Critique of Nursing Theories.

Critique of Nursing Theories.

1. Introduction 2. Select a grand or broad theory and a mid-range theory of nursing practice. 3. Use the “Guide for the Description of Theory” and “Guide for the Critical Reflection of Theory” (Chinn & Kramer, 2018, Chapter 8) to critique the theories selected. 4. Compare and contrast the broad and mid-range theory. 5. Using the broad theory as a framework, describe a client situation and expected outcomes. 6.

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Outline the process of advanced practice as articulated within the theory selected. 7. Using the mid-range theory, describe how an advanced practice nurse would facilitate the outcomes identified in the broad theory. (A diagram of theories as they are applied to the client may be included). 8. Conclusion The body of the paper should not exceed 8 pages. Critique of Nursing Theories.

Chinn & Krammer’s Description of Theory

1.     Theory Description

2.     What is the Purpose?- This question helps identify why this theory was formulated and the overall purpose of the theory. The purpose of the theory should be stated explicitly or at least be identifiable in the text of the theory. In addition to identifying the purpose of the theory, one needs to ask if the purpose reflects understanding and creation of meaning. Does the purpose describe, explain, and predict a phenomenon? When would the theory no longer be applicable?

3.     What are the Concepts?- This question assists in the identification of the ideas that are structured and related within the theory. Which concepts are defined and which are not? Are they explicitly defined or implied? Are there competing definitions for some concepts? Are there similar definitions for different concepts?

4.     What are the Relationships?– Concepts are structured into a systematic form that links each concept with others. Examining the nature of relationships helps to focus on the various forms relationship statements can take, and how they provide structure to the theory.

5.     What is the Structure?- Addressing the overall form of the conceptual interrelationships helps discern whether the theory contains partial structures or has one basic form. The relationships are linked to form a whole when the ideas of the theory interconnect. The structure emerges from the relationships of the theory and makes it possible to follow its reasoning.

6.     What are Assumptions?- This question addresses the basic truths that are believed to underlie theoretic reasoning. It questions whether those assumptions reflect philosophic values or factual assertions.Critique of Nursing Theories.

Introduction

            From a broader perspective, theory is the development and interpretation of the cognition aspect. In nursing practice, theory can be defined as a set of propositions that are closely related which control, predict or explain a phenomenon. Nursing theories are vital tools used to improve, explain and guide nursing practice. There is no doubt that theories have contributed greatly to the progress and growth of the entire nursing profession. Since they are central to scientific understanding, they explain concepts that express and explain observed patterns in nursing practice. Over the past decades, healthcare researchers and psychologists have formulated numerous theories that clearly explain how individuals can acquire, organize and utilize knowledge and skills in nursing practice. Critique of Nursing Theories.

Since theories form the basis of clinical nursing practice, understanding them is essential in helping nurses to create a learning environment, a therapeutic environment and to provide much better services. Nursing theories have generally helped nurses to identify and assist patients and families dealing with various illnesses and tends to change how patients feel, think or behave. Nursing theories are categorized into grand, broad or mid-range theories. Grand theories discuss nursing concepts from a broader perspective and provide insights in different aspects of nursing practice. This explains why they are based on conceptual and model frameworks which define nursing practice in different care settings. However, they are not designed for empirical testing. Critique of Nursing Theories.

Mid-range theories are however more specific on certain professional aspects. Therefore, they help to bridge the gap between broad and grand nursing theories. Broad-range theories are developed to be used in more specific nursing scenarios. As a result, they focus more on nursing interventions and how they impact nursing practice. This paper critiques, compares and contrasts the self-care deficit theory (a grand nursing theory) and the comfort theory (a mid-range theory). A discussion on how APNs processes are articulated in the self-care deficit theory and how APNs can facilitate the outcomes identified in it using the comfort theory is also provided.  Critique of Nursing Theories.

