NR 501 Week 6 Discussion Literature Review
Sample Answer for NR 501 Week 6 Discussion Literature Review Included After Question
Literature Review
Locate a scholarly journal article that uses either a health behavior theory or the Praxis Theory of Suffering as the basis for evidence-based research. Choose an article DIFFERENT than those provided in the weekly readings.
Summarize the research presented. How was the theory used? How do the research findings either support or refute the use of the theory in practice? How could you use the research in your own practice as an NP?
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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
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Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource
NR 501 Week 6: Application of Theory to Leadership and Management
Week 6: Impact of Nursing Theory Upon Healthcare Organization
No unread replies.7575 replies.
Discuss how a specific middle-range nursing theory has been or could be applied by nurse leaders or nurse managers to effectively deal with an administrative issue (i.e., staffing, use of supplies, staff performance issues). Include an example from the literature or your own experience to illustrate your points.
A middle-range theory that could be applied by nurse leaders or nurse managers, to deal with administrative problems such as staffing, and staff performance challenges is the Peplau’s theory of interpersonal relations. Among Peplau’s theory concepts we can find assisting other to identify their difficulties, applying human relations to the difficulties others are facing, being a resource person, a counselor and educator. These principles are of paramount importance for nurse leaders to apply in their professional environment to achieve effective leadership.
According to Hurley & Hutchinson (2013). effective nurse leadership positively influences the quality of clinical care, as well as work settings where nursing care is taking place. One of Peplau’s theory comprise assisting individuals to identify their difficulties. It is very important, for nurse leaders to engender a working environment that makes nurses and other personnel have a sense of safety and feel valued while carrying out their duties in the working environment. Such environment positively influences nurses and other personnel working moral and as a consequence will benefit nurses and other personnel retention as well as create a safe environment for nurses. Another demonstration of the application of Peplau’s theory is when a nurse manager detects any type of issue with the staff performance or getting used to the work environment, the manager has the obligation as leader to assist that personnel in identifying and overcoming such difficulties in order to promote a healthy working environment that is under her supervision. When any issue in the working environment is recognized, the nurse manager through the use of appropriate management skills should be able to provide assistance and resolve the issues identified. Although some issues can be resolved by each individual; there are other problems that indeed require the involvement of the manager.
I was employed to a facility that had a high rate of turnover and low morale. Nursing staff were leaving shortly after being employed and oriented for the job. It was like a cycle of employment and resignation not long after the orientation period was finalized. There was a common denominator in this situation, when staff personnel identified a problem that affected them, whether directly or indirectly, the manager would not intervene in a timely manner or sometimes not at all to resolve the situation affecting this nursing personnel. Nurses with senior positions were very indifferent, not training the new recruits properly and making degrading and unprofessional comments towards their newly employed junior colleagues. Some senior nurses were employed to the institution prior to the manager and therefore felt they had the right to have an upper hand in the institution due to their seniority. Newly employed nurses felt mistreated and professionally disrespected and they had no one to support them, and as a result there was an increased number of nurses leaving the institution. This situation stopped when there was an investigation from upper management to detect the reason why nurses were leaving in such a short period of time from this particular unit. Once the problem was addressed, and disciplinary action and changes made to management and in the working environment, nurses started to work in harmony, treating each other with respect and addressing each other professionally. Turnover rate decreased tremendously, productivity and patient healthcare also improved.
One of the main problem-solving avenues in management is communication. It is of paramount importance for a leader to be able to utilize leadership methods conducive to healthy communication, proper interpersonal and interprofessional relationships which will be able to develop a productive and healthy environment among nursing personnel, management and the institution. The application of Peplau’s theory of interpersonal relation may be of crucial value to nursing personnel with its implementation in their professional career.
References
Hurley, J & Hutchinson, M. (2013). Setting a course: A critical review of the literature on nurse leadership in Australia. Contemporary Nurse, 43(2), 178–182. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1698634428/fulltextPDF/EC172494A2C84A47PQ/1?accountid=147674 (Links to an external site.)
Collapse SubdiscussionBrenda Talley
Feb 5, 2018Feb 5 at 5:49pm
Adalaida, thank you for beginning our discussion for the week!
This sounds like a very difficult time for your organization.
Hurley and Hutchinson (2013) propose the the apparent lack of strategic direction in leadership may not lie at the door of the nursing profession (only) but may be a phenomenon that is embedded in the culture of healthcare organizations.
Adalaida, Class, do you agree?
Is there a nursing theory that might help to bring cohesiveness to leadership strategies?
References
Hurley, J & Hutchinson, M. (2013). Setting a course: A critical review of the literature on nurse leadership in Australia. Contemporary Nurse, 43(2), 178–182. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1698634428/fulltextPDF/EC172494A2C84A47PQ/1?accountid=147674 (Links to an external site.)Links to an external site.
Collapse SubdiscussionAdelaida Larduet Mayeta-Peart
Feb 6, 2018Feb 6 at 8:30pm
Professor Talley,
Peplau’s nursing theory may assist in bringing cohesiveness among the health care team, as through its application, leadership skills might be improved, which could positively impact cohesiveness in the clinical practice. Peplau’s theory of interpersonal relations is an adequate nursing theory that specifically play an excellent role in resolution of administrative problems as well as issues affecting staffing and staff performance when applied by managers and nurse leaders
According to Kumar, Deshmukh, & Adhish (2014) the skills associated with handling self, such as emotional capabilities, time management and active listening are crucial characteristics for the foundation of managing and leadership teams to be able to function in a constructive manner. The implementation of team building exercises play an essential role in accomplishing the goals of the organization. These exercises are of paramount importance when referring and addressing the health care factor in both the clinical as well as public health settings. The main and distinctive quality of a cohesive team is a joint vision towards the achievement of goals.
As a leader, creating and supporting a strong and cohesive team, the nurse will also help the patients take on maximum responsibility for meeting his or her treatment goals, as this will take place in a healthy working environment conducive to productive nursing work. A nurse leader who intends to promote a healthy working environment will take on other roles such as technical expertise and tutor in which this leader makes herself or himself available to the junior nursing staff, providing technical support, also act as a safety agent, environment manager, mediator in any circumstance that mediation is required, administrator and researcher.
According to Kumar, Deshmukh, & Adhish (2014) the team is a cooperative relationship supplementing and supporting each other’s skills, interacting openly and clearly with one another and holding themselves mutually accountable.
According to Hurley, J & Hutchinson, M. (2013) leadership is about relationships. For a nurse leader, it is important to adapt to a leadership style that nurtures healthy relationships intra-professionally and inter-professionally,that is among nurses, nurse leaders and other leaders within the organizations. Applying Peplau’s theory of interpersonal relation can be useful for nurses to adopt in their professional career.
References
Hurley, J & Hutchinson, M. (2013). Setting a course: A critical review of the literature on nurse leadership in Australia. Contemporary Nurse, 43(2), 178–182. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1698634428/fulltextPDF/EC172494A2C84A47PQ/1?accountid=147674 (Links to an external site.)
Kumar, S., Deshmukh, V., & Adhish, V. (2014). Building and Leading Teams. Indian J Community Med, 39(4), 208-213. doi: 10.4103/0970-0218.143020 (Links to an external site.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215500/ (Links to an external site.)
Feb 7, 2018Feb 7 at 7:16am
VERY well expressed Adaida!
Nursing theory has the potential for providing a “lens” by which multiple aspects of the organization can be viewed. The establishment of a common goal fosters cohesiveness.
Collapse SubdiscussionAllyson Tommasini
Feb 6, 2018Feb 6 at 9:42pm
Yes, I do agree that the phenomenon lies within culture of healthcare organizations. As healthcare providers we are always tasked with caring for a patient in every aspect. Caring for a patient can already be very tiring and difficult to do. With the addition of unit or organization stress causes people to feel unappreciated or not respected as workers. In regards to Adalaida’s response about the struggles of her work place I feel like that is all too common in nursing. I don’t specifically have a problem with that, but some of my friends who are nurses have had problems with management and other nurses that don’t get addressed in a timely manner if at all. I believe that a theory that could help to develop and engage employees would be the transformational theory. As stated in Hutchinson and Jackson’s article the attributes of a transformational leader are “dynamism, self-confidence, inspiration, emotional intelligence, and symbolism” (2013). Referring back to the difficulties felt and seen in a nursing unit that lacks cohesiveness between management and employees it is almost a unit that needs a very strong leadership person that can come in and put their foot down to stop all the hazing, bullying, and begin to solve staff problems. Strong leaders have to also show that they are willing to put in the time to listen and respond to any issues within the unit. they should start by addressing the most immediate concerns first and the least concerning as they have time to. By coming in with strong footing and helping to address the concerns of the unit can help people to understand how important it is to work as a team and if people do not change their behaviors they should get corrective actions and if that doesn’t work they should be terminated. While being a strong leader doesn’t in any way mean that you are disrespectful to the staff or rude in the way you approach situations, but you present your goals and enthusiasm for creating a healthy helpful environment and try to motivate the staff of the unit to take on those same thoughts and feelings will help to bring everyone together as a team.
References
Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing Inquiry, 20(1), 11-22. doi:10.1111/nin.12006
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 7:36am
Allyson, great response!
I can see that the defining roles with supportive leadership and the mutual establishment of common goals (vision) do have some of the qualities of transformation leadership.
Nursing does have nursing theories that are consistent and comparable with the principles of transformational leadership as described by the theories of transformational leadership, though not, of course, a nursing theory of transformational leadership…. Transformational leadership arose from the business/administration profession, namely Burns (1978) and Bass (1985, Bass & Riggio, 2006).
Class, does nursing need to have a nursing theory of transformational leadership or should we continue with using a “borrowed” theory?
How might the shared governance model, for instance, work with the idea of transformational leadership (Meyers, et al., 2014)?
References
Bass, B.M. (1985). Leadership and performance beyond expectations. NY: Free Press.
Bass, B.M. & Riggio, R.E. (2006) Transformational leadership. Mahwah, NJ: Erlbaum.
Burns, J.M. (1978). Leadership. NY: Harper & Row.
Myers, M., Parchen, D., Geraci, M., Brenholtz, R., Knisely-Carrigan, D. & Hastings, C. (2014). Using a shared governance structure to evaluate the implementation of a new model of care: The shared experience of a performance improvement committee. Journal of Nursing Administration, 43(10). 509-516. doi: 10.1097/NNA.0b013e3182a3e7ff
Feb 8, 2018Feb 8 at 2:24pm
Concerning the need for a nursing theory of transformational leadership, I do not see the need. The abundance of nursing literature translating the leadership style for use by nursing leadership is likely sufficient. Consolidating the information into a specific nursing theory seems redundant.
Transformational leadership has generally been acknowledged as the most effective leadership style. Unlike the quid-pro-quo style of transactional leaders, transformational leaders encourage followers to create a personalized vision of their role and the future of the organization (Jackson, Hutchinson & Jackson, 2013).
Shared governance would be maximally effective when used in conjunction with a transformational leadership style. The members from each unit that sit on the nursing practice counsel (NPC) can employ transformational leadership styles to encourage nurses on their units to identify deficiencies in practice and develop strategies to combat them. The CNO can act as the ultimate transformational leader in this model, as their approval is required for the development of new NPC bi-laws (Meyers, et al., 2014). Shared governance is a structure of leadership that necessitates follower engagement because leaders are identified throughout the organization and take suggestion from their peers and coworkers.
References
Jackson, D., Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: Towards a more critical interpretation. Nursing Inquiry, 20(1), 11-22.
Myers, M., Parchen, D., Geraci, M., Brenholtz, R., Knisely-Carrigan, D., & Hastings, C. (2013). Using a shared governance structure to evaluate the implementation of a new model of care: The shared experience of a performance improvement committee. The Journal of Nursing Administration, 43(10), 509-516. doi:10.1097/NNA.0b013e3182a3e7ff
Collapse SubdiscussionLolita Jerrell
Feb 9, 2018Feb 9 at 9:28am
Professor Talley,
Unfortunately, the nursing profession does not currently have a transformational leadership nursing theory and we continue to use borrowed theories from other disciplines. Most of the borrowed transformational leadership come from the business profession and lack the ability to deal with the nursing specific dilemmas such as maintaining unit performance measures, promoting effective interdisciplinary teamwork, recruiting and retaining experienced nurses and navigating increased consumer quality expectations with reduction organizational budgets. Although the nursing profession has no distinct nursing theory for transformational leadership we do have a structured model that is used as the framework for constructing and expressing professional practices, processes, and relationships (Porter-O’Grady, 2012), known as “shared governance”. Shared governance was originally developed by Virginia Cleland in the 1970’s to assist in the collective bargaining by nurses to provide a balance between the union, nursing profession and an organization. Today’s shared governance emphasizes that professional nurses should be accountable rather than responsible, that they should focus more on the relationship between the process and impact instead of just the function, and is more concerned with advancing, improving and achieving excellence in the practice of healthcare (Porter-O’Grady, 2010).
Reference
Porter-O’Grady, T. (2012). Reframing Knowledge Work: Shared Governance in the Postdigital Age. Creative Nursing, 18(4), 152-159.
