.) One of the most important benefits of invoking theories in education, administration, research, and practice has been the systematization of those domains of nursing activity.

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Module 2 Legal Overview And Discussion Post

Module 2 Legal Overview And Discussion Post

Module 2 Legal Overview And Discussion Post

The Law and License Investigation

Have you encountered a situation similar to the scenario in the Self-Evaluation? If so, how did you handle it? (Throughout Modules 2-3, we will cover information pertinent to this scenario and your options.)

How does your State Nurse Practice Act address Nursing Peer Review situations?

Post your responses to the questions above on the Discussion Board by 23:59, Wednesday of Module 2. Then respond to two or more of your colleagues’ responses by asking each colleague at least two probing questions. The probing questions may ask the person to clarify statements or provide more detail, or may ask the person to consider another viewpoint. Please respond to each of the questions you are asked by your colleagues during the onlinediscussion. You will be evaluated on the quality of your summaries, questions, and responses to colleagues’ questions.

Basic APA format is required.

Please open up the “My Groups” option on the left navigation bar and click on your group discussion link to post.

I already did the self assessment let me know thanks

Here is the scenario:

You, the RN, arrive early on your regular orthopedic unit. Your Charge Nurse comes to you and says that you need to go to the cardiac step-down unit. You protest, but she says she has no control over the situation and that you at least need to go to the step-down unit and see what is going on. You arrive at the step-down unit. The House Supervisor is present with the unit Charge Nurse. You are told that the unit is very understaffed that day and that you must take patients. You protest that you have worked only orthopedics for the past 10 years- that you do not know the current cardiac drugs and side effects, the current treatments and post-treatment care and that you have never had to read the type of cardiac monitoring strips that are generated on all the patients on this unit. The House Supervisor tells you to not worry. She explains as follows:

· There are monitoring techs who are responsible for reading the strips.

· You have access to a PDR and Pharmacy if you have questions about the drugs.

· A nurse with recent experience on this floor will be able to go around with you to orient you for about two hours. (That nurse must return to his regular floor in two hours.)]

You again express concerns that you are not qualified to take this assignment. The House Supervisor takes you aside and says, “We need you to step up and help out here. We need team players in situations like this. If you refuse, I’m going to have to discuss your refusal with the Director of Nursing and your unit manager — it may not be good for your career here at this hospital. Besides, do you think you are the first nurse who ever had to take patients in a less than perfect circumstance? The patients are worse off if you refuse.”

Reluctantly, you accept the assignment. About 5 hours into the 12-hour shift, you mis-titrate a cardiac drug. The patient codes, never regains consciousness and is transferred to ICU. The patient dies 3 hours after being transferred.

Two weeks later, you are called to Human Resources. Your unit manager, the House Supervisor, and an HR representative are there. You are told that you are being reported to the state’s Board of Nursing due to the negative outcome of your patient.

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Case Study Discussion

Case Study Discussion

Case Study Discussion

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.

· Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 Pulse 68

· HEENT (head, ears, eyes, nose, throat):  wnl (within normal limit)

· Neck: supple without adenopathy

· Lungs/CV (cardiovascular): wnl

· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

· Abd (abdomen): soft, +BS (positive bowel sound), no tenderness

· VVBSU (Vulvar vaginal bartholin skene’s uretha): wnl, except 1st degree cystocele

· Cervix: firm, smooth, parous, without CMT (cervical motion tenderness)

· Uterus: RV (retroverted), mobile, non-tender, approximately 10 cm,

· Adnexa: without masses or tenderness

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests (include explanation of the tests you might recommend).

Include your differential diagnosis. Be specific and provide examples. Use your Learning Resources and/or evidence from literature to support your explanations.

Some questions to answer in your post:

1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?

3. What are her current cycles like?

4. When was her last gyn exam and what were the results of the tests?

5. Are her migraines with or without auras?

6. What method has she considered.

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine?

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Qualitative Data Has Been Described As Voluminous And Sometimes Overwhelming To The Researcher. In What Ways Could A Researcher Manage And Organize The Data?

