Nursing Theory in Practice
Theories are critical in nursing because they guide the way professionals deliver services to patients. They form the foundation for research and practice in nursing. Hence, they are useful when evaluating the duties and roles of caregivers working in the nursing profession. Theories are critical in modern-day nursing and healthcare because they improve practice and patient outcomes. The United States is experiencing severe challenges in healthcare, including the changes in the demographics of patient populations and the increase in the cost of care. Therefore, effective theories to inform successful interventions should be available. Besides, an increase in a multicultural community is evident, which creates a challenge for caregivers to customize patient needs (Lee, Palmieri, & Watson, 2016). The changes require nursing professionals to comprehend and appreciate the new challenges and create efficient solutions. Nursing theories inform their skills and knowledge to improve care amid the problems that are evident in their work. Besides the conventional theories, such as Martha Rogers’ Unitary Human Beings, Fay Abdellah’s “21 Nursing Problems,” and Albert Bandura’s Social Learning Theory, nurses can develop and operationalize new theories to apply in the nursing practice.
Martha Rogers: Unitary Human Being
Background
Martha Rogers is one of the prominent theorists in nursing. She is the proponent of the “Science of Unitary Human Beings.” She was a nurse in the United States, as well as a theorist, researcher, and author of the book, An Introduction to the Theoretical Basis of Nursing, in which she described her theory. She developed the theory out of her belief that a patient should not be separated from the environment because of its impact on health. Therefore, the environment plays an important role when dealing with health and treatment (Smith & Parker, 2015). The idea of the connection between the human and the environment was critical in improving health care in the United States.
The Science of Unitary Human Beings considers nursing as an art and science because it provides the means that regard a person as a unitary human being. The human being is an integral part of the universe, one with the environment. Therefore, the caregiving profession should focus on the people and the manifestation that emerges from the shared interaction between the human and the environment (Petiprin, 2016). The theory focuses on the interrelation between the two aspects, human and environment, and applies the knowledge in helping nursing professionals to use the art and science of nursing to improve patient care and achieve positive outcomes. The concept allows patients to have a smooth recovery and attain the highest level of health.
Definitions of Major Concepts
The Science of Unitary Human Beings has various concepts and subconcepts. The conceptual framework has a significant impact on nursing practice because they work together to achieve positive outcomes for patients. The theorist defined health as the expression of a life process. Health is the result of the mutual interaction between the person and the environment. Nursing is the study of unitary, intricate, inseparable human, and environmental domains. It studies human beings and the world they live in. The profession enables nurses to serve human beings and provide them with a safe environment to eliminate illnesses and other health complications. The environmental field is the intricate, inseparable, pan-dimensional energy field, which is the basic unit that the living and the non-living exist in. Various other subconcepts are evident in theory. Openness suggests that no boundaries can stop the flow of energy between the two main fields, the human and the environment. Pan-dimensionality is the non-linear element that does not have any spatial or temporal characteristics. The pattern is the distinguishing attribute of the energy field viewed as a singular wave. The principles of homeodynamics are the energetic form of homeostasis, which postulates a means of looking at the unitary human being. Those aspects include Resonance, helicy, and integrality. Resonance is the nature of the change that occurs between the person and the environment. Helicy is the ongoing change because of the constant interchange between the two fields. Integrality is the interconnection between the people and the environment (Petiprin, 2016). All the concepts are the building blocks for its use in research and practice.
Theoretical Statements and Linkages
The nursing process, as it applies to the theory, has three steps, including assessing, voluntary mutual patterning, and evaluating patient needs. The assessment comprises patterns of events that occur at a specific time, along with the state of the patient and the environment in which the illness and health transpire. The theory helps nurses to manage the environment to prevent disease. The theory guides the assessment of an individual and the interaction with the environment. Some of the steps involved in the process include sharing knowledge, patient empowerment to control the environment, providing choices and alternatives, fostering partnerships, patient evaluation, implementation of interventions that include nutrition, wake/sleep cycles, work/leisure activities, relationships, fear and pain, identification of dissonance and harmony, and patient’s self-reflection (Petiprin, 2016). The process helps to understand the aspects of the environment that needs to change to achieve health outcomes.