Feb 10, 2018Feb 10 at 8:25pm
Dr. T. and classmates,
Thank you for your interesting commentary on transformational leadership. I believe that patients’ constructive input is an important component of this leadership style. I’m not sure if there are adequate nursing theories for guiding this practice, however.
Our unit practice council (UPC) seeks input from patients and family members at our monthly practice council meetings. We have had four or five family/patient advisors over the last ten years, and they have provided very useful perspectives on the care that we give our patients.
We pick prospective advisors that have stayed on our unit for extended periods of time. We’re also careful to select folks who will provide honest but supportive input to our monthly meetings. We value people who are enthusiastic and optimistic about their ability to provide their input in an effective manner with the nurses and techs. The nursing administration supports and appreciates their commitment to our hospital, as well.
Feb 10, 2018Feb 10 at 9:30pm
In response to whether we have had the opportunity to work with the shared governance model, I have had that opportunity. Shared governance is a great way to reflect on models of care, employee practice and patient outcomes. In addition, it has been revised to reflect the nurses’ actual views of their professional practice (Morgan, 2015). Fortunately, I work at a hospital that is Magnet recognized. I was on the shared governance committee last year. It was very rewarding and I wish I continued with it but time did not allow me. I liked it because it was a monthly meeting where other fellow nurses were allowed to bring up issues that were considered to be unsafe for patients in one way or another. These issues were discussed by the committee, then a solution was proposed. After that, we submitted these issues along with their solutions to another committee in upper management, who then would make a decision on whether or not to implement the new changes in the hospital.
References
Morgan, V. (2015). Team concepts. Focus on shared governance: Evaluation of a professional practice model. Nursing Management, 46(12), 8-10. doi:10.1097/01.NUMA.0000473509.15808.dO
Feb 9, 2018Feb 9 at 4:47am
Adelaida,
Nurse leaders should always strive to maintain best-practice in every clinical setting. It is important because logically best practice equates to improved patient outcomes. When nursing leaders encourage nurses to further their education it improves patient outcome and employee satisfaction all around. With every degree and educational advancement, a nurse gains more confidence in his/her practice and can learn different ways to consider a situation and how to resolve it appropriately. Nurse managers can offer incentives for nurses to continue education by offering raises, promotions, partnerships with colleges, and flexible scheduling.Great post
Collapse SubdiscussionNikki Ballinger
Feb 4, 2018Feb 4 at 5:53pm
Dr. T. and class,
Dr. Imogene King developed the Goal Attainment Theory to explain the interpersonal relationship systems in which people develop and progress through life to achieve personal life goals (Schub, 2016). King’s Theory of Goal Attainment is a dynamic notion that nursing interactions lead to actions that result in accomplishing a goal (Schub, 2016). According to King, goal attainment fosters successful nursing care as well as growth and development (Schub, 2016).
King’s Theory of Goal Attainment is used as a framework for nurse leadership and the director of nursing position. King’s theory is based on accomplishing goals, which is the duty of a director of nursing. As a director of nursing an issue that may arrive is staff performance issues. This could be due to many factors for nurses. Long hours and high acuity patients lead to unhappy nurses. They feel over worked and underappreciated. As a director of nursing, it is imperative to be aware of these issues and find ways to address them to improve nurse satisfaction and performance. King’s Theory of Goal Attainment is a method that directors of nursing can use to address these issues.
As a nurse leader, goal attainment is a necessary aspect of the job. A director of nursing is in charge of the nurses in a health care setting. Nurses who have an optimistic attitude in reaching work related goals show a stronger ability to acquire nursing competencies and skills (Korunsky & Wiemer, 2016). As a director of nursing, it is important to support nurses in continuing professional development and growth to increase performance in the workplace (Korunsky & Wiemer, 2016).
As an example, director’s use King’s Theory of Goal Attainment to assist nurses in accomplishing professional development by supporting beliefs, listening to fellow nurses, and organizing programs that support nurse’s skills. This could be by simply speaking with nurses and listening to their concerns, or by facilitating continuing education for nurses to expand their nursing knowledge to enhance nurse performance. By doing this, director of nursing and nurses alike, are able to accomplish goals, address performance issues, and provide competent care to patients through King’s theory.
Nikki Ballinger
Korunsky, J., & Wiemer, H., (2016). Goal attainment. CINAHL Nursing Guide.
Schub, T. (2016). King’s theory of goal attainment. CINAHL Nursing Guide.
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:09am
Nikki, excellent examples of applications of King’s theory of goal attainment.
The CINAHL Nursing Guides are excellent resources written by employees of CINAHL by which peer reviewed articles can be identified on a specific topic. They provide good summaries of relevant material on a topic but are not peer reviewed journal articles themselves.
In looking at the resources that these nursing guides incorporated into their summaries, is there one that speaks more to the application to nursing leadership and the healthcare organization more than others?
Collapse SubdiscussionNikki Ballinger
Feb 9, 2018Feb 9 at 9:29am
Dr. T.,
Thank you for your feedback! The article written by Korunsky & Weimer, 2016 on Goal Attainment used many sources that relate to nursing leadership. Some articles they used as resources include journals on association of goal orientation with work engagement and burnout, executive coaching, strategic and operational planning in leadership roles and management functions, as well as continuing professional development and choosing a professional practice model.
The articles used as references all relate to how King’s Theory of Goal Attainment can be used in leadership roles and how to continue to grow as a leader in the nursing field. They pointed towards key aspects of work engagement, coaching, teaching, and professional development. These sources gave a greater insight to how King’s theory is used for not only nurse and patient roles, but leadership roles as well. The use of these sources gave a guideline to how important leadership is in nursing and how King’s theory is used to achieve nurse leadership goals by using a Goal attainment scale in the healthcare setting.
Collaboration is an important aspect of the articles used as resources. They are used to give support nurses and facilities to make positive change. These articles used for research all touch base on the many aspects that are important to leadership in nursing and how King’s theory can be applied. They use numerous factors to make up a leadership role in nursing and help give insight on how to accomplish leadership goals in healthcare organizations.
Thank you again,
Nikki
Feb 10, 2018Feb 10 at 8:26am
Nikki, thank you for successfully illustrating what a wonderful resource the nursing guides are for locating sources from peer reviewed journals.
Feb 8, 2018Feb 8 at 9:25am
Nikki,
I enjoyed reading your post about Dr. Imogene King’s theory of Goal Attainment and how it is used by nursing leadership and administration to deal with staff performance issues. In a way I find that it goes hand in hand with the theory that I selected which was Patricia Benner’s model of skill acquisition in nursing. Benner’s model focuses on the different stages of a nurses skill development and the roles that we take on. The nurse leader has certain goals that they want met from their employees. A good nurse leader knows that those goals must be in line with the level of skill the employee has aquired. A good nurse leader is not going to set a goal for a nurse to teach a fellow nurse if they have a novice skill level. Leaders then take into account all of the goals that they need to attain for the facility and the skill level of their employees. By keeping those two factors in mind, a good nurse leader can match the right task to the right employee.
Collapse SubdiscussionAllyson Tommasini
Feb 4, 2018Feb 4 at 11:39pm
As advanced practice nurses we have to have an understanding of how to be a leader. To be a leader takes many different types of skills. All of which we gain over time from learned experiences. Maintaining staff retention is a big problem in every nursing unit. Many nurses leave before they have had time to fully understand the area of expertise. Patricia Benner’s theory from novice to expert outlines the milestones we overcome throughout our nursing experiences. As we advance through our careers we develop more complex knowledge and application of nursing interventions as we care for patients in the same nursing specialty. Benner’s theory can be “applied to support the principles of nursing practice, education, evaluation, and professional development and leadership” (Mennella, 2016). During the time we will transition “from relying on abstract nursing principles to incorporating past nursing experiences that facilitate nursing actions” (Mennella, 2016). For example, how to take a blood pressure or how to insert an indwelling urinary catheter. These are first taught to us during our fundamentals class in nursing school. As we begin to advance through the five different stages we begin to take real life experiences and turn them into learning experience that will help to guide us in the directions of what is positive and negative in our nursing experiences. As an advanced practice nurse we will start at a lower level than we may have previously been. Reason being is that we are learning a whole new aspect of nursing. We are still nurses, but we have more responsibilities to take care of when it comes to managing a patient load and managing other nurses or aids who are caring for our patients. As we begin to gain experience and reach the expert level we will start to achieve more of a management role where we are the subject matter experts who can help to educate the nurses that are below us. The expert nurse is able to understand all situations and anticipate changes. Mennella describes an expert nurse as one who performs their job in a fluid, flexible, and highly proficient manner (2016).
References
Mennella, H. A. (2016). Benner’s Professional Advancement Model. CINAHL Nursing Guide,
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:16am
Allyson, you’ve brought up an important issue in nursing, that is, leadership in the clinical area. Effective leadership impacts on the quality of care, the work experience, and the economic well-being of the organization.
In Mannella’s summary of the literature on Benner’s model, did any one resources speak to how the levels of competency impacts the progress of leadership competency? Could the stages of competency be applied to leadership development?
Feb 9, 2018Feb 9 at 6:03pm
Hi Allyson and Professor,
Leadership is so important to the structure and functioning of nursing. Benner’s Theory is my favorite one. She really defines the level of professional growth and advancement in our practice. It speaks so well in how we develop as nurses ,the support needed from our preceptors and mentors. The first experience as a nurse, the relationships with our colleagues and the skill/knowledge obtained is so important in developing an individual foundation in nursing. The levels of competency are not well described for leadership. Benner’s theory describes the expert nurse ability to use intuition, experience and the expertise in predicting the outcome of situations. Part of the responsibility of the expert nurse is to mentor and precept nurses that are advancing in their practice. Nursing leadership is a specialty that requires patience, understanding, maturity to deal with others. Being mindful of our own behaviors and how we present to others as a leader. Knowing the strength of our position and words, also knowing not to abuse our positions of power. Continuing our education and implementing best practices that affect an entire staff and ideally, the patients/families. The stages of competency can be applied to leadership, with a specific and guide for leadership. There are many stages of leadership. Each experience, years of leadership roles ,professional growth and advancement comes with a new stage of nursing leadership.
Feb 8, 2018Feb 8 at 8:13pm
Allyson,
I really enjoyed reading your post. Understanding of what a leader is is key to becoming a successful leader. By actively listening, attending to the staff and simple allowing oneself to be formed into the leader they are supposed to be is the foundation of developing the necessary skills to lead others. In nursing, possessing various qualities have significance and one of those qualities is leadership. It is important that a good leader can guide their team members in the right direction to produce a positive outcome for all involved.
Leaders inspire others to do and be their best. Possessing self-awareness as well as social awareness involves relationship management. When a nurse understands and recognizes the need to monitor one’s own feelings and emotions, this information can be used to guide their thinking and actions. Leadership habits of the nurse determines the nurse’s effectiveness in practice (Hood, 2014). Being effective in leadership requires continuous learning, listening and giving and receiving feedback. As a leader, nurses can recognize their peers and subordinates’ emotional needs in which they gain trust and become more effective. When leadership skills are being developed, it is good to focus on being genuine, honor the nurse’s own strengths and work on any weaknesses that may be present.
Thanks again, Allyson.
References
Hood, L. (2014). Leddy and Pepper’s conceptual bases of professional nursing (8th ed.). Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott, Williams & Wilkins.
Collapse SubdiscussionHailey Whisenant
Feb 5, 2018Feb 5 at 7:50am
I am sure that nurse managers struggle when it comes to making assignments. They must have an equal balance that promotes quality care without leading to nursing fatigue or poor patient care. I have chosen the Synergy Model to further explain this.
The Synergy Model was made by the AACN and is applied everyday to clinical settings. This model is the relationship nurses and patients share while optimizing patient and family outcomes. It is a phenomenon that occurs when individuals work together towards a common goal. This applies to nurses because we as nurses have one common goal: caring for our patient. This model recognizes the actions of the nurse and the actions of the patient (Sechrist et al., 2010).
Nurse managers utilize the Synergy model when it comes to staffing assignments because they must consider the acuity of their patients. Does the patient need to be one-on-one? Does the patient need any particular care for any reason? What is the patient’s diagnosis? Nurse managers also must consider the nurse. Can this nurse handle this assignment? Can this nurse be diligent with this patient’s care? There are a lot of considerations that fall into play with nursing assignments and the Synergy Model is the best way this is applied today.
I no longer work as a floor nurse. I am in the Operating Room, but if the floor I previously worked on utilized the Synergy Model, I think I wouldn’t be so veered away from floor nursing.
Before I graduated nursing school with my Bachelors, I was a Certified Nursing Assistant on a Neuroscience Floor. Working as a CNA ruined floor nursing for me. My assignments every time I worked consisted of 18-22 patients at a time. If anybody has ever worked on a neuro floor, then you know this is not feasible. As a CNA, I was responsible for bathing every patient, taking them to the restroom, doing their vitals (sometimes every 15 minutes), etc. Most of our patients were either brain dead or had strokes. Stroke patients, as we know, can only utilize one half of their body. They were heavy patients. This whole floor was a total care floor, and nobody could just get up and walk themselves. They needed several staff members to assist with their moving. I would drown in my assignment, not because I could not handle it, but because the nurse managers did not realize how hard it was to take care of patients like this when it came to making the assignments. 18-22 patients were just far too much.
