NURS 324 Theories In Nursing Practice

Theories of practice

Introduction: 

Grand theories are broad in scope addressing a variety of concepts and propositions that the nurse deals within the field of practice. Middle range theories of nursing are specific and offer more concrete connections between the grand theories and the practice (Ahtisham, 2015). This essay discusses Dorothy Orem’s grand theory of self-care and Dorothy Johnson’s middle-range behavioral system model.

Orem’s Self-care grand theory

The self-care theory is established on improving the quality of nursing and the general hospital that the practitioner works in. The theory is divided into three parts; self-care theory, self-care care deficit and theory of nursing (Hojjati, 2015). The self-care theory part self-care activities initiated by the individual to maintain life, the self-care agency which is the ability to engage in self-care that is conditioned by environmental factors and the therapeutic self-care demand which entailing the healthcare actions to be taken. Here five methods of helping are used in the deficit; acting and doing for others, supporting others, guiding others, providing a convenient environment for personal development and teaching others the process of care (Meleis, 2012). From all these, the nurse’s process has three parts of collecting data to determine the problem, diagnosing and creating a nursing plan and lastly implementation of required nursing approaches.

Orem’s self-care theory can be applied to patient settings by identifying the needs of the patient’s and developing interventions for them. When handling patient issues, the practitioner needs to follow the steps set out in the process to ensure that the practitioner investigates the problem of the patient. For example, in the case of psychiatric patients, Hajira & Ali (2018) argue that the practitioner has to determine the compensatory care that the patient needs. In this case, the patient required wholly compensatory care due to the fewer abilities that the patient has and the inability to fulfill daily living. This means that the practitioner identifies the patient’s needs and then plans interventions based on the specific needs of the patient (Meleis, 2012). This leads to setting goals of care on what needs to be done to restore the patient by preventing the symptoms from worsening and developing a cure. From here, the practitioner correlates the problem that the patient is facing to the eight universal self-care requisites and developing the one that fits the patient situation and developing a plan of care that is directed through assisting the patient to overcome the problems.

Johnson’s Middle Range Systems Behavioral Theory

The behavioral system model sees nursing as an external regulatory force for preserving the organization and integrating patient behaviors in relation to illness. The theory is guided by four major concepts of human being, society, health and nursing. For Johnson, the nursing process entails assessment, diagnosis, planning and implementation and evaluation of the outcomes (Ghanbari & Pouy, 2018; Poster & Beliz, 2002). This leads to the four goals of commensuration of social demands, modifying behaviors to support biological imperatives, ensuring patient’s benefit from the nursing processes and reducing trauma as a consequence of illness

When applying the theory like in the case of designing nursing care programs for children with acute lymphoblastic leukemia Ghanbari & Pouy (2018) argue that the first step that the practitioners need to do is an assessment of the patient to determine the best suitable intervention for the patient. The practitioner then develops a systems approach to the patient’s problem through setting goals that need to be achieved. This approach utilizes the development of relationships between the practitioner and the patient and his/her to develop new behavioral approaches. To restore the condition of the patient, the practitioner develops nursing interventions that address the patient’s environment thus increasing the outcome of any healthcare intervention on the patient. The practitioner developed measures for addressing the problem through identifying insufficiency in protective and aggressiveness of the subsystem, insufficiency in controlling the subsystem, insufficiency in the eliminative subsystem, the discrepancy in restorative and achievement subsystem and insufficiency in achievement subsystem.

These theories guide the way the nursing practitioner needs to approach the nursing process. The behavioral model suggests the process that the practitioner needs to follow through assessment, diagnosis, planning and implementation and evaluation. By viewing the nursing environment as a system, the practitioner understands the different subsystems that they need to work on to increase clinical outcomes (Schaffner, Tillett, & Volz, 2016). This means that the nurse’s responsibility is to support and restore balance to the patient. The nurse needs to ensure that an environment is created for the patient to open up on their problem. The nurse needs to understand that behavioral efforts arise as a result of the patient’s ability to deal with the problem that they are facing.

Conclusion: 

Therefore, the grand and middle-range theories of nursing offer propositions that nursing practitioners need to follow in practice. The practitioner is supposed to follow a set of stages that the selected theory defines the nursing process. This means that nursing practitioners can apply different nursing principles depending on the one that suits the situation that they are in. therefore each theory carries its own utility that the practitioner can apply.

References:

Ahtisham Y. (2015). Integrating nursing theory and process into practice. International Journal of Caring Sciences, 8, 443-450.

Ghanbari, A., & Pouy, S. (2018). Designing Nursing Care Program Based on Johnson Behavioral Model in Children with Acute Lymphoblastic Leukemia: A Case Study. International Journal of Caring Sciences, 11(1).

Hojjati, H. (2015). Concepts and theories of Nursing. Tehran: Jameenegar.

Meleis, A. (2012). Theoretical nursing:development and progress. LippinCott Company.

Poster, E. C., & Beliz, L. (2002). The Use of the Johnson Behavioral System Model to Measure Changes During Adolescent Hospitalization. International Journal of Adolescence and Youth, 4(1), 73-84.

Schaffner, L. D., Tillett, N. L., & Volz, T. M. (2016). Empowerment works! Clinical Nurses and the Professional Practice Model. Nursing Management, 7(11).