The Science of Unitary Human Beings connects human beings with the environment in a unified manner. Since a person is a unified whole, he or she possesses integrity as well as the manifesting aspects that are more critical than the parts (Smith & Parker, 2015). Therefore, for a nurse, it is essential to avoid separating the human from the environment for proper care and achievement of holistic health. The person and environment always exchange energy and matter with each other. Nurses should understand the aspects of the surroundings that have a direct impact on the person. Controlling these elements is the only way to provide adequate care to their patients. The theory offers a worldview from which caregivers generate their hypotheses and approaches that support their care delivery.
Application with Examples
The theory can be used in nursing because of the need to monitor and control the environment to prevent illness and promote health. The environment remains one of the elements with a considerable impact on disease and health. Hence, it is crucial to make the environment safe for people. Health promotion can use the theory to educate people on the way to manage their surroundings to ensure that it is safe for them to live in. It is part of the patient-centered strategies to improve health care in the country (Lee, Palmieri & Watson, 2016). The process makes the theory more practical in nursing. The model could be used in preventing lifestyle diseases, such as cancers, diabetes, and obesity.
Health promotion should focus on creating a healthy environment. For example, it should be part of a community effort to eliminate such elements as lead and other pollutants to maintain clean surroundings. Research reveals that some diseases such as lung cancer emanate from living in a polluted environment. Therefore, to address the epidemic, people should live in a clean environment. One of the applications of the theory is to promote smoking cessation programs to protect people from primary and secondary smoking that may cause cancer. The theory relates to the concerted effort to control the environment because it is an integral part of the person and the basis for health promotion.
Fay Abdellah “21 Nursing Problems”
Background
Faye Abdella is another renowned theorist. Besides being a theorist, she is a military nurse and a researcher. She is the proponent of the “Twenty-One Nursing Problems.” The theory was progressive during its development because it focussed on nursing diagnosis. It was proposed during a time when nurses were trained to believe that diagnosis was not part of their role. The model has interrelated concepts, which include problem-solving, nursing problems, and health (Snowden, Donnell, & Duffy, 2014). She considered nursing as a science and an art that define the intellectual competencies, attitude, and technical skills of the nursing professionals and transform them into the ability and desire to provide help to people in order to deal with their health challenges.
Abdella applied Henderson’s 14 basic human needs and integrated the theory with nursing research to create a solution to problems affecting nurses and their practice. The theory is a patient-centered approach to the practice that was created out of the theorist’s personal experience. It is also viewed as a human needs theory aimed at improving care through addressing problems affecting people (Smith & Parker, 2015). She desired for the theory to be a tool for nursing education. Thus, it is most pertinent to the nursing education field because it develops nurses with the ability to meet patients’ needs. Besides, it was aimed at guiding health care in hospital facilities, although it can also be used in community health through the nursing practice.
Definitions of Major Concepts
The 21 Nursing Problems Theory has several interrelated concepts that are the basis of its application in research and practice. Those aspects relate to health, nursing problems, and problem-solving. Individual or person is the recipient of care in nursing. However, the theory does not delineate the nature of the human being in the care process. Health is the purpose for which the nursing services are provided to the person. The theorist speaks about the “total health needs ” as well as the need for a healthy state of body and mind (Alligood, 2014). The concept defines the dynamic pattern of effective working in an ongoing interaction between the external and internal forces that leads to the optimal utilization of resources to prevent illness. Society is a concept that is entrenched into the plan for optimum health on various levels, including localized, state-wide, and global (Smith & Parker, 2015). However, the focus of nursing, according to the theorist is the individual. Nursing problems are defined as the client’s health needs, which can be covert or overt. The former includes health issues, such as sociological, emotional, and interpersonal challenges, which are commonly misunderstood or incorrectly perceived. However, they should all be solved to achieve optimal health. Problem Solving suggests the need for nurses to be capable of identifying and solving visible and hidden nursing problems. The process entails problem identification, selection of pertinent data, formulation of hypothesis, collecting data to test hypothesis, and revising it whenever necessary to conclude.