I grew a fatigue when it came to floor nursing. I wish this was not the case because often I feel I am missing out on a lot of the floor nursing hands on experience.
Reference:
Sechrist, K., Berlin, L., & Biel, M. (2010). The synergy model: overview of the theoretical review process. Critical Care Nurse, 20(1).
A Sample Answer For the Assignment: NR 501 Week 6 Discussion Literature Review
Title: NR 501 Week 6 Discussion Literature Review
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:24am
Hailey, what an experience you had as a CNA. I have worked on a brain injury/CVA unit and cannot imagine such a work load!
We can learn as much from our negative experience, maybe more, than from the good ones!
So you are saying that application of the synergy model would allow clinical mangers to better assess the care needs of patients. Part of our tradition, I suppose, it going by the “numbers”, that is the nurse to patient ratio. The synergy model, based on assessment of multiple aspects of needs, gives the clinical leader a guide for assignments.
Well said Hailey!
Feb 8, 2018Feb 8 at 3:12pm
Professor Talley,
Yes, I am saying that the Synergy Model would allow clinical mangers to better assess the care needs of patients and the nursing staff!
The Synergy Model shows a very significant promise in providing the decisions on the level of care necessary both safely and effectively. This model has been proven effective because it focuses on the needs of the patient, the competencies of the nursing staff, and then matches the two together. I believe that this is what floor nursing is all about! Making sure the needs of the patient can be provided by a competent nurse. The assignment is made by the nurse manager, and this is where I think this model would work! This model consists of 8 characteristics that determine the care needs of the patient (Swickard et al., 2014).
The patient characteristics include:
1) Resiliency (Swickard et al., 2014).
2) Vulnerability (Swickard et al., 2014).
3) Stability (Swickard et al., 2014).
4) Complexity (Swickard et al., 2014).
5) Available resources (Swickard et al., 2014).
6) Ability to participate in care (Swickard et al., 2014).
7) Ability to participate in decision making (Swickard et al., 2014).
8) Predictability (Swickard et al., 2014).
The 8 characteristics are then evaluated according to their category and are assigned a numeric value. This numeric value then determines the care needed for the patient and is then therefore matched with the nurses competencies. I wish that the floor I worked on utilized this model (Swickard et al., 2014). It would have prevented so many patient falls, so many further injuries of patients and staff members, lack of teamwork, lack of motivation to come to work, etc.
This is why I absolutley do believe utilizing the Synergy Model can relieve administrative issues!
Reference:
Swickard, S., Swickard, W., Reimer, A., Lindell, D., & Winkelman, C. (2014). Adaptation of the AACN Synergy Model for Patient Care to Critical Care Transport. Critical Care Nurse, 34(1), 16-28. doi:10.4037/ccn2014573
Feb 11, 2018Feb 11 at 8:41pm
Hailey,
I enjoyed reading your application of the Synergy model to address nurse-patient assignments. I have researched the Synergy Model of Patient Care extensively throughout this course and have also come to love it. I had not previously thought about how the Synergy model could be used with nurse to nurse interactions, but it certainly applies. Like you outlined, the Synergy model matches the competencies of the nurse with the needs of the patient. Or, in this scenario, matches the needs of the nurse. Part of what makes this model so powerful is the examination of what the patient needs, and this often includes an investigative dialogue to understand what the patient feels are health challenges, obstacles to meeting health goals and a path towards improved health that fits into the patient’s life. If these sorts of dialogues occurred semi regularly between nurse managers and staff perhaps patient loads would eventually be more appropriate. Additionally, the nurse would be helped along towards meeting what they see as areas that need focus, as opposed to nurse managers being blind to what individual nurses see as their weaknesses, or areas they would like to further develop. The Synergy model would be a great framework for this type of nurse manager-nurse discussion!
-Mary Claire
Collapse SubdiscussionJacqueline Kenton-Jones
Feb 5, 2018Feb 5 at 10:04am
Hi Professor,
The application of Hildegard Peplau’s theory of interpersonal relations relates to staffing. The staffing of a facility has one of the most significant roles in the operation to function. Nursing staff is usually the largest discipline that is employed and provides the most contact with patients and families. Currently, over 300 nursing staff work under my direction and supervision. There are many factors that affect staffing. A competent staffing coordinator, an adequate nursing schedule program, staffing the units according to needs and acuity, most of all the relation between staff and management. Staffing is also incorporated into healthcare and financial management. Budgeting overtime and allotted use of staffing. The model of nursing schedule that was utilized in my facility was fragmented , inaccurate and confusing. The schedule caused many errors in staffing, over budget costs, poor relationships between the nursing coordinator and the nursing staff. Poor attitude dealing with the staff escalated situations that could have been avoided. A new model of staffing was developed with a six week core schedule with a daily schedule to capture all of the daily changes. Email communication was now in use for any updates and changes to agencies that supply additional staffing, to payroll and administration. A review of the staffing matrix was completed to assess staffing needs without over use and over budgeting. The hypothetical model was incorporated into the current payroll system to financially mange the new system. There has been a performance improvement plan for the scheduling coordinator and communication with the nursing staff has improved. Lees scheduling errors and payroll issues occur. The new model will be reviewed quarterly, to continue to assess the new implementation.
Maria Joao,F. (2015) . Grounded theory in nursing: building a middle range theory in nursing . Journal Biomedical and Biopharmaceutical Research, Vol 12 pp 11-20 (2015), (1), 11.
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:35am
Jacqueline, thank you for sharing that experience with us. This staffing system sounds like a good match to your needs.
Tell us, please, the nursing theory that helped you develop the new system for staffing. This sounds exciting!
Grounded theory is important to nursing because it is a theory (one of the developers is a nurse) and also a qualitative research design (Strauss & Corbin, 2008).
Reference
Strauss, A., & Corbin, J. (2008). Basics of qualitative research. Grounded theory: techniques and procedures for developing grounded theory (3rd ed.). Thousand Oaks, CA: Sage.
Feb 10, 2018Feb 10 at 11:37pm
Hi Professor,
Hildegard Peplau’s theory of interpersonal relations was the foundation of resolving the staffing issues. There were obvious organizational issues with the staffing coordinator, as well as the technological issues with our staffing program. The staffing issue involving communication and developing a rapport amongst staff had the greatest impact. The problems that affected staffing involved the lack of appropriate communication between staff members. The acuity of the units, adequate staffing needs, relationships between the organization and staff, communication with staffing agencies all impacted the staffing issues. Basic information needed to appropriately staff and the lack of experience/knowledge of the staffing coordinator increased an existing problem. The foundation of interpersonal relations between staff, management and the organization helped to resolve the staffing issues. The technological issues have been addressed and continue to be a work in progress. The process started with the orientation phase, which was the introduction to a new staffing pattern.The working phase, the new model has been implemented and a continuous assessment is in progress to manage the staffing and budget. Payroll and administration will monitor the budgetary affects. Staff relations with the coordinator has improved. It will be an ongoing process of improving communication and integrating a new concept.
Smith,M.J.,& Liehr,P. (2008). Research Briefs column:Theory guided translation: Emphasizing human connection.Archives of Psychiatric nursing, 22 175-176
Feb 10, 2018Feb 10 at 7:50pm
Hi Jacqueline,
I had not read much about Peplau’s Theory of Interpersonal Relations, and I thank you for prompting me to do a bit of research on the theory. It sounds as if a lack of communication between nursing staff and management lead to low employee morale. The integration of communication based on the Theory of Interpersonal Relations could be utilized to help the situation, and your new staffing model sounds comparable.
Peplau’s theory posits three phases of interaction: The orientation phase, the working phase, and the termination phase. The orientation phase, as it relates to staffing levels in the hospital, would be when the management introduces the new model to the nursing staff. It seems that in-person introduction is ideal, although I assume emails and notices may useful if the burden of meetings is too high. During this phase, nursing staff will be able to ask questions, give their input, and possible make suggestions for improvement. When reasonable agreements are made, the working phase begins.
In the working phase, management would employ the new model. Management would keep a close eye on the efficacy of the model, while nursing staff would assess the benefit of the new model to their personal preferences. This phase would include collection of data, including employee opinions of the new model. Data would be synthesized to assess how the current model is functioning.
Eventually the termination phase begins. When enough data has been collected over a sufficient amount of time, and the assessment of the model’s benefits to the organization are concluded, decisions about the future of the model can be made. These may include continuing with the model as is, changing aspects of the model that are not functioning ideally, or perhaps scrapping the model entirely in favor of a different model. During this phase, employee input should be encouraged and considered (Dean & Fain, 2016).
References
Deane, W. H., & Fain, J. A. (2016). Incorporating Peplau’s Theory of Interpersonal Relations to promote holistic communication between older adults and nursing students. Journal of Holistic Nursing, 34(1), 35-41. doi:10.1177/0898010115577975
Collapse SubdiscussionMedinat Balogun
Feb 5, 2018Feb 5 at 3:02pm
Hello Dr. Talley and classmates,
Imogene King’s theory of goal attainment is based on interpersonal system. Interpersonal systems are the interactions between individuals. Personal and social systems are important to the quality of care a patient receives. The more people involved in the interaction, the more complex it becomes. The concepts for the interpersonal system include: interaction, communication, transaction, role and stress. Khowaja (2006) shows that King’s goals for nursing is health: its promotion, maintenance, and/or restoration, the cure of the sick or injured and the care of the dying. This can be applied to nurse leader’s role as they struggle with staffing concerns, the communication, the stress in staffing. For instance, the hospice community I work with, staffing is a big concern as it’s based on the number of medications the patient takes daily, also on the decline status of the patients, if they require continuous care or routine level of care. The residents are also placed on medication levels based on times, either daily, BID, TID etc. level 1 is <6 meds, Level 2 is > than 10meds and level 3 is > than 11meds with 3 or more med passes. The more patients on higher level medications, the more staffs needed. Irrespective of how the company staffs, the goal is to have optimal patient/ family satisfaction, and this is reflective of the leaders. Nurse Manager’s goals and King’s goals are one in the same and that is to promote health. To do that, goals, communication and interpersonal relations is imperative. As a nurse manager, setting goals based on staffing is a must. For example, currently, there are 55 residents and there is a 24hrs/day which means assignments and tasks are divided between all shifts, the nurse manager might be able to staff for just 21hrs, due to shortage, but there must be positive interactions among staffs and the leader as this can bridge the gap in the lap. Interactive communication is priority for tasks to be completed on all shifts. Our staffing is called variable since it changes on a weekly basis dependent on how many patients, level of care, medications times and usage, assessments and patient care involved. Staffing is a big concern in health care, with the different grids that managers have to staff by, the result is the difficulty nurses face to complete their tasks and provide quality care, if the goal attainment theory is applied effectively, some of the problems may be alleviated.
Reference
Khowaja, K. (2006). Utilization of King’s interacting systems framework and theory of goal attainment with new multidisciplinary model: clinical pathway. Australian Journal of Advanced Nursing, 24(2), 44-50.
Collapse SubdiscussionNikki Ballinger
Feb 6, 2018Feb 6 at 6:16am
Medinat,
I too am using King’s theory to look at staffing issues in nursing. As a charge nurse on my unit I am constantly dealing with staffing issues. As an OB nurse, we decide our own staffing because our supervisors do not understand the acuity of our patients. We have labors, C-sections, recoveries, as well as moms and babies on our floor that all require different amounts of time and medications. Because of this, the charge nurse is responsible to make the assignments based on the nurses available. Staffing is a huge issue daily for me. I am constantly trying to rearrange or figure out how I can make the number of nurses I have work for the assignment. There is so much thought that goes into it that the task itself is exhausting.
Communication is a key aspect of staffing. While assignments will not always be ideal, King’s theory shows that promoting health and accomplishing common goals is important to the care of the patient as well as the nurse’s well-being.
Staffing is an issue that affects patients and nurses. If there are not enough nurses on the floor to competently cover the number of patients we have, we are endangering not only a mother but an infant as well. At any point in time a laboring mom can turn into a C-section and a nurse must be ready for that. Unfortunately, if they are too busy with another assignment they could miss a life or death situation. This is just one example, among many others that could occur if staffing is not appropriate. This issue and others not only affects the patients, but the nurses as well. As a nurse we are responsible for our patients and their care. If a nurse is unable to provide competent care due to staffing issues, other problems arise such as burnout and nurses leaving due to unsafe circumstances.
If floor nurses, charge nurses, and managers could all use King’s Theory of Goal Attainment they could establish common goals and use communication and environmental factors to take care of patients, and nurses. Creating a safe and respected environment for nurses and patients alike.
Thanks for your post!