Critique of the Self-Care Deficit Nursing Theory by Dorothy Orem and the Comfort Theory by Katharine Kolcaba

            Dorothy Orem’s self-care deficit theory is one of the most applied grand nursing theories in clinical nursing practice. It helps to identify clinical scenarios where patients have some deficit in self-care and the appropriate nursing interventions. This theory comprises of for additional theories which are inter-related namely: the theory of dependent care, theory of self-deficit care, the theory of self-care and the nursing system theory (Hartweg, 2015). Collectively, these theories help to provide a more individualized care model to patients in the clinical setting.     The self-care theory involves the ability of a person to take care of themselves with a purpose of being able to regulate individual development (Hartweg, 2015). The basic requirements for self-care include: human basic and developmental needs and an abnormal situation-specific well-being status that needs professional care. In dependent care, since a person is not able to meet individual needs due to self-deficit, either a nurse or close family member is required to assist. In terms of the nursing system, actions that care for a person in contractual, professional or interpersonal interactions are performed. Critique of Nursing Theories.

Katharine’s comfort theory clearly explains four contexts within which care arises. These contexts are: physical, psychospiritual, environmental and socio-cultural. The socio-cultural context involves the relations of a patient with traditions, family and religious beliefs and practices (Kolcaba, 2015).  The psychospiritual context has sexuality, life’s meaning, self-esteem and identity. The physical aspect includes: homeostasis, physiological functioning of the body and sensation. The environmental perspective encompasses the external factors that are likely to affect a patient’s senses such as: bad tastes, temperatures and loud sounds. Three major types of comfort are discussed namely: relief, transcendence and ease (Kolcaba, 2015). Ease, according to the works by Henderson is important in executing fundamental functions needed to maintain homeostasis. Relief is derived from the theory by Orlando which explains that the need expressed by a patient is what is met by nurses. Lastly, transcendence as derived from the works of Patterson permits a patient to triumph over difficulties with a nurse’s assistance (Azevedo Ponte & Fátima, 2014). Critique of Nursing Theories.

Comparison and Contrast of Self-Care Deficit Theory and the Comfort Theory

            There exist a number of differences and similarities between the two theories as illustrated in the nursing metaparadigm. Both theories consider a patient as the individual who needs care. However, in Katharine’s comfort theory the patient can either be a community, individual or family who needs care. Katharine Kolcaba further explained that a nurse can also be the one who needs an improved state of affairs such as an improved working environment (Kolcaba, 2015). Critique of Nursing Theories.

The environments being discussed in both theories differ significantly in terms of meaning.  According to Dorothy Orem, the environment is basically the biological, physical, social and chemical aspects of a person. In Katharine’s comfort theory, the environment can either comprise of a family, the individual patient or setting that can be changed by a nurse, friend or close family member to enhance comfort. As acknowledged by Hartweg & Pickens (2016), both theories acknowledge that the environment plays a vital role in a patient’s well-being and recognize the need of a caregiver or a nurse to manipulate the environment to positively influence patient outcomes. Critique of Nursing Theories.

According to Hartweg (2015) Orem defines health as a state of being that is characterized by sound and wholly developed human structures and adequate physical and psychological functioning. On the same note, Katharine’s definition of health concentrates on a patient’s health but more specifically, it can be the community, family or provider (Shah, 2015). Therefore, it can be concluded that both the self-care deficit and comfort theories are determined by the environment and the ability to either modify behaviors of the environment to fit within it. Critique of Nursing Theories.

Lastly, both theories have different categories that nursing as a metaparadigm falls within. According to Orem, these components are a system that is supportive-educative, wholly-compensatory and partly-compensatory. The major goal of nursing is to either overcome or compensate for deficiencies in a patient’s self-care. In such a context, care can be in the form of nursing help to achieve individual therapeutic goals, be able to care for one-self or through the assistance of a caregiver, assist a client to self-care through close supervision (Hartweg & Pickens, 2016). Similarly, Katharine considers nursing care as assessing the needs of a patient to attain comfort, the nursing interventions needs to meet these needs and reassessing the comfort given to a patient through objective, intuitive and subjective approaches (Shah, 2015). The major difference in these two theories is that, according to Dorothy’s theory, a patient can be directed to assist themselves to be independent whereas according to Katharine’s theory, nurses take the entire responsibility of a patient’s comfort or regaining health status. Critique of Nursing Theories.