Theoretical Statements and Linkages
The theory helps nurses to identify and solve patient problems through evidence-based approaches. Abdellah identified three groups of nursing problems that caregivers encounter in their practice. Firstly, she identified physical, sociological, and emotional needs. Secondly, she categorized the types of interpersonal relationships between the caregiver and recipient. Finally, she grouped common elements of patient care (Snowden, Donnell, & Duffy, 2014). Nurses should use their skills and experience to identify and create interventions to resolve problems that include the need to maintain proper hygiene and physical comfort, promote activity, improve safety, maintain appropriate mechanisms, facilitate adequate oxygen supply, achieve right nutrition, and enhance effective interpersonal relationships, among other aspects. Health professionals achieve these concepts by working with individuals and their families to prevent disease or injury, hence achieve optimal health.
The theory plays a critical role in the development of a suitable therapeutic environment that can support patient-centered care and help in addressing patients’ needs. Therefore, the caregiver should have the necessary competence to involve the person in the care delivery process. The role of the nurses facilitates the achievement of optimal emotional, sociological, and physical wellbeing. Abdellah used the problem-solving process to create a nursing practice in which the professionals understand and resolve the identified issues affecting individuals, and by extension, the society (Smith & Parker, 2015). The concept also helps them to delineate nursing (patient) challenges as the individual progresses towards a reliable result. Nurses with the knowledge of the required steps to resolve the issues and meet the needs are required for a well-functioning healthcare system.
Application with Examples
The theory applies to the nursing practice directly because of the importance of understanding patient needs and creating successful interventions to address them. It requires caregivers to develop the necessary therapeutic connection with the patient to understand both overt and covert needs (Alligood, 2014). For example, nurses have to communicate and interact with an individual to comprehend what the patient says directly and what is implied using other cues. For example, a teenager might come to a hospital with physical injuries, but the professional can identify other emotional traumas affecting the patient when having therapeutic contact. They should engage in proper assessment and evaluation of the patient before implementing any intervention. The intervention should include an adequate design of a therapeutic plan.
Abdellah’s theory is useful for nurses striving to implement patient-centered care. The approach works in an environment where a patient is in the middle of any therapeutic process. For example, it informs the strategies used by professionals to engage the patient in the problem-identification process. As a result, the nurses can quickly identify the patient’s needs while collaborating with the recipients of care. The nursing practice should be oriented towards the client-centered approach and the desire to evade the disease-centered model because it ignores some of the most important elements of holistic care, such as emotional problems (Alligood, 2014). The model can play a critical role in creating a conducive environment for patients suffering from psychological challenges, such as depressive or anxiety disorders. Generally, the theory is based on meeting client needs holistically by influencing the internal and external environment.
Albert Bandura Social Learning Theory
Background
Albert Bandura’s theory is a social learning theory that postulates the role of the social environment in the learning process. Children learn by observing the people around them and how they behave. The process was highlighted during the Bobo doll experiment. From the investigation, children behaved violently because they witnessed adults acting in the same way. Teenagers observe their models and emulate their behaviors (Bandura, 2017). Society has many influential individuals that they can learn from, such as parents, TV characters, teachers, and friends, among other people. The models provide examples of the behavior that children can learn through observation. Some of the behaviors may include pro-social while others could be anti-social and negatively affect their health and wellbeing.
Children pay attention to people around them (models) and encoding the way they behave or act. They later imitate or copy whatever they learned. They internalize the behavior through the learning process. Various processes can increase the probability that a child will later reproduce the actions that society promotes as being appropriate for their gender. First, they are more likely to learn from those individuals they perceive as being similar to them. Thus, a high possibility exists that they will imitate people of their gender. Second, people around the child respond to the imitated behavior positively or negatively through reinforcements or punishments (Bandura, 2017). For example, if a child receives a rewarding response from imitating an action, he or she will continue performing the act accordingly. If a child is applauded for consoling a doll, he or she will most likely continue showing such kindness.