The Data

The Data

The Data

Details:

Use the practice problem and a qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

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Analysis And Evaluation Of Frameworks And Theories

Analysis And Evaluation Of Frameworks

Analysis And Evaluation Of Frameworks

Analysis And Evaluation Of Frameworks

Theory analysis is particularly helpful in research because it provides a clear idea of the form and structure of the theory in addition to the relevance of content, and inconsistencies and gaps present. The ‘missing links’ or inconsistencies are fruitful sources of new research ideas. They also point to the next hypotheses that need to be tested.
—Walker and Avant, 2011, p. 206

Nurse scientists often find that examining the literature is a productive way to see how existing frameworks and theories have been applied in other research studies. By engaging in this process, they may gain insights about a particular framework or theory, be able to identify gaps in research, or uncover new questions they are eager to explore.

In this Discussion, you analyze existing frameworks/theories using the procedure proposed by Walker and Avant. Your analysis should provide an objective understanding of the strengths and weaknesses of each framework or theory. This, in turn, should enable you to evaluate whether the framework/theory is useful for the purposes of your theoretical foundation for a program of research.

To prepare

• Review the information that Dr. Hathaway presents in the Week 1 media program, “Theoretical Foundation for Research,” regarding the phases of theory development and the similarities and differences between frameworks and theories.
• Search the literature and identify two frameworks/theories that may be useful for investigating your phenomenon of interest.
• Review the procedure for theory analysis presented in Chapter 12 of Walker and Avant (2011). Apply these steps to each framework/theory you have selected and identify the strengths and weaknesses of each framework/theory. Determine whether additional development or refinement is needed (i.e., for each framework, identify which aspects would require further research in order for it to meet the requirements of a theory).
• Evaluate the value of each framework/theory for addressing your phenomenon. Determine which framework/theory has the most potential for use as part of your theoretical foundation of your research.
• Think about any questions you have related to theory analysis and evaluation.

By Day 3

Post a description of the two frameworks/theories you analyzed and evaluated, and explain why each is considered either a framework or a theory. For framework(s) you have selected, explain which aspects would require further research to meet the requirements of a theory. Explain why one has the most potential for use in your theoretical foundation for research, noting its strengths and weaknesses. Also pose any questions that have arisen through your examination of frameworks/theories.

Read a selection of your colleagues’ postings.

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Theoretical Foundations For Nursing

Theoretical Foundations For Nursing

Theoretical Foundations For Nursing

Theoretical Foundations For Nursing

Running head: GRAND THEORIST REPORT 1

7

GRAND THEORIST REPORT

Grand Theorist Report

Grand Canyon University: NUR 502

Grand Theorist Report

There are many grand nursing theories that have helped to set the foundation for the nursing profession. Faye Abdellah was one of the first pioneers for shaping nursing as a profession using her framework for Patient-Centered Approaches to Nursing. Abdellah’s theory is easy to apply to nursing practice in a healthcare institution because her framework is readable and clear (McEwen & Wills, 2014). In addition, another rationale for implementing her theory into practice at a healthcare institution is the fact that it clearly addresses the four metaparadigms—person, environment, health, and nursing. In this paper, we will discuss the theorist Faye Abdellah, her theory on Patient-Centered Approaches to Nursing, and how this theory can be integrated into practice at a healthcare institution.

Description of Theorist

Faye Abdellah was born in New York City on March 13, 1919. Abdellah decided at a very young age she wanted to pursue a career in nursing. She received her original certification in nursing from Fitkin Memorial Hospital. She continued her study of nursing at Columbia University getting her BA in Nursing along with her doctorate degree, which focused on psychology and education (Dewey, 2016).

Abdellah was highly influential in the profession of nursing. She was the Chief Nursing Officer and Deputy United States Surgeon General until 1993, and she was ranked as a Rear Admiral. She retired in 2000 from her last position as Dean of the Graduate School of Nursing at the Uniform Services University of Health Sciences (McEwen & Wills, 2014). As a whole, throughout her career Abdellah received many academic honors for her achievements in nursing. Her main focus was to reshape nursing as a profession by encouraging nurses to look past a physical illness or diagnosis and see “patients as people with a complex of emotional and psychological needs” (Dewey, 2016, n.p.). Clearly, this concept of looking at patients as more complex beings significantly helped to influence and shape her Patient-Centered Approaches to Nursing.

Category of Theory

Abdellah’s Patient Centered Approaches to Nursing is considered a grand nursing theory that is based on human needs. She believed that patients should be seen as ‘people’ who have individual unique needs that require personalized care from nurses. Furthermore, Abdellah developed her theory based on how she practiced while providing care to patients—which is what helps to make the theory highly applicable. McEwen & Wills (2014) further explain that Abdellah’s theory is applicable not only in the hospital setting, but also in the community setting.

