Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two.
Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.
Create clinical nursing (not medical) theory in the form of Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.
This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.
Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” our “our” in your theory, you are probably too complex.
If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).
Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.
Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion.
Application of Concepts from Caring Science
Healthcare practitioners, including nurses, strive to improve the quality of patient care and positive patient outcomes. They adopt nursing theories concepts as guides in their nursing practice to achieve the desired results. Appropriate theoretical underpinnings are the basis of all the evidence-based interventions which nurses adopt in improving patient care. These underpinnings are available in nursing theories’ conceptual frameworks. Therefore, conceptual frameworks provide nurse practitioners with evidence-based practice, which guides them in their clinical practices to enhance the quality and safety of patient care. Nursing theories are categorized into grand theory, mid-range theory, or practice-level theory. Grand theories are the most abstract, while the least abstract is associated with practice-level theories. Mid-range theories consist of most nursing theories that fall between grand and practice-level theories (Brandão et al., 2019). While there is a wide range of nursing theories, this paper will focus on Jean Watson’s Theory of Human Caring. The paper will focus on applying theoretical concepts to nursing practice to resolve the high rate of falls among the geriatrics in an Emergency Department.
Nursing Practice Outcomes to be improved
This paper will focus on improving the high rate of falls among the geriatrics aged 65 years and above in an Emergency Department. The patient falls rate in this center is approximately 35 falls per 1000 patient days. This rate is three times higher than the national benchmark for patient falls, 11.5 falls per 1,000 patient days Venema et al. (2019). Thus, this clinical issue necessitates implementing quality improvement (QI) initiative in the Emergency Department. Patient falls among geriatrics is a major concern for any healthcare organization since providers are no longer reimbursed for health care services provided to fall victims (Fehlberg et al., 2017). Accidental patient falls in healthcare settings reflect gaps in clinical practice that needs to be addressed. The risk of patient falls is relatively high among geriatrics in various healthcare organizations, including Emergency Department s (Michalcova et al., 2020). Thus, resolving this clinical issue will reduce the high out-of-pocket cost incurred in treating falls among this patient population. Additionally, preventing falls among elderly patients will prevent disabilities and other health complications related to falls.
A Clinical Nursing Theory
A clinical theory in terms of concept A | Proposition | concept B can be developed within the patient falls among elderly patients. Thus, the proposed concept-proposition-concept theory will contain the following elements:
Elderly patients aged 65 years and above are frail and at a high risk of various health complications than other patients in an Emergency Department. The high fall risk is associated with the physiological deterioration that their bodies have undergone, subjecting them to adverse health outcomes. These patients suffer comorbid physical conditions that compromise their functioning capacity. Some of the common disorders among the elderly population include cardiovascular disease (CVD), hypertension, type II diabetes mellitus (T2DM), and multiple sclerosis. According to Petrie et al. (2018), hypertension and T2DM usually occur together among the geriatric population due to common risk factors, such as vascular inflammation, endothelial dysfunction, arterial remodeling, dyslipidemia, atherosclerosis, and obesity. Additionally, mental disorders are common among elderly individuals aged 65 years and above. Mental illnesses increase the risk of fall-related injuries. Furthermore, neurocognitive disorders, including dementia and Alzheimer’s disease, are highly prevalent among elderly individuals above 65 years. These neurocognitive disorders are associated with cognitive impairment, such as disorientation, memory loss, and disordered speech. These symptoms trigger elderly patients aged 65 years and above to rise from their beds without intending to injure themselves since they fall as they leave the bed. In research studies, this concept is measured through descriptive statistics that involve the tabulation of demographic data.
Evaluation of patient fall risk indicates that the prevalence of falls is relatively high among patients above 65 years in all departments in a healthcare organization. This trend is reflected in the Emergency Department, which has a relatively high number of elderly patients than other units in a medical facility. Evidence-based tools, including the Morse Fall Scale, are utilized in conducting patient fall assessments (Falcão et al., 2019). The concepts from Caring Theory are applicable since the victims of accidental falls suffer from fall-related injuries in the emergency unit. These injuries increase patients’ frailty and may result in further complications, including intracerebral hemorrhage or death.
A positive correlation exists between the two concepts discussed above; Concept A and concept B. Concept B directly results from concept B, and their relationship involves direct causality. Advanced age increases accidental fall risk, and it’s attributed to various issues, including comorbidities and frailty. In terms of research, age above 65 years is the independent variable. Conversely, the occurrence of an incident of accidental fall within the Emergency Department is the dependent variable. The independent variable presented in this case is constant. On the contrary, the occurrence of the dependent variable is 50% depending on various factors. The dependent variable can be prevented through evidence-based fall prevention interventions. Hence, the clinical nursing theory developed for this incident considers age advancement (Above 65 years) as accidental falls independent risk factors.