Definitions of Major Concepts
Unlike nursing models, the social learning theory does not explicitly define building concepts. However, critical conceptual underpinnings are evident in the theoretical framework. One of the ideas manifest in the learning theory is the person. The individual is either the learner of the negative behavior or the model that provides a conducive environment for the learning process to happen. People learn through observing what others in their environment are doing or saying. Consequently, they learn behaviors, attitudes, and outcomes of behaviors of others. Besides the learner, the theory defines the environment. The concept outlines the social surroundings within which the learning process occurs. It is the person’s surrounding that forms the basis of the observed behavior of a model. Modeling is the process through which most of the human behavior is learned through observation. The person observes others, forms the idea of the performance of the behavior, and later uses the coded information as the guide to one’s behavior (Bandura, 2017). Social learning theory explains behavior among human beings concerning the ongoing reciprocated interaction between behavioral, cognitive, and environmental influencers.
Theoretical Statements and Linkages
The theory has a close connection between people and their environment. Although it is not a nursing theory, it explains the interconnection, just like the hypotheses that nurses use to describe their practice. The environment plays a vital role in the way an individual turns out, negatively or positively. The theory is applied to various learning situations. The theory can be used in many environments where learning takes place, including in nursing education and training (Duane & Satre, 2014). Furthermore, many of the theories in nursing focus on prescribing the most effective approach to the nursing practice in a professional setting. In general, theories strive to establish the best way to develop nursing professionals who can provide quality care to patients.
Compared to many of the learning theories, Albert Bandura’s takes into consideration the role of the environment in influencing responses to one’s surroundings and developing a person’s behavior. The process takes place through the learner’s cognitive skills. The social learning model connects with the deliberate nursing process theory, which focuses on the importance of a response to the actual environment when developing nursing interventions (Duane & Satre, 2014). It argues against the blind use of prescribed solutions to nursing problems. According to the theory, it is essential to understand the environment of the person before concluding about the efficacy of an intervention to a clinical problem. Generally, patient problems emerge from the ongoing interaction with the surroundings, and hence, arguments should be incorporated into the intervention.
Application with Examples
The learning theory applies to the nursing field because of the relationship between the person and the environment. For example, children have the potential to develop, positively or negatively, depending on their environment. The process has implications on the nursing practice because caregivers have the opportunity to care for children and adolescents learning from their social environment (Duane & Satre, 2014). One of the leading challenges for caregivers in modern society is alcohol and substance abuse. Many young people are addicted to drinking and drugs because they have learned the vices from their social environment, such as from their parents. The learning process explains the high prevalence of the problem in contemporary society.
The theory can help to inform interventions to prevent alcohol and substance abuse in society. Nurses can engage in health promotion and behavior change campaigns in their communities to eradicate the negative models and replace them with positive ones to support the learning of positive behavior. Such programs should target adults to help them eliminate ant-social behaviors and replace them with pro-social ones (Duane & Satre, 2014). For example, they can use media campaigns to educate parents about the dangers of drinking alcohol or using drugs while their children are observing. In addition, they can teach their children about the risks of these substances. Through the learning process, children and teenagers will avoid destructive behaviors. Even in their future, they will only imitate the positive behavior and reduce the burden of care for nurses involved in the treatment of alcohol and substance abuse.
Operationalization of the Proposed Theory
The proposed theory aims at creating a substantial change in a community to address an identified nursing problem. It will integrate the essential aspects of the three models already discussed. The theoretical framework focuses explicitly on the relationship between the person and the environment and how to change the individual’s surroundings to solve an identified patient’s need and achieve quality outcomes.