Nikki
Feb 7, 2018Feb 7 at 10:30pm
Hello Nikki and classmates,
Nikki thank you for your input and I must say I can relate with you on staffing being a major issue. However,with you at the helm of affairs I trust your unit will do well. I also work in an OB unit and it’s about to close down due to staff shortage and low census. All of which did not just happen out of the blues , it was a cycle of insensitivity on the part of the nurse manager taking it upon herself to manage the staffing and scheduling without considering the routine or work ethics of the floor nurses and different shifts. She lacks communication skills. Nurses became burnt out, lots of call offs affecting the work and telling on the unit as a whole, with a small community, words got around, no nurse want’s to lose their license. Currently it’s almost like a ghost town with no one wanting to birth there. Nurses gain gratification from giving compassionate care and patients gain satisfaction from a feeling of trust and confidence in nurses which has been lost. Management is constantly sitting at a round table to find a ways to salvage the situation. If the nurse manager had used some of the nursing theories as a framework for governing the unit, we might have had better outcome and the unit will be in a better position today. I have come to an understanding that the most effective leadership has been from those that have completed a master’s program compared to those that have completed a baccalaureate’s degree or lesser equivalent. Improved patient outcomes have been associated with this elevation in nursing education (Clark, Casey & Morris, 2015). If she had, it would have reflected in her ways of dealing with most issues, she would have gained more knowledge of nursing theories, be able to apply it to practice with higher level of critical thinking.
Reference
Clark, L., Casey, D., & Morris, S. (2015). The value of Master’s degrees for registered nurses. British Journal of Nursing, 24(6), 328-334. doi:10.12968/bjon.2015.24.6.328
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:53am
Medinat, thank you for sharing your work experience and how it relates to King’s theory. You demonstrated how a singular path may not be the optimal means by which a goal is reached. The utilization of critical paths is a great example of a how an approach to care can be supported by nursing theory.
Critical paths, though not a theory, but rather a care management tool in use for some time, is not unique to nursing. Indeed, the inherent usefulness is interdisciplinary collaboration (Coffey, et al., 2005).
Class, how could various nursing theories support interdisciplinary care?
Reference
Coffey, R. J. Richards. J. S., Remmert, C. S., LeRoy, S. S., Schoville, R, R. & Baldwin, P. J. (2005). An introduction to critical paths. Quality Management in Health Care, 14(1), 46-55.
Collapse SubdiscussionMegan Edwards
Feb 10, 2018Feb 10 at 9:50am
Dr. T,
Nursing theories can be support interdisciplinary care. For example, Patricia Benner’s model of skill acquisition focuses on skill levels a nurse can acquire. As I previously discussed the levels are novice, advanced beginner, competent, proficient, and expert. Skill acquisition can be applied to many different roles. The skill of a physician goes from novice once out of med school to advanced beginner through residency, to competent when graduating residency, to proficient while working in their field, to expert with years of experience. If you look at an interdisciplinary team and their skill acquisition as a whole, they pool their skill levels to attain a common goal. In terms of the patient, the nurses role has already been discussed. However, ever person on the team is acquiring skills to take care of that patient. Janitorial staff are being trained on proper cleaning and disinfecting to protect patients and themselves. Hospitality is being trained on diet restrictions. The unit secretary is being trained on unit policies and procedures. The nurse aid is being trained on safe care of the patient. The physician is being trained on how to treat the patient. All of these jobs will progress through different skill levels and improve the interdisciplinary team as a whole.
Feb 10, 2018Feb 10 at 5:14pm
Meghan and class,
We do multidisciplinary rounds daily at my hospital in the intensive care unit. During rounds we are also skill building. The collaboration that occurs between pharmacy, respiratory, medicine, nursing, case management, and physical therapy are unmatched. It is amazing to see how the different disciplines intertwine within the care plan for the patient. It is crazy how one thing like decreasing sedation for a spontaneous breathing trial can change the clinical outcome for the day. Also, with that same patient, how early mobilization can have a profound effect on length of stay. We learn daily just how much of an effect we can have on a patient. We learn from each other and from the physicians that we collaborate with each day. Sharing in each others knowledge helps to shape us into better nurses, physical therapists, respiratory care practitioners, and CNA’s.
Feb 11, 2018Feb 11 at 8:14pm
Professor,
Thanks for question.
A theory basically is a means for the interpretation and organisation of information. The theories give the nurses the tools to ensure nursing assessments are comprehensive and systematic. They ensure that the delivery of care is meaningful. There are nurses who do not sue theories in their practice, but others will sue theories to provide reflection and cognition in nurse practice. This is important in nursing holism and in selecting theories nurses need to ask themselves which theories are comfortable for them, and which theories are comfortable for the client. There are two, wide reaching interdisciplinary theories that are the most useful. They allow for the insights in thinking about the changing dynamic of healthcare. We are in a fast paced world now that nurses can get lost in their endeavours. These theories, the Complex Adaptive Systems theory and the Integral Theory, present ideas and concepts that provide the nurses with a holistic framework where they can articulate care needs and processes to the members of the healthcare continuum. The theories allow for debate with other healthcare members on how to better care delivery across board as well as provide the basis for interdisciplinary innovation.
Clark, L., Casey, D., & Morris, S. (2015). The value of Master’s degrees for registered nurses. British Journal of Nursing, 24(6), 328-334. doi:10.12968/bjon.2015.24.6.328
Collapse SubdiscussionYoko Khan
Feb 6, 2018Feb 6 at 10:42am
Week 6: Impact of Nursing Theory Upon Healthcare Organization
Dear Dr. Talley and class,
A middle-range theory, “Bureaucratic Caring Theory” by Marilyn Anne Ray discussed how a nurse leader/nurse manager could effectively deal with administrative issues, such as staffing and cost-effective/performance. “Theory of Bureaucratic Caring” was developed by nursing scholar Dr. Marilyn Ray in 1981. It was a contemporary nursing practice as complex, dynamic, relational, caring, and emergent: foundations of the theory of bureaucratic caring.
Potter & Wilson (2017) applied the Theory of Bureaucratic Caring those items showing below to a clinical unit of a facility and obtained an effective result. A division of labor based on roles, departments, leadership, and authority.
- A hierarchy of offices with diverse social-cultural orientations
- A set of general policies and rules that govern performance
- A separation of the personal from the official technical/professional qualifications
- A movement toward interprofessional and collaboration’
- Equal treatment of all employees or standards of fairness, ethical applications, and reimbursement
- Employment viewed as a career by participants
- Protection of dismissal by tenure or evaluation
(Eisenbuerg & Goodall, 1993; Leavitt, 2005; Perrow, 1986)
The result revealed that employees’ retention rate increased by being fairness, unit costs saved by systematic budgeting, patient satisfaction rate increased, and hierarchy of administrative much cleared with diverse cultural society increased. Overall the result, the goal was to foster self-efficacy for all health care team members. Self-efficacy has been defined as both activation and engagement. Clearly, most work has been accomplished with the idea of the patient as activated and engaged (Potter & Wilson, 2017).
In conclusion, Bureaucratic Caring Theory seemed effective toward some groups/organizations generally, ethically, and costly. My specialty is FNP but I have observed my unit managers and clinical leaders for considering this week’s discussion topic. An organization where I have been belonging to had been utilizing the Bureaucratic Caring Theory effectively. As an employee at the organization, my satisfaction rate is high. I feel like I am treated fairly, being valued as a career, respecting cultural diversity, proactive for interprofessional and collaboration, and being protected from dismissal by tenure or evaluation. As a healthcare organization, my employer utilized the theory to save overhead budget by recycling items, eliminate overtime staffing cost, and open communications to eliminate incivility. That would be leading to the best outcomes for patients.
Reference
Eisenberg, E., & Goodall, H. (1993). Organizational Communication. New York: /St. Martin’s Press.
Leavitt, H. (2005). Top-down: Why hierarchies are here to stay and how to manage them more effectively. Boston, MA: Harvard Business School Press.
Perrow, C. (1986). Complex organizations: A critical essay (3rd ed.). New York: McGraw-Hill.
Potter, M. A. & Wilson, C. (2017). Applying Bureaucratic Caring Theory and the Chronic Care Model to Improve Staff and Patient Self-Efficacy. Nursing Administrative Quarterly, 1(4). 310.doi:10.1097/NAQ00000000000256.
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 8:59am
Yoko, The theory of bureaucratic caring connects to the multiple facets of the organization. None of these aspects can be understood in isolation.
Great find on the application of the theory in the nursing literature!
Ray is working on revising the theory of bureaucratic caring (Ray, 2016).
Ray, M. (2016, June). Theorist Panel: Elizabeth Barrett, Richard Cowling, John Phillips, Marilyn Ray, Marlaine Smith, and Jean Watson. The International Association for Human Caring and The Society of Rogerian Scholars Conference: Advancing Unitary and Caring Science for Nursing Praxis. Boston.
Feb 8, 2018Feb 8 at 6:54pm
Dr. T. & Yoko,
Thank you for your commentary regarding Marilyn Ray’s Theory of Bureaucratic Caring (TBC).
Medication barcode scanning is an important administration tool for bedside nurses. It guides them in their strife to adhere to the “5 rights” (right patient, right drug, right time, right route & right dose) when giving patients medication.
However, the process is not as easy as it sounds sometimes. A few days ago, I was sharing some of the technological aspirations of the ANA with one of my patients as I was passing her meds. I attended an ANA conference a few years ago and learned about the potential creation of a robot that would circulate throughout the hospital and converse with the patients. These robots would be designed to provide medical information in the hallways and at the bedside upon request. However, my wow cart suddenly froze, and I had to stop our conversation to find another computer that was working properly.
I attempted to use three different wows at that point, but they all froze up on me! At that point, I had to revert to the old way of manually checking the “5 rights” and giving the patient her meds in that manner. It makes the creation of the robots sound a little farfetched at this point.
Bureaucratic Caring Theory describes the synthesis of a caring philosophy that is illustrated by both the both the institution and the people that work within it. The institutional leaders and the nurses would come together as intersecting domains which would provide a caring and supportive atmosphere for the patients (Wu et al, 2016).
On a micro level, the hospital would show caring by providing the staff with fully functional equipment to enable the nurses to conscientiously pass meds to their patients. Of course, both the nurses and the hospital administration have leadership roles in this situation, however. The nurses demonstrate technological caring behaviors when they promptly report malfunctioning appliances to the medical engineering department. Likewise, that department demonstrates caring behaviors when they utilize adequate hospital finances to replace faulty equipment when necessary (Wu et al, 2016).
Reference
Wu, C.J., Ray, M.A. (2016). Technological caring for complexities of patients with cardiac disease comorbid with diabetes. International Journal for Human Caring, 20(2), 83-87. Retrieved from: internationaljournalforhumancaring.org/doi/abs/10.20467/1091-5710-20.2.83
Collapse SubdiscussionMegan Edwards
Feb 6, 2018Feb 6 at 6:10pm
Impact of Nursing Theory on Healthcare Organization
There are many theories in nursing that can relate to issues in nursing leadership. One such theory is Patricia Benner’s model of skill acquisition in nursing. Benner’s model is a middle range theory that focuses on five stages of skill acquisition. The five stages are novice, advanced beginner, competent, proficient, and expert (Bennett, Grimsley, Grimsley, & Rodd, 2017). Benner also sited seven domains of the nursing practice, which are the helping role, teaching or coaching function, diagnostic client-monitoring function, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring quality of health practices, and organizational and work role competencies (Bennett et al., 2017).
One administrative issue for nurse leaders is the ability to retain skilled staff and bring up new nurses who become skilled staff. I have worked at three different hospitals and the satisfaction and retainment of staff seems to be related to the ability of the leadership to provide adequate support and role modeling along with career advancement opportunities like clinical ladders. Benner’s model of skill acquisition can be applied to this issue. The units that I have worked on that had the best staff morale and retainment offered a large amount of training that was easily accessible. They also had a well hashed out orientation process that included a buddy system, hands on training, and frequent check ins to gauge progress. They placed novice nurses with expert nurses so that they might receive the training that they need. Once you progressed from novice to advanced beginner nurse leaders would constantly check up on your progress and ask if there was anything that you felt you needed more training in or anything that you were interested in learning. Once you progressed from competent to proficient they would encourage you to offer input on unit improvement programs and pursue additional classes like getting trauma neuro critical care certified. Finally, once you reached expert level, they began encouraging you to pursue things like clinical ladder, charge, or management.
References
Bennett, L. L., Grimsley, A., Grimsley, L., & Rodd, J. (2017). The gap between nursing education and clinical skills. ABNF Journal, 28(4), 96-102. Retrieved from http://web.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/detail/detail?vid=49&sid=6cfd5f17-39ee-480c-af74-2ba033c850cc%40sessionmgr4006&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=ccm&AN=125885622
Feb 7, 2018Feb 7 at 9:33pm
Hi Megan, Professor and Colleagues,
It is interesting to read your post. I agree with the content you included in your discussion and the reason for choosing Benners’ theory.
According to Hurley, J & Hutchinson, M. (2013), nurse leaders should be responsible for creating a learning environment for new nurses to become competent care givers. Unfortunately, in the real world, it is not unusual for nurses to face workplace bullying, especially those new nurses on the floor. Nurse leaders should intervene promptly to address this issue, so that all the nurses will know that bullying is not tolerated and eradicate situations where nurses have to deal with harsh situation and are exposed to unhealthy and negative working environment.
Since I read the Peplau’s theory I have become conscious of its relevance and have developed a passion for this theory, and I strongly believe we as nursing personnel ought to put this theory and its concepts in use during our daily nursing practice. According to Hurley, J & Hutchinson, M. (2013) Peplau’s theory of interpersonal relation also stresses the importance of nurses being a resource person, a counselor and teacher. Nurse leaders can apply these principles and be a resource person to its staff nurses. The leaders should be responsive when the staff needs help from them, and they should teach and guide nurses how to support each other and learn from each other. They should create an environment of helping each other on the basis of mutual respect which will nurture healthier relationships among nursing personnel.