A Comparison of the Created Clinical Nursing Theory with Watson’s Theory of Human Caring
Jean Watson developed the Theory of Human Caring. According to this theory, mutual benefit is generated through caring for the needy. Additionally, a therapeutic bond is developed between a nurse practitioner and a patient, thus enhancing a nurse’s innate capabilities. According to Alharbi and Baker (2020), Watson’s theory major concepts that pertain to nurse practitioners include caring for those in need of help selflessly to restore their wellbeing; acting as a patient advocate and change agent in a therapeutic environment; fostering the therapeutic relationship between nurses and patients to enhance wellbeing and healing process, and believing in spirituality or divine intervention.
Caring is the basis of the nursing profession considered a key preposition in Watson’s Theory. According to Pajnkihar et al. (2017), individuals have a moral obligation to protect and preserve human dignity, wellbeing, and wholeness. This proposition can be compared to the one developed in the clinical nursing theory discussed above since moral obligation consideration and patient prevention determine the evidence-based interventions to be implemented. The high rate of falls among the elderly patients in the emergency department can be reduced through various interventions, including hourly rounding, equipping nurses with skills to enable them to identify patients who are at a high risk of fall, and the installation of bedside alarms (LeLaurin & Shorr, 2019). These interventions aim at preserving patients’ wellbeing and restoring human dignity.
Watson’s Theory of Human Caring also consists of the ten Caritas processes. Out of these, concept ‘A’ discussed above matches the creation of a healing environment that respects the human body. According to Concept ‘A,’ the human body deteriorates with age. Consequently, the elderly population is susceptible and frail to adverse clinical complications and health outcomes. Therefore, geriatrics above 65 years must be respected in a healing environment. For instance, the Emergency Department, which is frequently visited by the aged population, should be located on the ground to ensure the geriatrics do not use stairs to get to the department. Additionally, beds should be very low to prevent elderly patients from falling when leaving their beds. These healing environment attributes respect the human body and protect human dignity.
Based on this comparison and the congruency between the selected concepts and propositions, Watson’s Theory of Human Caring applies in different practical incidents. It is compatible with various clinical nursing theories. For instance, in this case, Watson’s theory fits the context of accidental patient falls perfectly.
Discoveries and their Effect on the Nursing Profession
The author made various discoveries from multiple readings that were used in completing this paper. The first discovery entails the existence of multiple mid-range nursing theories that can guide nurse practitioners in their clinical practice. These nurses enhance the nursing profession, which was developed so many years ago. Additionally, I discovered that nursing nurses add to the models developed by first theorists such as Florence Nightingale, thus enhancing the nursing profession. The second discovery involves the impact of proven concepts from nursing theories on nursing interventions. Nurse practitioners incorporate these concepts into their practices as evidence-based practice (EBP) that effectively improve the quality of patient care and health outcomes. Finally, a discovery was made that nursing is a unique profession in which practitioners should care for the patients to restore their health, wellbeing, and dignity. Additionally, Watson’s theory presents nursing as a certain profession from the 10 Caritas processes. Nurse practitioners should be selfless, prioritize caring for their patients, and advocate for their healthcare needs in their respective healthcare settings. The three discoveries relate to the nursing profession and the obligation of nurse practitioners. Thus, nurses should incorporate these discoveries into their clinical practices to prioritize caring for their patients to restore their wellbeing and human dignity. However, some questions have been discussed, necessitating further research. The first question is whether the efficacy of grand theories, mid-range theories, and practice-level theories in guiding nursing practice differs. The second question involves which theory is most effective in guiding nurse practitioners in providing patient care in the emergency unit.
Overall, the three categories of nursing theories effectively guide nursing practice through their concepts, which are developed in terms of evidence-based interventions. These theories enable nurse practitioners to address various clinical issues, thus improving the quality of patient care and patient outcomes. One of the most influential nursing theories is Watson’s Theory of Human Caring, which considers caring for the patients as the center of nursing care. Nurses are obliged to take care of their patients to improve their health and wellbeing and restore human dignity. Thus, this theory can resolve the high rate of patient falls among elderly patients above 65 years in the emergency department. The theory can be applied by defining Concept A and Concept and a preposition and aligning them to Watson’s Human Caring Theory. Adopting this theory will guide nurses in implementing fall intervention, thus reducing the high rate of patient falls.
Alharbi, K.N., & Baker, O.G., (2020). Jean Watson’s middle-range Theory of Human Caring: A critique. International Journal of Advanced Multidisciplinary Scientific Research, 3(1), 1-14. https://doi.org/10.31426/ijamsr.2020.3.1.3011
Brandão, M. A. G., Mercês, C. A. M. F., Lopes, R. O. P., Martins, J. S. D. A., Souza, P. A. D., & Primo, C. C. (2019). Concept analysis strategies for the development of middle-range nursing theories. Texto & Contexto-Enfermagem, 28.
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention-related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.
Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics, 20(1), 1-11.
Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis) harmony with patient satisfaction. PeerJ, 5, e2940.
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575-584.
Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study. BMC geriatrics, 19(1), 1-10.