Client Situation and Expected Outcomes Using the Framework of the Self-Care Deficit Nursing Theory

RN is a 50 year old Caucasian female with type 2 Diabetes mellitus now for 10 years. Recently, she had numbness and pain of the lower extremities which prompted her to visit a primary care provider. Her PCP assessed and ruled out peripheral neuropathy and referred her back to the clinical nurse specialist (CNS) who was also the diabetes educator. The CNS assessed RNs diabetes education and self-management skills which turned out to be poor.

The self-care deficit theory provided a framework to help the client meet the requirements of self-management and be responsible for her own health. Critique of Nursing Theories.

A detailed heath assessment was done including a family assessment and patterns of health promotion. The goal was to empower RN on the self-management of diabetes. In the long term, it was expected that RN would be able to maintain glycemic control through blood-glucose self-monitoring, observe the recommended diet, medication regimen and exercise (Lee et al., 2016). In the long term, the patient would be able to prevent the progression to long-term complications of neuropathy, nephropathy and retinopathy. Critique of Nursing Theories.

The Process of Advanced Practice As Articulated Within the Self-Care Deficit Theory

            The self-care deficit theory is usually applied in daily nursing practice. Patients seek for help when they recognize some form of deficit in their own care, which is provided by nurses in a comforting manner. Using Orem’s self-care deficit theory, the following processes would be used by APNs to construct a care plan: assessing a patient’s self-care level to identify potential gaps, assessing the presence of dependent care (care given to a child by a parent), assessing areas of deficit in self-care and lastly establishing the role of the caregiver/nurse (Hartweg & Pickens, 2016).

After identifying the deficits and needs of a patient, nurses can assist patients to perform their tasks and maintain balance or alternatively develop newer ways that this balance can be achieved. This can be done through prescriptive, regulatory and diagnostic management. In order to meet self-care needs, developing a patient care plan can be actualized through five approaches: guidance, doing for the patient, giving support, environmental maintenance to support the patient and empowering patients with the appropriate knowledge and teachings (Hartweg & Pickens, 2016). Critique of Nursing Theories.

How APNs Can Facilitate Outcomes Identified in Self-Care Deficit Theory Using the Comfort Theory

            Outcomes in self-care deficit theory can be facilitated through comfort theory by communicating, collaborating and developing professionally. For instance, nurses can give patients with written and audio resources based on individual needs to increase their knowledge, understanding and ability to care and provide comfort to themselves. Providing holistic care in clinical settings is another effective strategy that outcomes can be facilitated. As explained by Azevedo & Fátima da Silva (2014), holistic care comprises of an individual’s social, cultural, physical and mental perspectives. Besides, the patient and the consented friends or families are included in clinical decision making. This has shown to improve the rates of patient satisfaction and comfort and to increase the development of self-care. Critique of Nursing Theories.

Nurses can ensure self-care is achieved through the implementations of interventions such as administering medications, continuous monitoring, active listening, making referrals, patient advocacy and reassurance. At organizational level, strategies such as purposeful hourly rounding and interprofessional collaboration which guarantee comfort can be implemented to achieve self-care (Azevedo & Fátima da Silva, 2014). The schedules for visiting patients in clinical settings can also be limited to ensure that patients get adequate rest. Lastly, continuous/lifelong education of APNs is also important in increasing measures of comfort, safety and self-care as it improves nurses knowledge and skills. Critique of Nursing Theories.

Conclusion

            Dorothy Orem’s self-care deficit theory is a grand nursing theory   which comprises of three other theories with limited but simple terms, which makes comprehension easy. However, this simplicity increases its complexity of use as a discipline as it relates to the clinical care of patients. A major drawback in the self-care deficit theory is that it clearly separates nursing from other disciplines. Katharine’s comfort theory is simple and makes use of concepts that can easily be learned or applied into clinical nursing practice by students and nurses. Nursing forms the basis of the comfort theory which can ultimately be applied in all patient populations and settings. Critique of Nursing Theories.

Presently in nursing practice, the comfort theory and self-care deficit theory are prevalent. While the latter looks at defining nursing care, its processes and the necessary goals to achieve individual self-care patient needs. The primary outcomes of self-care as mentioned includes:  preventing illness, maintaining life and wellness. The comfort theory centers on comfort as a major nursing care goal which is attained through relief when comfort is provided. Comfort makes a patient to be calm and at ease to be able to rise and transcend personal challenges. Critique of Nursing Theories.