The learning process in nursing practice, with the support and foundation of nursing theories such as Peplau’s theory, are vital to nursing education and the construction of a professional identity in the future of nursing as a profession. The skills developed with the use of solid knowledge, based on a theoretical framework learnt during nursing studies, should be carried into the professional clinical environment, This will serve as preparation for a working environment, conducive to productivity, which will allow the nursing personnel to focus on the main working stream, which is a client-centered environment, prepared to assist with the client’s recovery and incorporating society without any barrier, and also positively influencing patients to assume personal obligation when dealing with their health.
References
Hurley, J & Hutchinson, M. (2013). Setting a course: A critical review of the literature on nurse leadership in Australia. Contemporary Nurse, 43(2), 178–182. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1698634428/fulltextPDF/EC172494A2C84A47PQ/1?accountid=147674 (Links to an external site.)
Feb 6, 2018Feb 6 at 7:19pm
Dr. Talley and fellow students,
When addressing administrative issues, I prefer to consider a resolution to an issue versus a “quick-fix.” In my experience, I have witnessed countless occurrences where there was a quick-fix but, the causal agent was never fully addressed and managed. This led to repeated occurrences and little to no resolve of the underlying issue. One area of nursing that has been an ongoing issue for years is the topic of staffing (or short-staffing). Strategizing on how to stop the hemorrhaging seems to elude administrators. For the frontline staff, it seems simple, “hire more nurses.” Unfortunately, it is not that simple. In my opinion, it is mostly related to retention. One must ask, what is causing the bedside nurses to leave the bedside? What is it that has nurses furthering their education in directions away from direct patient care? From my previous literature reviews, I believe that majority of the time it is how nurses are supported, mentored, and treated as novice nurses. Nursing leaders are responsible for coordinating and guiding preceptors and novice nurses through the transition from the academic environment to the work environment.
A middle-range nursing theory that nurse leaders can utilize in addressing the issue of staffing shortages and/or retention is the Transitions Theory by Meleis. The Transitions Theory describes periods of change within a person or environment (Kumaran & Carney, 2014). Some identifying markers of change include: disconnection from former supports, absence of familiar surroundings, presence of new needs, inability to address old needs in familiar ways, and the conflict between what was and what is (Kumeran & Carney, 2014). All of these are thematic within the transition period experienced by novice nurses. Once they begin to practice on their own, novice nurses are disconnected from their preceptors; they are unfamiliar with undertaking certain procedures on their own; they experience new needs as they become a part of the team; they are unable to address old needs by relying on preceptors and are responsible for making independent decisions; and they must adapt to the reality of not always being able to provide holistic care as they did in the clinical setting (Kumeran & Carney, 2014). Novice nurses must be encouraged and supported by the healthcare team to help foster a positive transition experience.
Nurse leaders are vital in recognizing and addressing the experiences of novice nurses during this transition period. Understanding the emotions and uncertainty experienced by novice nurses throughout the transition period allows for nurse leaders to develop strategies to aid in producing successful outcomes. Some strategies include implementing a transitions class to inform and educate novice nurses of the expectations that come with transitioning to the work environment; classes for preceptors on how to teach novice nurses; and/or the facilitation of frequent huddles with the preceptor, novice nurse, and nurse leader to ensure efficacy. Although there is much more that can be discussed in regard to staffing issues (e.g., effective leaders), utilizing the Transitions Theory with implementing strategies may help with retaining nurses from leaving the bedside and reduce staffing shortages.
Thank you,
Pauline
Reference
Kumaran, S., & Carney, M. (2014). Role transition from student nurse to staff nurse: Facilitating the transition period. Nurse Education in Practice, 14(6), 605-611. doi:10.1016/j.nepr.2014.06.002
Feb 6, 2018Feb 6 at 10:17pm
Professor and Class,
Nursing theories integrated into clinical nursing practice enhances patients’ outcomes. Research has shown that clinical nursing practice has improved from middle range theories that have been implemented to change organization’s issues to better outcomes. Outcomes such as nurse staffing and retention has improved as a middle range theory, Nursing Intellectual Capital theory, has been adapted to nursing and is suggested as a guide to further research. This theory is a combination of employees’ knowledge that are employed by an organization and are held valuable to the organization while the person is employed there. Intellectual capital is the process of effectively using knowledge resources to gain a competitive advantage for the place of employment. In nursing, this capital is the actual stock of nursing knowledge within a healthcare organization and this knowledge is utilized by registered nurses (RNs) to facilitate their clinical decision-making while delivering nursing care. Nursing Intellectual capital also reflects the RNs’ knowledge and available resources that emphasize and concentrate on RNs that provide care to patients in a healthcare environment.
One concept of Nursing Intellectual Capital theory is Nursing human capital. This concept is reflected in nursing staffing. The recruitment and retention of RNs with experience, knowledge and skills preserves the organization’s nursing human capital to competently care for patients (Covell & Sidani, 2013). Nursing staffing is the supply of RNs and the mixture of nurses who have the knowledge and skills to competently meet the needs of patients on the unit. According to Covell & Sidani (2013) higher levels of RN staffing have been associated with better patient outcomes. This theory introduces a framework for understanding the contribution of nursing knowledge within an organization. Innovative in its conceptualization of the work environment as a major influencing factor on the development and use of the collective nursing staff’s human capital, nursing intellectual capital theory is explanatory in nature. It proposes meaningful interrelationships among characteristics within the work environment, such as nurse staffing levels; employer support for nurse continuing professional development; nursing human capital; and the quality of patient care and the recruitment and retention of registered nurses (Covell, 2008).
The middle-range theory of nursing intellectual capital proposes nursing human capital, operationalized as registered nurses’ knowledge, skills, and experience, is related to patient outcomes associated with quality of patient care and organizational outcomes associated with registered nurse recruitment and retention (Covell & Sidani, 2013). Two factors within the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital’s association with quality of patient care and recruitment and retention outcomes. The theory also proposes that the second concept, nursing structural capital, is directly related to quality of patient care outcomes.
Organizational performance aspect of this theory leads to improvement in organizational outcomes, such as costs that are related with the recruitment and retention of knowledgeable and experienced registered nurses including (e.g. lower orientation hours, registered nurse turnover, vacancy, higher recruitment and retention statistics) as stated by Covell & Sidani (2013). Nurse staffing aspect is the supply and the mix of registered nurses who possess the knowledge, skills and experience to competently meet the care needs of patients on the unit (American Nurses Association, 2002). It is segmented into (1) Hours per patient per day, (2) Skill mix, and (3) Registered nurse-to-patient ratio. For example, since investing in the development of nursing human capital seems to result is lower nurse voluntary turnover and the retention of a highly competent nursing staff, keeping records of the types and hours of internal and external continuing professional development activities attended by registered nurses is required. Since registered nurses are the most knowledgeable about continuing professional development in which they take part, the development of a nursing human capital database where registered nurses can independently update their knowledge, skills, and experience profile would give nurse managers a clearer idea of the amount of nursing human capital available on their unit. Nurse managers may be able to use this information to make decisions regarding the type of continuing professional development to provide to the nursing staff, identify mentors for new graduates or newly hired staff, and complete patient assignments and performance appraisals.
Thus, it is the combination of the registered nurses’ academic preparation, specialty certification, and tenure and professional experience, which are associated with higher quality patient care and better recruitment and recruitment statistics.
References
Covell, C., & Sidani, S. (2013). Nursing Intellectual Capital Theory: Implications for Research and Practice. OJIN: The Online Journal of Issues in Nursing, 18(2). doi:10.3912/OJIN.Vol18No02Man02
American Nurses Association (2012). Principles of nurse staffing (2nd ed.) Retrieved from www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards/ANAPrinciples/ANAsPrinciplesofNurseStaffing.pdf.aspx (Links to an external site.)
Covell, C. L. (2008). The middle-range theory of nursing intellectual capital. Journal of Advanced Nursing, 63(1), 94-103.
Feb 7, 2018Feb 7 at 12:42am
Dr. Talley:
Nurse leaders, such as nurse educators, are responsible for educating and mentoring nursing students in a way that they are able to develop enough knowledge and skill so that they successfully integrat into their practice. To encourage teamwork and leadership, McQueen, Cockroft, and Mullins (2017) suggest a technique that encourages learning. They state that teachers should sit or stand somewhere where they are not positioned in the front of the class or sitting at the head of the table. Given this, the chosen middle-range nursing theory that can be applied to nurse managers and staff is Imogene King’s attainment theory. This theory is used by nurse educators to mentor the millenial generation (McQueen et al., 2017). Specifically, it helps the educators and students to highlight the importance of communication, transaction, self, stress, growth and development, personal space, and time in both their personal and work lives (McQueen et al., 2017).
Furthermore, when it comes to nurse leaders, such as nurse educators, they will need to stay up-to-date with all the technological advancements and other communications devices in order to stay engaged and to effectively mentor students. Other electronic devices include the use of mobile phones. Other than the use as communication devices for effective delivery of patient care, nurse educators will have to learn how to utilize mobile devices as methods of looking for information on medications, diseases, and treatments. This all illustrates how there is a difference in educational experience between baby boomers and millennial students due to the current technological advancements (McQueen et al., 2017).
The other example illustrated from literature that can be applied by nurse educators is giving feedback on tests. McQueen et al. (2017) gives an excellent example about how baby boomers used to be able to wait days to weeks in order to receive feedback from educators on tests or written assignments. These days, millennials expect grades to be assigned online as soon as possible or else they feel inconvenienced and impatient. To summarize, King’s goal attainment theory gives a framework to guide the new nurse into practice and that the nurse educators must be able to embrace changes so that the next generation of novice nurses are well prepared for the nursing field.
References
McQueen, L., Cockroft, M., & Mullins, N. (2017). Original article: Imogene King’s theory of goal attainment and the millennial nurse: An important mentoring tool for nurse educators. Teaching and Learning in Nursing, 12, 223-225. doi:10.1016/j.teln.2017.03.003
Collapse SubdiscussionJanice Bethards
Feb 7, 2018Feb 7 at 4:41am
As I ponder some of the administrative issues on my med-surg unit, I’m coming across an issue that affects many different workplace situations. Employees who are chronically tardy inconvenience their coworkers on a regular basis. They also cause a persistent disruption to the normal workflow on the unit.
Some of our employees and managers have fallen into a pattern of chronic tardiness on the unit. Of course, it’s hard for the managers to discipline the employees for this behavior when they’re engaging in it themselves.
The solution to this issue requires a behavioral change for both parties. Nursing theory, such as Hildegard Peplau’s Interpersonal Relations in Nursing hypothesis, can be applied as a guideline for correcting this situation.
D’Antonio, Beeber, Sills & Naegle (2014) described aspects of Peplau’s theory that can be applied to this situation. Her postulate that describes the interpersonal relationship between a nurse and her patient can be applied to a manager and her employee in this case.
Peplau believed that in order for a nurse to help her patient work through illness-related issues, she has to look at her own feelings and behaviors first (D’Antonio et al, 2014). In this case, the manager needs to reflect on her tardiness habit before she confronts her employees about the same issue.
Peplau also postulated that nurse-patient relationships have an initial phase, a working phase and a terminal phase (D’Antonio et al, 2014). The manager needs to contemplate and correct her own behavior before she can confront her employee regarding that same issue during that first phase.
In the working phase, the manager begins the disciplinary stage with her employee. Peplau recommended that nurses just present a professional front to their patient during these relationships (D’Antonio et al, 2014). However, it may be best for the manager to acknowledge her past issues to avoid the perception of hypocrisy. In any case, the manager must emphasize to the employee that her tardiness habit will not be tolerated anymore.
During the terminal phase, the effectiveness of this disciplinary counseling will be evaluated by both the manager and the employee. If additional counseling is required, steps two and three will be repeated until the employee corrects her behavior in a satisfactory manner.
Reference
D’Antonio, P., Beeber, L., Sills, G. & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317. doi: 10.1111/nin.12056
Feb 8, 2018Feb 8 at 11:52am
Janice,
Your posting reminded me of somewhere I worked with exactly same situation: chronic tardiness, inconvenience to others, purposely being mean and incivility to new comers, and etc. It was that unit’s culture and carried on and on. When you floated to other unit, you would feel “what a difference!” I saw some particular differences between managers who were functioning or not. A manager from a functioning well unit constantly had her staff reward each other, compete each other, and having funs together. The manager made a box of “Thank you” card, so her staff made a note and toss in the box. Those notes were on staff lounge, then everyone could see whose was thankful for what, when, and how. It motivated her staff to become a good worker for others. At their annual evaluation, the manager had everyone evaluate each other between staff, manager, clinical leaders, educators, janitors, porters, and all. Another competition was the “Lab sample collection without hemolyzed”, and the Biggest looser for weight loss and healthy purpose. I saw that unit’s staff were having open communication, proactively becoming helpful to others, valuing fairness, justice, and civility. On the other hand, non-functional unit’s manager was often complaining of others with her staff, experienced staff bullied new-comers, staff leaving for other units, managers changing frequently.