Assumptions Underlying the Theory

Abdellah’s original theory did not have any stated assumptions; however, as time passed she did add the following six assumptions related to: 1) change and anticipated changes that impact the nursing profession, 2) the importance of how social enterprises and social problems are related, 3) how poverty, racism, pollution, education, etc. impact health and health care delivery, 4) changes in nursing education, 5) continuing education for nurses, and 6) development of nursing leaders (McEwen & Wills, 2014).

In addition, it is important to clearly define the metaparadigm concepts/assumptions underlying the theory as well. Abdellah’s Patient-Centered Approaches to Nursing is all encompassing, and the metaparadigms addressed in the theory are related to person, environment, health, and nursing.

Person

Person is defined as the patient needing care. McEwen & Wills (2014) explain that Abdellah’s theory views the patient as the “individual who needs nursing care and who is dependent on the health care provider” (p. 141). When using Patient-Centered Approaches to Nursing, it is important to know that Abdellah emphasized the significance of individualized care and knowing the person’s needs.

Environment

When using Abdellah’s theory, it is important to know that the environment from the patient’s standpoint is interconnected to include not only the physical environment, but also external factors that impact the patient such as social problems, poverty, racism, etc. These are all factors within the environment that affect the health of patients and how they approach health care delivery (McEwen & Wills, 2014).

Health

Health can be viewed as a better state of being. The purpose of Abdellah’s theory is to identify problems that are negatively impacting patients and eliminating these problems. Later we will discuss Abdellah’s 21 Nursing Problems and nursing’s responsibility to identify these problems.

Nursing

Nursing is considered “a service to individuals and families to society, which helps people cope with their health needs” (McEwen & Wills, 2014, p. 141). Nursing is expected to identify nursing problems and work collaboratively with the healthcare team to ensure that patients get desired outcomes.

Major Concepts of the Theory

The major concepts related to Abdellah’s theory involve using ten steps to identify and develop treatment to nursing problems related to patients. Abdellah explains that there are 21 basic nursing problems related to patients, and it is important for nurses to know these identified nursing problems so they can use them while trying to identify what needs to be the plan of care. Below is an abbreviated version of Abdellah’s 21 Nursing Problems.

Abdellah’s 21 Nursing Problems

(McEwen & Wills, 2014)

Clearly, it is very important to know the 21 Nursing Problems because these are the problems nurses must link to their findings while using the ten steps for identification and development of a nursing care plan. The ten steps build upon each other from learning about the basics of a patient, then getting more specific to identify the exact nursing problem(s) that need to be addressed. Below are the ten steps that nurses must follow to successfully develop a plan of care and reach expected patient outcomes.

Ten Nursing Skills to Identifying Problems & Developing a Treatment Plan

(McEwen & Wills, 2014)

Understanding how to use the 21 Nursing Problems along with the Ten Nursing Skills is important for nurses to grasp in order to see the full potential of this nursing theory for patients. Each of the Ten Nursing Skills needs to be followed so nurses can individualize care plans and work collaboratively with the patient and family to improve the patient’s state of health.

Major Propositions

The major proposition of Abdellah’s theory focuses on looking at the patient as a human being, not an illness. While her theory touches on many factors, it primarily focuses on patient centered care (McEwen & Willis, 2014). Due to its broad nature, it is testable in principle such as patient satisfaction and nursing care.

How has it been used?

In the past, Abdellah’s theory has been used in nursing education and nursing research. In nursing education, her theory has been used to organize lectures and curricula by categorizing nursing problems based on the patient’s needs and developing a classification of nursing skills and treatment (McEwen & Willis, 2014). Abdellah’s nursing theory has also been used in research such as patient-centered approach to nursing, evolution of nursing, perspectives on nursing theory, public policy impacting on nursing care of older adults, and preparing nursing research for the 21st century to name a few (McEwen & Willis, 2014).

Action Plan

It would behoove this institution to adopt Abdellah’s theory as a foundation of practice. The following action plan could be used as daily practice for all nurses to not only hone their critical thinking skills, but to also give more person centered care (PCC). PCC is important and has been a focus for many healthcare institutions for years. In 1969, Edith Balint described person centered care as “understanding the patient as a unique human being” (Santana et al., 2017, p. 430). Many healthcare systems are adopting a PCC to help gauge high quality care.

