Theterm nursing theory refers to the knowledge body used in supportingnursing practice. Nurses are provided with professional education andin the process study a wide range of subjects that are interconnectedand apply to a practical setting. The source of this kind ofknowledge could be from learning by experience, it could come fromsources that are particularly formal for example, research carriedout in the nursing field or even those that are from sources that arenot related to nursing. Nursing is wide and universally it has beenagreed upon that nursing is a science that involves processes thatare propelled by a vision of supereminence in a healthcare context,people, and the environment.
Mostof the Nursing theories being used today have been formulated withinthe past 20 years. Not long ago. In many schools today, students areadvised to come up with nursing theories that should then become partof their curriculum. There is, however, an argument that it isdetrimental when it comes to practice, having the multiplicity oftheory, as it sabotages a common vision. Formulating nursing theoriesinvolve a lot of vanities, this fact cannot be refuted.
Thereare several theories that have been generated under the critical carenursing field. In critical care nursing, the main section ofspecialized practices is in intensive care units and emergency units.Nurses who specialize in this field of critical care have theknowledge to handle patients who are in critical conditions. Theyoften specialize in different particular critical illness aspects.Examples of such are cardiac care, to be able to provide care forpatients who suffer from serious illnesses or injuries to their best.Critical care nurses are also involved in dealing with the patients’emotional health in addition to providing care in the physicalaspect. As they deal with their emotions, they have to cope withtheir states and in the process work closely with their families toensure the decisions made for the patients’ health care are thebest. The nurses normally operate in conjunction with professionalsin health care as a team to make a care plan for the person who isunwell. One essential thing in critical care nursing iscommunication. On top of all that, a nurse should be ready andwilling to adapt to the care of a patient as quickly as possibledepending on the health of the patient.
ASpecific Nursing Theory
Peoplewith some good knowledge about nursing have over time come up withmodels and theories to link nursing theory to the practical world. Anexample of a developed theory is the Orlando’s middle-range theory.It falls directly under the critical care field because the nursingtheorist, Ida Jean Orlando’s process of deliberative nursing, isguided by the behavior of the patient. In the theory, she explainsthat any behavior by a patient can either be a verbal or a non-verbalcry for help. The nurse has a duty to correctly interpret thebehavior of the patient and determine what the patient needs. TheDeliberative Nursing Process is made up of up to five stages. Thepatient is assessed, diagnosis is carried out, followed by planning,implementation follows and then finally evaluation.
Theassessment stage is where the nurse finalizes an assessment carriedout on the needs of the patient. The assessment is done withoutconsidering the reason for the encounter. A nursing framework is usedby the nurse to collect subjective data as well as objective dataabout the patient.
Thediagnosis stage employs the clinical judgment possessed by the nurseabout problems of health. Using links to characteristics that aredefining, any risk factors present in the assessment of the patientand defining characteristics.
Atthe planning stage, each of the identified problems is addressed.Every problem is assigned a specific objective or an expectedoutcome. To each outcome or goal, nursing interventions are given toassist in achieving the goal. The nurse has a nursing care plan bythe end of this stage. That is the general outlook of the Orlando’smiddle-range theory
Applicationof Orlando’s middle range theory in resolving an issue of nursingpractice in nursingleadership.
Themiddle-range theory by Orlando concentrated on the process used bynurses to identify distress in patients and their instant needs.Specifically, it underlines the interpersonal process taken to attainthose objectives. In 2000, Laurent proposed a dynamic leader-followerrelationship model. He used Orlando’s theory for his backgroundinformation.
Thetheory stated that the exchanges between the leader and the followerare actively changing. Both the leader and the follower are importantto ensure that the unit succeeds. The leader should provide directionand not control to the employee. This gives room for the employee todeliver maximum participation and not show contempt towards theleader hence a dynamic relationship. (Laurent, 2000). When there is adynamic interaction between a manager and a new nurse, motivation andcommitment are instilled in the nurse. Nurses, from here, can developsome basic principles of good leadership. This is due to the nichethey find and also due to the good interactions with nursing leaderswho are already established.
Resolvingproblems of nursing practice in nursing leadership
Evenwith claims that the economics are perfect, a lot of the expendituredoes not originate from vital inelastic goods. Procedures that arefollowed put off patients because they are the ‘just in case’kind of procedures. The patients develop a mentality of going to seekmedical help when there is strictly no other option. The questionthat faces these nurse leaders at this point is, what do they do whentheir hospital systems or facilities have a cut in the budget? Thefollowing are ways that one can go about it.