Feb 11, 2018Feb 11 at 11:45pm
Janice:
Interesting issue regarding chronic tardiness and how management is also involved with this problem. On our floor, we have a daily problem with nursing assistants being tardy and I wish I can just post a bulletin about Peplau’s theory suggesting they are actually impacting the patient the most!
Also, wonderful idea about the Robot! I would say that I have a patient nearly every shift that can use the benefits of a robot. I had a patient that did not sleep the whole night due to anxiety and just wanted someone present with him in the room. The robot would definitely be more cost-effective than having a sitter to provide the company. However, we are removing the human contact/interaction aspect, because some patients want their hand held, literally. That would be the only downfall.
Regarding the Bureaucratic Caring theory, it is so great to learn about all the theories and how they impact our daily profession. It is astonishing to know that all this time we have been utilizing nursing theories and not directly make the connection that we are utilizing them. My personal favorite is Peplau’s theory of interpersonal relations because it can be applied to many situations.
Collapse SubdiscussionFride Edith Wandji
Feb 7, 2018Feb 7 at 5:09am
Professor and class,
Middle-range nursing theories open the door for specific and goal oriented resolutions in our health care system. I think we are all aware that our health care system has several flaws and inconsistencies. The cost alone of current health care is astronomical and leaves many individuals unable to pay for certain treatments or take the steps necessary to manage and improve their condition or illness. Nurse leaders and nurse managers are often at the forefront of trying to balance the increasing gap between providing the best care possible and maintaining a certain budget or quota. I have witnessed my current nurse manager deal with frustrations regarding staffing and the current grid our unit utilizes for nurse to patient ratio. The hospital I work at does not have a step down unit which often leads to critically ill patients being admitted or transferred to the medical-surgical floor. On any given shift each nurse on the medical-surgical unit I work on has six to seven patients. There is nearly always a critically ill or unstable patient within each group. My manager has fought to change our grid to no more than five patients per nurse but has been unable to get upper management to agree-in great deal because of cost and the concern for budgeting. In my opinion this is contradictory. In order to save money patients need to be well taken care of in order to improve patient outcomes and decrease admission rates-which in the end would save the organization money.
A middle range nursing theory which relates to the above mentioned issues is The Nursing Intellectual Capital Theory. This particular theory addresses the increasing cost of health care and how nursing knowledge and care can directly impact this issue. “Intellectual capital includes the knowledge of individual employees or groups of employees who are deemed critical to a company’s continued success, and organizational structures that contain information about processes, customers or other information that contributes to improved business performance or profits” (Covell & Sidani, 2013). Nursing Intellectual Capital theory is broken down into two concepts: human capital and structural capital. Nursing human capital has shown a direct link between nursing knowledge and improved patient outcomes whereas structural knowledge provides the protocols and guidelines that make the improved outcomes possible (Covell & Sidani, 2013).
Without a doubt, nurse managers and leaders need to support the growth of nursing knowledge and practice. By implementing this theory into their leadership they will be able to provide a healthy work environment for their staff which will lead to better patient outcomes-in turn generating profits. If leaders and managers neglect to acknowledge the important role nurses play in the success of their units there is not much hope for conflict resolution. Without conflict resolution and doing their best to provide the most up to date protocols and practices it will be nearly impossible to improve outcomes and fiscal growth. All in all, leaders/mangers need to value their employees and allow them the tools necessary to provide competent, thorough care to patients in order to achieve the best outcomes possible.
Resources
Covell, C. L., & Sidani, S. (2013). Nursing Intellectual Capital Theory: Implications for Research and Practice. Online Journal of Issues in Nursing, 18(2), 1. doi:10.3912/OJIN.Vol18No02Man02
Feb 7, 2018Feb 7 at 12:13pm
Fride,
The Nurse-Patient ratio has always been an issue. Too much for nurses would not be safe for patients, and too less for nurses could be over-budgeting. Between safe and cost effectiveness, nursing leadership must consider and analyze the best way to operate her unit and serve for patients with optimal outcomes within fixed budget. Otherwise, staff RNs would be in jeopardy; they would be afraid of losing their license by making mistakes or making incidents due to over-loaded assignment. The Nursing Intellectual Capital Theory sounds like a smart theory that hospitals should follow and implement for better outcomes. I believe that nursing executive and leadership could become nurses’ voice from bedsides and utilize this theory to show their hospital administrators for protecting nurses’ license, nurses’ retention, patients’ safety and better outcomes. The organization I currently belong to has a RN council from each unit and raise our concerns as our voice to executive levels systematically. Those concerns sought solutions and caught administrators’ attention.
Collapse SubdiscussionBrenda Talley
Feb 7, 2018Feb 7 at 9:03am
Week 6 Midweek
Hello everyone!
This week is moving quickly!
We have made progress on achieving the course and lesson outcomes!
This week’s graded topics relate to the following Course Outcomes (COs).
- Propose strategies for use of relevant theories that nurse leaders can employ in selected healthcare or educational organizations, considering legal and ethical principles. (PO #2 and 6)
- Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO #3)
- Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO #4)
- Recommend strategies for the use of theory as the basis for actions of advanced nursing practice in leadership and education. (PO #5)
We are engaged in spirited discussion about application of mid-range nursing theory concerning leadership and on the healthcare organization. So far, we have had interest in Benner’s Model involving skills acquisition. The Synergy Model has received attention as has King’s theory. Others are beginning to emerge.
An article you may want to look at is:
Clarke, P. M., Cody, W., Cowling, R. (2014). Transformative leadership based on nursing science. Nursing Science Quarterly, 27(2), 126–131. doi: 10.1177/0894318414522662
The examples of application of nursing theories that you are sharing is critical to our understanding of the theories. This makes it REAL!!!
I look forward to the reminder of the week.
Dr. T.
PS: Class, has anyone had the opportunity to work in an organization that applied the Shared Governance Model as presented by Tim Porter-O’Grady (2004)?
Porter-O’Grady, T., (January 31, 2004). Overview and summary: Shared governance: Is it a model for nurses to gain control over their practice?” Online Journal of Issues in Nursing, 9(1), Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/Overview.aspx
Feb 7, 2018Feb 7 at 2:09pm
Dr. Talley,
I currently work within an organization that tries to apply the Shared Governance (SG) Model that is presented by Tim Porter-O’Grady. Unfortunately, I have to say that this organization “tries” to apply the SG model because they do use the term but, it is not aligned with Porter-O’Grady’s model. I first heard of Shared Governance around 2008. The organization where I am employed brought this model to all of our five hospitals as a way to engage and empower the bedside nurses as well as for the intent to apply for Magnet Excellence status. The first five years was exactly what we expected. The process was in accordance to Porter-O’Grady’s model. As nurses, we loved this model and there was an abundant of nurses actively participating. Over the next five years, the zest and enthusiasm wore off to the point of little involvement from nurses. Personally, I believe that this decrease in support was entirely due to the nursing leadership.
When the model was initiated, we had three tiers of SG: unit/department based, facility based, and system based. Within these tiers we had three councils: clinical practice, professional practice, and management. If nurses were interested in being on any of the councils, they had to be nominated and then voted in by their peers. The system tier was comprised of the chairs from the facility tiers and the facility tiers were comprised of the chairs from the unit tiers. Each chair position had a term of two years to allow for a rotation of nurses and new ideas. The first two years of implementation, I was the chair of my unit, the facility clinical practice council, and the chair of the system SG. Yes, I was nervous and anxious about this role; however, I had an amazing leadership team who mentored and supported me through the process. We were seeing positive changes within our organization. Without a doubt, I contribute the positive changes to the collaboration between frontline nurses and nurse leaders (administration, directors, and managers).
As time progressed, new leadership was introduced into the organization. Once this happened, there was a noticeable decrease in the unity and collaboration among all nurses. The support, mentoring, and encouragement from nurse leaders quickly faded. The nurses stopped participating in SG councils due to the autocratic leadership. Administration and directors started coming to the meetings—where before they were not allowed to do so unless they were invited. Nurses did not feel comfortable speaking up; each time they had an idea, it was quickly shut down by the nurse administrator; additionally, the nurses felt belittled and as if they were not competent in making decisions to improve the quality of patient care. Commonly spoken by many nurses was, “if everything we say and do gets a negative response from her [the nurse administrator], what’s the point?”
Presently, the organization has recognized some of the barriers and has hired an outside manager to focus solely on SG within our system of, now, eleven hospitals. This manager and I were in a class together and I shared with her my insights to the changes over the years with SG in our organization. I was able to share with her my personal experiences and thoughts on how to improve SG throughout our system. One key point is to begin addressing the barriers. The number one barrier that I see that must change in order to make our SG successful is the relinquishing of control from the autocratic nurse leaders. Otherwise, I do not see how nurses will be able to enact positive changes.
Thank you for allowing me to jump on my soapbox,
Pauline
Feb 10, 2018Feb 10 at 7:39pm
Dr. Talley,
In response to “Has anyone had the opportunity to work in an organization that applied the Shared Governance Model”: My facility follows the Shared Governance Model. I work in the IT department at my hospital, not at the bedside, so my opinion is from that perspective. Our facility has Leadership Councils at the system-wide and facility-wide levels that focus on specific goals. One such Leadership Council focuses on Quality and Patient Safety. I am a member of this council, and the lone RN from the IT department that is represented there. The council has members from across departments, and spans nurses from many different backgrounds within the facility. As I mentioned, I am from IT, we also have a nurse that works in communication on the council, educators, unit managers and staff nurses. The diversity of the group is the source of its strength. Ideas are brought up and discussed with nursing representatives across the facility able to offer input, ultimately ensuring decisions made move the organization in a positive direction. I have direct exposure to the collaboration that occurs and how decisions are made, and see the metrics we track improve with initiatives the council introduces. Shared Governance via our Shared Leadership councils has been excellent at ensuring input is well rounded, and each department represented.
-Mary Claire
Feb 11, 2018Feb 11 at 8:59am
Dr. Talley,
Our facility uses the shared governance model. It was put into place about 7-8 years ago and fell to the wayside. This past year, it was brought back to the table. Our entire organization is taking steps to include the nurses in the development of policy, procedure, and structure. In the hospital, a majority of the staff are nurses. This is true of even the top level management. Although most hospital boards are made up of less than 6% RN’s. They are usually nurse executives whose careers began at the bedside. In fact nurse staffing is directly related to the financial performance of a hospital (Al-Amin, Everhart, Neff, Nogle, & Weech-Maldonado, 2013). It only makes sense to utilize them and their opinion and experience when creating the items that will govern them. Allowing the staff to have a voice regarding work practice is also a staff satisfy-er that tends to decrease the employee RN turnover rates and leads to better RN retention. It is cost effective to hire quality staff and provide them effective training than to have to find new staff and provide new training repeatedly. It also increases the quality and consistency of care that is being provided.
.
Feb 7, 2018Feb 7 at 10:13am
There are several middle-range nursing theories that can be applied to nursing administrative duties, but, in my opinion, the Theory of Bureaucratic Caring is the most interesting. The theory describes eight dimensions within an organization that are interrelated and reflect different domains of caring. These are educational, spiritual-ethical, legal, physical, technological, economic, political, and social-cultural. In this model, caring is the thesis, dimensions of the bureaucracy are the antithesis, and the reconciliation of the two diametrically-opposed concepts into bureaucratic caring is the synthesis. Within the organization are different stakeholders with different interests in how care is provided (Potter & Wilson, 2017).
Potter and Wilson (2017), applied the theory to a group of military dependents with Type 2 Diabetes Mellitus. In this example, the stakeholders are the military dependents, the healthcare staff working with the dependents, and the American public, who fund the healthcare received by the dependents. The results showed increased patient satisfaction, increased staff satisfaction as well as a reported higher level of fulfillment in patient interactions. A marked healthcare cost savings was also present.
This theory builds upon the idea that caring is the job of all members of the healthcare staff, not just those in direct patient-care roles. Administrators and management display caring through economic management (if the patient cannot afford healthcare, they cannot receive care). Administrators can exercise their power to ensure that all patients have access to affordable equipment as well as safe and cost-effective staffing levels. The American public shows caring using their tax dollars to finance the treatment of military dependents. They also show caring when they elect public servants that are advocates for military dependent healthcare. The healthcare staff in direct patient-care roles display caring in the more traditional, empathetic services they provide to the patient. Healthcare staff can also display an economic level of caring to patients by reducing waste of products used on individual patients and providing highly efficient care to reduce hospital stays and re-admissions.
References
Potter, M. A., & Wilson, C. (2017). Applying bureaucratic caring theory and the chronic care model to improve staff and patient self-efficacy. Nursing Administration Quarterly, 41(4), 310-320. doi:10.1097/NAQ.0000000000000256
Collapse SubdiscussionJamie Taylor
Feb 7, 2018Feb 7 at 4:47pm
Professor and class,
As a director of a critical care unit, I deal with performance issues frequently. I would like to explore application of King’s theory of goal attainment and how it applies to nursing performance issues.