This action plan would focus around the Person-Centered Nursing (PCN) Framework developed by McCormack and McCance. The PCN Framework comes from research focusing on PCC with older people and the experience of caring in nursing (McCance, McCormack, & Dewing, 2011). The PCN Framework is comprised of four steps.

The first is prerequisites, which focuses on the professional competence of the nurse and his or her commitment to their job. The nurse needs to be able to demonstrate their beliefs and values and know himself or herself before they can move on. The second step is the care environment. This includes if the nurse and the service line are an appropriate fit, making sure the nurse is equipped with the skills and the knowledge to take care of patients. It is important that the heath care system is organized and can offer a supportive system for its employees so that they can safely deliver patient care and have effective relationships with one another. Third is person-centered process, which can be thought of as one of the most important steps. This step includes care that is focused on cultural competence, employee and patient engagement, staff being present, and providing holistic care. The fourth and final step is outcomes. This is known as the central component of the PCN Framework and where we can tie it all together. This includes patient and nurse satisfaction, feeling of well being, and obtaining a therapeutic work environment (McCance et al., 2011).

Integration

A PCC Team would need to come together to develop current data within their hospital. Data would include patient satisfaction scores, nurse satisfaction scores, readmission rates, and a basis of patient-centered care knowledge among nurses by developing a questionnaire for them to fill out. The PCC Team would them form a class for all currently employed nurses with an in depth explanation of the PCN Framework and what each step includes. Role-playing and case studies could be used in order to help staff put PCC into play in a practice setting. This portion would be integral to the roll out of PCC because it helps nurses to see the importance of person-centered care within their own healthcare setting and would help them to deliver higher quality care (McCance et al., 2011). Once staff is completely trained, leaders will be able to put the PCN Framework into action. According to McCance et al., “using the Framework ‘in action’ within the workplace as a tool to evaluate care during handovers or during analysis of critical events, both positive or negative; and using the Framework to assess the experience of patients being cared for in each site” (para. 17) we can evaluate the outcomes listed previously: patient satisfaction scores, nurse satisfaction scores, and readmission rates. It would be important to reevaluate the nurses after one year with the same questionnaire that was handed out at the beginning of the PCN Framework roll out. The PCC Team would be able to assess their effectiveness in delivering the information and the data from the satisfaction scores and readmission rates would give them the ability to verify how well the PCN Framework works.

After data is collected, the PCC Team would move forward in presenting the information to all new hire nurses and developing a curriculum for preceptors to be able to teach the PCN Framework and to help to develop new nurses within it. It would be important to continue with the PCC knowledge questionnaire so the PCC Team can continue to evaluate the efficiency of their team. After one year of new hire education, the team will then collect satisfaction scores and readmission rates to submit to the Board of Directors for the healthcare institution so that the PCN Framework can be presented as a standard of practice in all hospitals within the healthcare institution.

In conclusion, health care costs are rising at an exponential level and due to this rise; patients and their insurance companies are expecting higher-grade care. Nursing as profession needs to move towards a more patient centered approach. Without this approach, nursing is just assumed to be medicine and patients will continue to feel that they have no place in their care team. Currently, patients are being told what medications they should take, when they should take it, and who will be overseeing their care. In order to reduce readmission rates and subsequently cut costs, patients need to have ample say in their treatment plan and should be able to have open conversations with their caregivers about how they feel about their illness and their plan of care. If they feel their nurses are competent in their skills and that they truly care about their wellbeing, patients will feel safer and more willing to speak up when they do not understand something and will trust in their care plan to continue it after discharge, thus reducing their risk of readmission.

References

Dewey, J. P. (2016). Faye Abdellah. Salem Press Biographical Encyclopedia. Retrieved from

http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=4&sid=b8238afd-f12d-4800-89ca-ff4e2c58d36d%40sessionmgr101&bdata=JnNpdGU9ZWRzL

WxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=113931050&db=ers

McCance, T., McCormack, B., & Dewing, J. (2011, May 2). An exploration of person-centeredness in practice. The Online Journal of Issues in Nursing, 16. http://dx.doi.org/10.3912/OJIN.Vol16No02Man01

McEwen, M., & Willis, E. M. (2014). Theoretical Basis for Nursing (4 ed.). Philadelphia: Lippincott Williams & Wilkins.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2017, September 30). How to practice person-centred care: A conceptual framework. Health Expectations, 429-440. http://dx.doi.org/http://dx.doi.org.lopes.idm.oclc.org/10.1111/hex.12640

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