The “Theory in Action”
The proposed theory brings together aspects of Martha Rogers’ Unitary Human Beings, Fay Abdellah’s “21 Nursing Problems,” and Albert Bandura’s Social Learning Theory to create a model of care that will achieve positive results of the caring process. The implementation of the theory blends the theoretical concepts to develop a patient-centered care theory that outlines the role of the person in changing his or her environment to achieve improved health outcomes. It also involves the part played by the nurse in promoting health education to ensure the success of the change process (Glanz, Rimer, & Viswanath, 2015). The implementation approach will consider the procedures and methods of assessing the needs of individuals and society to create targeted interventions. It will involve the identification of the problems through effective communication as proposed in Abdellah’s “21 Nursing Problems.”
Besides the identification of the needs, the model will ensure operational health promotion and behavior change efforts to change the environment for the health benefits of the person as proposed in Martha Rogers’ Unitary Human Beings and Albert Bandura’s Social Learning Theory. Since the surroundings are in a unitary relationship with the person, changing it will affect health and illness. Notably, the transformative action will depend on the identified patient needs and the unique aspects of the social setting that cause health challenges for an individual (Glanz, Rimer, & Viswanath, 2015). The focus of the model is to improve the environment to prevent the development of mental health challenges, such as substance abuse, which has become prevalent among the youth. Therefore, the nurse should work with community members to change the environment to promote pro-social behaviors.
Personal View of Concepts
Person. The person in the proposed model is the recipient of the behavior change communication to improve behavioral outcomes and reduce health care problems that emanate from negative behaviors learned from the social environment (McEwen & Wills, 2017). The individual will play an active role in the assessment of the patient need and participate in the implementation of the targeted changes through health promotion and behavior change efforts. He or she will also be part of the transformation through the patient-centered model of intervention.
Health. From the perspective of the proposed model, the concept is defined as the absence of patient problems achieved through health promotion and behavior change campaigns (McEwen & Wills, 2017). The nurse will play a critical role in the achievement of the outcome by using targeted interventions to eradicate the dangers to health inherent in the person’s environment, such as drug use. The progress of optimal health in the society will depend on collaboration between the nurses and the target community to change the environment.
Nursing. The concept is the actual caring process that will achieve the proposed change in the target community. Professionals will engage in nursing efforts, including health promotion and disease prevention, to create a healthy environment for members of the target community (McEwen & Wills, 2017). They will work with the individuals through the patient-centered approach to achieve health outcomes.
Environment. The concept is defined as the actual patient setting that will be targeted for the change effort. It is the variable that the nurses will manipulate to achieve health promotion and behavior change goals to address the identified patient needs. The environment is the surrounding within which the people targeted by the change process live.
Application to Practice
The proposed model will be useful in preventing negative behaviors in the target community. Research has revealed a high prevalence of alcohol and substance abuse among the youth in society. Hence, to address the problem, nurses will use the proposed theory by blending important aspects of the three models discussed earlier. To begin with, the nurses will use Abdellah’s “21 Nursing Problems” to understand the challenge of implementing an effective intervention. The health need in the community is the alcohol and substance use, but other related issues emerge, such as mental health effects. Albert Bandura’s Social Learning Theory will inform the proposed change by determining the role of the social environment in developing the health-related problem. The model will update the actual change that is necessary, that is, to remove the negative aspects and access to alcohol and drugs from the reach of children and adolescents. Finally, the campaign will use Martha Rogers’ Unitary Human Beings to create the desired environment for the health benefits of the youth. The proposed theory will involve nursing and community effort to create an enabling environment to achieve optimal health outcomes for children and adolescents. The proposed model will be used in theory, research, and practice to inform health promotion and behavior change efforts to create a healthy environment.
Conclusion
The theoretical analysis focuses on the use of nursing and other models to achieve positive health outcomes in a community. The purpose is to provide a description, analysis, and evaluation of three theories, Martha Rogers’ Unitary Human Beings, Fay Abdellah’s “21 Nursing Problems,” and Albert Bandura’s Social Learning Theory to develop a personal model of nursing that can be used in practice to address a patient need or problem. The proposed model will change the environment and create a positive learning process for young people. It will inform education, research, and practice in the nursing practice. Overall, it will support health promotion and behavior change efforts to address significant health care challenges in the target society.
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