King’s theory draws parallels between critical thinking, nursing, and the nurse-client transaction (Parker & Smith, 2015). When a breakdown in process occurs, the client can be adversely affected. These performance issues can be intentional or unintentional. An example of an intentional performance issue may be a nurse taking a short-cut in order to save time or trouble. When there are intentional performance issues they must be addressed by the nurse manager in order to prevent future error.
Example: Nurse Jane has a ventilator patient. There are orders on the chart for daily spontaneous breathing trials. For this, the nurse is to stop the sedation and allow the patient to awaken enough to participate in their breathing trial with the assistance and support of the respiratory therapist. On this particular day, the nurse had two patients and did not want to decrease the sedation because the patient would need closer monitoring. The sedation remained on, and the patient was never given the opportunity to pass of fail the breathing trail to achieve ventilator liberation. Thus, there was no goal attainment because of the nurse’s choice to avoid interaction and transaction with the client. The patient remained on the ventilator for an additional day and experienced a delay in care.
As the nurse manager, I was obligated to complete a corrective action. It is the intentional errors that are the most difficult to address. As nurses we are trusted to care for and take an oath to do no harm to those for which we care. Perhaps, some nurses do not realize the true impact of delaying goal attainment for clients. This nurse actually supplied a rebuttal to her write up stating that she has never placed a patient in harm’s way and was only considering the patients safety. Delay of care is a real issue and it is a safety issue.
Parker, M. E., & Smith, M. C. (2015). Nursing Theories and Nursing Practice Fourth Edition.Philadelphia: F.A. Davis Company .
Feb 8, 2018Feb 8 at 7:30pm
Jamie,
I really connected with your post on King’s Theory of Goal Attainment. I was the nurse manager for the last two years of my fourteen-year tenure as a critical care nurse. This is a critical issue that has been ongoing for years within the department where I was employed. I had issues with addressing it from a peer, charge nurse, and manager standpoint. Even with physician support, it was difficult for many nurses to understand the impact this has on the overall state of the patient’s well-being. We also had many nurses voicing the “safety” term but, majority of the time it was due to time management issues and/or not understanding the need to perform the sedation vacation trials. I really appreciate how you utilized King’s theory to focus on the patient’s need for goal attainment and the nurse’s ineffectiveness of care in assisting the patient with achieving the desired goal. Unfortunately, the nurse was the factor who affected the attainment of goals for the patient by not performing the sedation vacation trial and coordinating efforts with the respiratory therapist to perform a spontaneous breathing trial; therefore, potentially increasing risks for ventilator associated events, length of stay, and need for physical therapy. I hope the counseling helped the nurse to recognize and take ownership of her actions (or inactions) and change her practices as well as her goals for patient care.
Thank you for your post,
Pauline
Collapse SubdiscussionMary Pollard
Feb 7, 2018Feb 7 at 7pm
This discussion post will outline how the theory of goal attainment can be applied by nurse leaders to deal with administrative issues more effectively. McQueen, Cockroft and Mullins (2017) outlined how the theory of goal attainment is used by nurse educators to educate and mentor younger nurses. The goal attainment theory can be used in this way by providing the educator and younger nurse a framework on which to base communication, jointly set goals and work together to lay out the steps needed to achieve the goals (2017). In a similar way, I believe the theory of goal attainment can be used by nurse leaders to work with their nursing staff on goals outlined in performance improvement plans, departmental goals, or in conjunction with annual review personal goal setting. Using the theory of goal attainment in this way would allow for a dialog between the nurse and the nurse leader to collectively move towards a defined goal. This would ensure both parties understand why the goal was chosen, its importance and agree on a path to move forward.
An example of how this could be used is with an existing goal at my facility of barcode medication scanning compliance targets. Departments each have an overall goal of being 95% compliant, and individual nurses are tasked with being at least 95% compliant as well. Using the theory of goal attainment, nurse managers could meet with individual nurses that are having a difficult time meeting the 95% compliance level, to outline the goal, discuss the importance of the goal and also talk about what the nurse sees as personal obstacles to meeting the compliance threshold. The nurse and the nurse manager could come up with a plan to help the nurse meet their goal in a way that works for both parties. Using the goal attainment theory in this way would make the interaction focused on working towards positive results, rather than penalty for not meeting defined metrics. This would be an application of the goal attainment theory by utilizing communication and collaboration to move towards a defined goal.
Reference
McQueen, L., Cockroft, M., & Mullins, N. (2017). Imogene King’s theory of foal attainment and the millennial nurse: An important mentoring tool for nurse educators. Teaching And Learning In Nursing, (12) 223-225. doi:10.1016/j.teln.2017.03.003. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S1557308716301494&site=eds-live&scope=site
Feb 9, 2018Feb 9 at 4:09pm
Mary Claire, perfect example of shared goal setting. An idea that really stands out is that this framework provides the opportunity for the nurses who actually use the system to provide feedback about facilitating factors and barriers to meeting the goals.
Good insight!
Feb 10, 2018Feb 10 at 10:33pm
Hello Mary,
I enjoyed reading your post. Goal Attaintment Theory is an excellent method for nure mentors, educators and leaders to help new and experience nurse set personal goals as well as goals as a unit. The example provided was the overall goal of being 95% compliant with barcode medication scanning. Goal Attainment Theory is useful in this application as well as many others. I also believe the theory can be applied with new millneal nurses teaching more advance nurses how to be more compliant with EMR charting, medication barcode scanning, armband scanning and any other medical compliance that deals with advanced technology (McQueen, Cockroft, & Mullins, 2017).
As a bedside nurse, we set goals with more experienced nurses. The goals were to encourage them to chart as much in the EMR at that current moment as possible instead of writing on paper and waiting until the end of the shift. This allowed for them to decrease missed errors with chartings. It took longer than expected but eventually nurses left on time unless there was a code or a patient with an extreme higher acuity.
McQueen, L., Cockroft, M., & Mullins, N. (2017, July). Imogene King’s Theory of Goal Attainment and the Millennial Nurse: An Important Mentoring Tool for Nurse Educators. Teaching and Learning in Nursing, 12(3), 223-225.
LaQuanta
Collapse SubdiscussionCatherine Resendez
Feb 7, 2018Feb 7 at 11:29pm
Hi Professor and Class,
A middle-range theory that can be applied by nurse managers to effectively deal with staff performance issues would be Patricia Benner’s novice to expert model. When a nurse manager is hiring new nurses, it is important to have a clear understanding of what level of experience the need is for. For example, if my manager in my unit has a need for a Neuro ICU nurse because there is a shortage then a nurse with several years of experience in the specific area should be heard. We had a new hire recently that was coming from a Medical ICU and was expected to be on her own within four weeks. When it came time for her to be on her own she did not feel ready to be on her own, so she required a couple more weeks of orientation. The unit was still short staffed. Charge nurses constantly asking for people to pick up. This causes exhaustion for the nurses working overtime and exhaustion for the charge nurse because they are always trying to find coverage or having to take patients of their own on such a busy unit. If there is a clear understanding of Benner’s model it may be helpful when hiring employees. If the Medical ICU nurse is starting on a Neuro ICU then she may be going back to the novice level of the model or even advance beginner but should not be hired for a position where she was expected to be competent or proficient levels. Our hospital does offer nurse residency programs for nurses that decide they want to try other specialty’s which could also be an option for this nurse, so she didn’t feel so overwhelmed coming into this new role.
References
Mennella, H. A. (2016). Benner’s Professional Advancement Model. CINAHL Nursing Guide.
Collapse SubdiscussionAllyson Tommasini
Feb 8, 2018Feb 8 at 3:11pm
Catherine,
You make a very good point that a nurse that is transferring fields of study may very well be at the level of a novice. Where I work is in a Medical ICU I can speak from experience when I have been floated to a Neuro ICU I feel so lost and confused as to what needs to be done per their protocol. I am always asking what the documentation is that needs to be completed and where things are. If I was to transfer jobs that are a different category of caring I would need to be trained for more than 4 weeks. I am looking to transfer to labor and delivery and that would put me at an entry level nursing experience. I love the ICU, but I eventually want to work up to being a midwife. My current unit is constantly hiring new grads. We very rarely see nurses with years of experience come in here. Not because they don’t apply, but I think they hire so many people who are still in school for nursing and we wait so long for them to graduate and get their numbers take the NCLEX and then get through orientation. I do wish that our managers hired some more nurses who have more ICU experience. Last year we hired on 16 new grads all at one time. So we have a big chunk of nurses who are in the same category instead of having nurses of all different levels working together sharing knowledge.
Collapse SubdiscussionCatherine Resendez
Feb 8, 2018Feb 8 at 5:13pm
Hi Allyson,
Oh WOW, sixteen new grads! That’s so many! We have two residency programs a year and only two new residents at a time. I feel like that is a good thing because the two new grads can really feel like they are being focused on. I can’t imagine how hard that may be for the nurses that precept and for the new grads as well. I haven’t floated to the Medical ICU but I can imagine I’d be so lost. I did do one rotation there when I started my residency program just to get an idea of what the unit flow was like. Definitely a different world over there.
That’s great that you are looking to going to labor and delivery. I’m sure your experience in the Medical ICU will be useful even if it such a different specialty area. We have had a few pregnant women and a few that have already delivered. Mostly because of preeclampsia that have led to strokes. We normally have a labor and delivery nurse that is sent to stay on the unit to monitor the patient and baby. I’m glad they do that because even though mom requires our level of care, taking care of mom and baby is definitely a level of care I feel more comfortable with is the appropriate nurse is close by. Best of luck with your journey:)
-Catherine
Feb 9, 2018Feb 9 at 4:06pm
Catherine, Allyson, and class
This is certainly an opportunity to apply what we understand to the professional development needs of nurses, and especially new nurses.
Thank you for shairng your experiences with us. It gives much to think about!
Feb 10, 2018Feb 10 at 5pm
Catherine,
This was an interesting post because it highlights how large hospitals often have to deal with nurse shortages because they have so many different units (SICU, MICU, ICU, step-down ICU) where the nursing skills do not overlap. I work at a large hospital myself and see the same thing with some nurses that transfer from units that are not considered critical care, and they seem to struggle until they get their bearings. One thing our unit manager decided to do to improve this situation is to have new nurses to the unit partner with experienced nurses for the first 8 weeks to help build their confidence. I agree that nurses that change units should probably be seen as advanced beginners until they become proficient with the skills required for the unit. It is suggested that in order for new nurse preceptorship to be successful three things must occur: 1) the preceptee and preceptor must physically work together to ensure learning outcome, 2) the preceptee and preceptor must engage in health-related work together to obtain skills and, 3) the preceptee and preceptor keep a balance professional and personal relationship (Nielsen, Finderup, Brahe, Elgaard, Elsborg, Engell-Soerenson, Holm, Juul, Sommer,2017).
Reference
Nielsen, K., Finderup, J., Brahe, L., Elgaard, R., Elsborg, A. M., Engell-Soerensen, V., & … Sommer, I. (2017). Clinical education: The art of preceptorship. A qualitative study. Nurse Education In Practice, 2639-45. doi:10.1016/j.nepr.2017.06.009
Collapse SubdiscussionLaquanta Russell
Feb 7, 2018Feb 7 at 11:54pm
Hello professor and class,
Middle range nursing theories can be effective guidelines in nursing care but also as teaching tools used my administrators and nurse leaders to encourage employees to report to work on their scheduled days and also to help keep a positive rapport amongst staff. Having a happy staff will decrease the turnover rate for new employees thus allowing an adequate patient to nurse ratio. I believe Katherine Kolcaba’s Comfort Theory is a nursing theory that focuses on safety and comfort. The state of comfort means to be absent of worry, pain, suffering and any other adjective used as synonym for discomfort. When the nursing staff is inadequate, it induces a sense of worrying and discomfort on administration, nurse leaders, and other nurses who must carry a heavier patient load. Most nurses became a nurse because they care and to care for someone is to make sure all their needs are met within the scope of your practice and to collaborate with other disciplines when that scopes exceeds what you are capable of doing. The goal is to provide the optimal quality of care. “Healthcare professionals need to reflect on their healthcare actions to achieve the improvement of care and contribute to the security of being careful” (Mendes, Cruz, Rodrigues, Figueiredo, & de Melo, 2016).Not showing up for scheduled assignments, apart from being sick or family member being sick, increases the work load for other nurses therefore increase the possibility of a sentinel event. The comfort theory is able to explain how comfort measures are important for the maintenance and promotion of health. As nurses, the goal is to show up for scheduled assignments to provide adequate safe care for patients and to reduce the burden on our co-workers (Mendes, Cruz, Rodrigues, Figueiredo, & de Melo, 2016).
Feb 7, 2018Feb 7 at 11:57pm
Mendes, R., Cruz, A., Rodrigues, D., Figueiredo, J., & de Melo, A. (2016). Comfort Theory as Support for Safe A Clinical Nursing Care. Cienc Cuid Saude, 390-395.
Collapse SubdiscussionBrenda Talley
Feb 9, 2018Feb 9 at 4:03pm
Laquanta, excellent application of Kolcoba’s Comfort theory!
How might Comfort theory apply to the nurse as a leader? Of course, as you said, fostering/supporting quality outcomes is one responsibility of the nurse leader. What strategies might promote “comfort” in terms of the work environment?