• Innovativebudget reduction ways should be applied. This can be done bycombining nursing units, limiting the number of patients nurses carefor, reduction of the time spent by employees in orientation andimproving retention of employees.
•Acknowledgmentto leaders of the awareness of the problem. No matter who one isanswerable to, be it a Board of Governors or a nurse in charge, it isimportant that they get to know both of you are aware of the problembeing faced and that you are doing your part. The perfect way tostart is by providing higher-ups with reports on status, resolutionsthat could provide a solution to the problem and the budget.
• Havinga budgetary need, that is in context.
Thisis a practical scenario where the Orlando’s middle-age theory canbe applied to solve the problem. The budgeting problem leads topatients developing a negative attitude towards hospitalizedtreatment because of some damaged facility. As it states, the patientalways comes first according to the theory, the nurse should,therefore, find a way of making the patient believe that they canstill receive maximum attention at the facility and don’t have towait until their illness has gone too far. It is the relationshipthat exists between the nurse and the patient that even motivates thenurse leader to seek help from the person they answer to.
Whenbudget cuts are implemented, and facilities operate in a lean way,the concern that should always remain is the patients’ safety andthe quality of care they receive. This is the way to ensure thequality of care and the standards of safety are at par.
• Leadernurses should push specialty nurses to get approved then becomeinvolved in organizations that are of their specialty locally.
• Amonitoring process should be put in place to constantly evaluate thecare standards. A perfect resource is a specialty nursingorganization.
• Keymetrics should be monitored regarding safety and quality followed byan address of any deficiencies present.
Orlando’smiddle-range theory can be applied in this case to ensure safety andhigh-quality care. It brings us back to the patient-nurserelationship that should at all costs be good. As nurse leaders facethe problem of ensuring that there is patients’ safety, a healthyrelationship between them and the patients should be maintained. Theyshould still seek to understand their patients better and ensuringthey are safe. Making a patient feel at home and appreciatedalleviates his suffering because his heart is at peace and notanticipating death.
Often,issues to do with the operation, contribute highly to thesatisfaction of a patient. The following are key indicators to beconsidered at a facility.
• Whenthe number of patients who are admitting from the emergencydepartment is too large, the satisfaction of the ED is key.
• Surgicalservices is another major point of admission. Satisfaction inpatients can be increased by, making the admitting process easy,providing education, communicating with the patients effectively, anddischarging the patients at the right time.
• Inpatientunits should also be part of ensuring safety and quality service.Similar rules like educating the patient and communicating to them.Other significant factors that indicate satisfaction are medicationand providing treatments in time.
Orlando’stheory is logical in this practical clinical scenario. All thoseefforts to ensure a patient’s satisfaction come after applying thetheory of middle-range. The nurses’ care for the patients puttinginto considerations different units and patients with various needs,critical cases first. Orlando’s theory is therefore very practicaland applicable.
Insummary, the processes of how care is delivered are not considered asmuch as the outcomes of that care. There are standards that areassociated with better outcomes, and that is where all attentiongoes. A new focus has been set on reporting federal satisfaction of apatient with the kind of services received. Production of qualityresults, the satisfaction of the patient and measurements that areeffective are centrally considered now as the requirements of afacility.
Inthe case of a nurse leader, an explicit accountability is representedfor the management and leadership of the staff responsible foradministering care to patients. There is a direct link betweenquality and safety matters to the pressure resulting from thefinances. Hospital compensation is being done away with because thereis great scrutiny from the government and those providing privateinsurance on financial accountability. There is a shortage inworkforce posing a great challenge. Nurse leaders have identifiedinadequacies in the pipeline for nursing leaders. Nurses haverecognized those main concerns that will result to a more successfulfuture.
Whena nurse decides to choose a leadership theory, she should choose onethat reflects her standards. The nurse should settle on the one thatshe feels she can use more effectively. The theories are never ratedas most enlightened or ones that are received best. When the nursebecomes aware of the theories that exist, she is free to subscribe toany that suits best her personality. It is advisable that nursesshould take up roles as leaders. There is some course offered atmost nursing schools, which equips nurses with management andleadership skills, as part of the curriculum. The problem thatarises, however, is the lack of follow up once the nurses are in theclinical area. When nursing leaders trended in 2000, their firstnoted topic was how the nurses would have the opportune moment tobecome leaders who are very active in the coming healthcare deliverysystems. It is possible for the leadership to come from all possiblelevels. Nursing shortages were put an end to. Without it in site,however, nursing does to itself some injustice by failing to trainmore nurse leaders. The nursing unit needs to be urged to make adedicated effort to mentor its young to become motivating andeffective leaders.
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