Feb 9, 2018Feb 9 at 7:52pm
Hello Dr. Talley and Classmates,
The Comfort theory provides a framework for clinical practice. The outcome is important to nurse leaders to empower the patients and their families to engage in health seeking behaviors. The comfort theory guidelines when applied by a nurse leader can be a powerful tool for supporting employee performance and if duly supported will also enhance productivity, team work, employee health and wellness. Comfort is a state of contentment and relief from discomfort (Wensley et al., 2017). To promote comfort in practice, the nurse manager will need to implement mentorship and promote teamwork and collaboration. This will reduce stress, foster good work ethics and provide comfort. Another way to promote comfort will be to reduce health and safety risks as it creates negative impact and an uncomfortable work place. Also, by adjusting the work environment and personal practices, they may be able to minimize fatigue and discomfort. Lastly, by acting on, and periodically reevaluating the outcomes of the theory application, it is possible to create a safer, more comfortable, healthful, and efficient work environment. Comfort is relief when the work environment is stress free, it reflects on the nurses and the patients they care for.
Reference
Wensley, C., Botti, M., Mckillop, A., & Merry, A. F. (2017). A framework of comfort for practice: An integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings. International Journal for Quality in Health Care. doi:10.1093/intqhc/mzw158.
Feb 11, 2018Feb 11 at 10:51pm
Hello Professor Talley and class,
As a nurse leader it is imperative to be supportive, caring and attentive. Possible strategies that might promote comfort in the workplace are similar to those practitioners and nurses would use on their patients. One method could be positive reinforcement. Oftentimes, nurses are told on how to improve in areas and less praise is given to areas where they are meeting expectations. Positive reinforcement can help the nurse reach the point of exceeding in a particular area. Being a support person for new and experience nurses to bounce ideas off us of or just to confirm a hunch is another method of providing comfort in the work place. Having an open-door policy where the staff feels comfortable enough to express their grievances without the fear of punishment is a major method to induce comfort by a nurse leader. Above everything else, a nurse leader must show they care about their staff. The staff should know they are not just another employee who is only important to meeting staff quota.
LaQuanta
Feb 11, 2018Feb 11 at 11:43pm
Hi Professor,
As a nurse leader there is a responsibility to create and have a safe environment for others to work. In Kolcaba’s theory the practice is centered on the individual and how comfort is important to promote health and maintenance(Mendes, Cruz, Rodrigues, Figueiredo, & Melo, 2016) . For example, our unit manager has to worry about staff being happy and content with their job so that she is sure that our patients are receiving quality care. Our care starts with ourselves and as a nurse leader it is important that it is displayed that our health is cared about. Our unit manager demonstrates to us that she cares that we are okay. Every time we lose a patient she has something called “tea for the Soul” set up in our conference room. She has them come in and set up somewhere we can sit and relax in silence and peace.
Reference
Silveira Mendes, R., Miranda Cruz, A., Paiva Rodrigues, D., Vieira Figueiredo, J., & de Melo, A. V. (2016). COMFORT THEORY AS SUPPORT FOR A SAFE CLINICAL NURSING CARE. Ciencia, Cuidado E Saude, 15(2), 390-395. doi:10.4025/cienccuidsaude.v15i2.27767
Feb 10, 2018Feb 10 at 12:15pm
Laquanta, Professor Talley, and class,
I discussed this theory in a previous post and I believe safety and comfort are essential components in our profession with a lot of advantages! Laquanta, my favorite part of your discussion post is the part where you mentioned that a low census of staff leads to sentinel events. I think every one of us have experienced near misses, sentinel events, or something close too these due to the floor being understaffed. Staffing in hospital settings always seems to be hit or miss, that’s for sure! But, I do like how you mentioned the comfort theory as a way to improve this.
I think you were correct to use this theory! I say this because Kolcaba’s theory is strictly based on patients’ needs. With proper staffing, nurses can intervene in specific ways with their patient’s care and even identify patient needs without feeling the sense of being overwhelmed or overworked. By utilizing this theory, nurse managers can also assess the effectiveness of interventions given to the patients by using this theory as a tool that can gauge the degree of comfort attained when comfort needs are targeted (Smith et al., 2015).
Not only can this theory help nurse managers, it can help the hospital as a whole. Using this theory can assist the hospital in attaining its goals, creating plans for possible changes, all while making it a comfortable, healthy place of work. This theory can increase census and improve staffing by also using it as a tool to care for staff and make them also feel comfortable and satisfied with their work and workplace (Smith et al., 2015).
Reference:
Smith, M. C., & Parker, M. E. (2015). Nursing theories & nursing practice (4th ed.). Philadelphia, PA: F.A. Davis Company.
Collapse SubdiscussionLolita Jerrell
Feb 8, 2018Feb 8 at 8:24am
Professor Talley and class,
The specific middle-range nursing theory that could be applied by nurse leaders or nurse managers to effectively deal with the administrative issue of staffing shortages is Marilyn Anne Ray’s theory of bureaucratic caring(BCT). The bureaucratic theory of caring examines the relationship between all stakeholders in the healthcare bureaucratic system who include ( patients, nurses, and nursing administrators) and how each stakeholder shares caring as the thing that binds them to each other. The BCT consists of eight interrelated dimensions which include such humanistic tenets as educational, spiritual-ethical, legal, physical, technological, economic, political and social-cultural, as well as structural tenents of a healthcare organization such as political, economic, legal and technological that,and how they serve as a bridge between the patients and the healthcare organizations (Potter & Wilson, 2017). This theory is often used by healthcare organizations in their pursuit of Magnate Recognition by incorporating evidence-practice, nursing research, and professional models of care delivery into the practice setting.
Marilyn Anne Ray’s bureaucratic theory of caring is currently being used in our hospital to address our staff nursing shortages. One specific example of its use is when our nursing director held our monthly unit staff meeting and one of the major concerns was the safety issue surrounding having a nurse to leave the unit to transport a patient to off unit testing (MRI, CT, ultrasound) which leaves the unit dangerously short staffed. As an intermediate care unit, all of our patients are required to be on continuous telemetry monitoring.The director listened to our concerns and possible solutions such as employing addition nurses just to transport patients to procedures and reported those issues to our hospital CNO to develop a solution. The director and CNO used BCT to review the budget of the unit, and how it relates to staff concerns about safety and morale, before developing a compromise where nurses received additional assistance from clinical managers in transporting patients during peak hours while maintaining budgetary requirements, while all the time providing safe, quality patient care.
References
Potter, M., & Wilson, C. (2017). Applying bureaucratic caring theory and the chronic care model to improve staff and patient self-efficacy. Nursing Administration Quarterly. 41(4). p.310-320.
doi:10.1097/NAQ.0000000000000256
Collapse SubdiscussionBrenda Talley
Feb 9, 2018Feb 9 at 4pm
Lolita, you described well the usability of BCT. It highlights the important connections among all of the aspect of the organization with an underlying theme of caring.
BCT has been adopted by the U. S. Air Force for the conceptual framework for their clinics. Dr Ray (known as Dee Ray) has connections to the military and is active with them as a consultant (Ray, 2016).
Class, does the theme of caring seem at odds with the idea we may have of strict military discipline and “following orders”? But then, who more gives of themselves for the benefit of others???
Reference
Ray, M. (2016, June). Theorist Panel: Elizabeth Barrett, Richard Cowling, John Phillips, Marilyn Ray, Marlaine Smith, and Jean Watson. The International Association for Human Caring and The Society of Rogerian Scholars Conference: Advancing Unitary and Caring Science for Nursing Praxis. Boston.
Feb 9, 2018Feb 9 at 6:59pm
Professor Talley and Class,
The theme of getting the job done and following orders is military style. As nurses, there is a tendency to care, communicate and pay attention to what patients are experiencing so the strict art of taking care of patients is altered. Orders are followed as instructed until a situation or issue arises with a patient that is contradictory to what is occurring with the patient. This is where the nurse intuition dials in. For example, if a patient is supposed to get insulin every day for increased blood sugar. Currently, their blood glucose is low for some reason, Now, most nurses have the knowledge to know not to administer the prescribed insulin no matter what.
Caring is the foundation of nursing, so the strict-military-following orders concept does not work most of the time; however, there are standards of nursing care that we stay within the guidelines to provide quality care for patients. As nurses the role is to assist patients with essential activities to maintain their health. By providing education in how to maintain this state of health, the patient can be more aware of what it takes to care for themselves and their own well-being.
A selfless person gives more of themselves and looks out for the other person’s best interest rather than their own. Their satisfaction is in making sure that the patient’s well-being is stable. Values consistent with the art of nursing are the basis for an authentic nurse-patient relationship, which is the hallmark of high quality nursing care (Alligood & Fawcett, 2017). An emphatic nurse-patient relationship is evident in responsible professional nursing that is associated with increased nurse respect for patients.
References
Alligood, M. R., & Fawcett, J. (2017). The Theory of the Art of Nursing and the Practice of Human Care Quality. Visions: The Journal of Rogerian Nursing Science, 23(1), 4-12.
Feb 10, 2018Feb 10 at 8:35am
Week 6, Summary: Impact of Nursing Theory upon Healthcare Organization
Hello everyone! On this discussion thread, we discussed grand nursing theories. We explored how application of a grand nursing theory by nurse leaders and nurse managers can influence outcomes from thShow More (Links to an external site.)
Hello everyone!
We’ve had a great interchange of ideas this week with many insightful applications of nursing theory. Our discussion this week was:
Impact of Nursing Theory upon Healthcare Organization (graded)
Discuss how a specific middle-range nursing theory has been or could be applied by nurse leaders or nurse managers to effectively deal with an administrative issue (i.e., staffing, use of supplies, staff performance issues). Include an example from the literature or your own experience to illustrate your points.
Our course objectives for this week were:
This week we are working toward Course Objectives:
CO 2: Propose strategies for use of relevant theories that nurse leaders can employ in selected healthcare or educational organizations, considering legal and ethical principles. (PO #2 and 6)
Weekly Objectives
CO 3: Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO #3)
CO 4: Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO #4)
CO 5: Recommend strategies for the use of theory as the basis for actions of advanced nursing practice in leadership and education. (PO #5)
Our discussion involved the application middle-range nursing theory in a specific area of nursing leadership practice. We examined the role and application of middle-range nursing theories in healthcare and educational organizations.
We shared a number of perspectives and some great resources that I’m sure were useful for your papers! The discussion were lively. Each of you proposed methods of applications, given that many nursing theories are about relationship and values held dear in nursing…..these convey easily to the work environment and have meaning in patient care experiences and outcomes.
Some have asked if a theory of transformational leadership specific could be found. We did find some interesting research and dialogue articles which used transformational leadership theory. Although their synthesis of transformational leadership included many sources, most found a theoretical base in the theories of transformational leadership that arose from the business/administration profession, especially Burns (1978) and Bass (1985, Bass & Riggio, 2006). We were not able to find a theory of transformational leadership that arose in nursing or that was unique to nursing.
We learned that nursing theory keeps evolving….for example, Rays’ theory of Bureaucratic Caring is being actively refined (Ray, 2016).
We were impressed by the Synergy model and it impact on care in the nursing unit and in making assignments based on multiple factors.
Goal setting was an especially important concept the application of nursing theory on the organizational level and in nursing leadership and can be found in more than one nursing theory!
It proved to be amazing…awesome…that so many nursing theories had relevance to nursing leadership!!!
It was a VERY GOOD week!!!!
References
Bass, B.M. (1985). Leadership and performance beyond expectations. NY: Free Press.
Bass, B.M. & Riggio, R.E. (2006) Transformational leadership. Mahwah, NJ: Erlbaum.
Burns, J.M. (1978). Leadership. NY: Harper & Row.
Ray, M. (2016, June). Theorist Panel: Elizabeth Barrett, Richard Cowling, John Phillips, Marilyn Ray, Marlaine Smith, and Jean Watson. The International Association for Human Caring and The Society of Rogerian Scholars Conference: Advancing Unitary and Caring Science for Nursing Praxis. Boston.
Feb 11, 2018Feb 11 at 3:27pm
Hello Professor and Classmates,
A theory is a notion or an idea that explains experience, interprets observation, describes relationships, and projects outcomes. Middle range theories are narrower in scope and offer an elective bridge between grand theories and the description and explanation of specific nursing phenomena (Parker & Smith, 2015). Kristi Swanson’s Theory of Caring can used by nurse managers to help with staff performance issues as well as new graduate orientation. Caring groups, during the orientation process, which provide the opportunity for new RNs to experience and learn to care for self and each other, may help to retain new graduates within an institution, thus saving costs. In addition, a smoother transition into nursing practice may help to alleviate the large numbers of new nurses who leave the profession or change jobs and institutions within the first year (Wilson, Martin & Esposito, 2015). Swanson used to investigation to propose that caring consisted of five basic processes: knowing, being with, doing for, enabling, and maintaining belief. Swanson defined caring as a “nurturing way of relating to a valued ‘other’ toward whom one feels a personal sense of commitment and responsibility (Smith & Parker, 2015).
Although the five concepts stated by Swanson can be applied to patients, it can also be applied by nurse managers to their staff. The five concepts allow nurse managers to solidify a relationship with each staff member by making it seem personable. Knowing what each staff members struggle/and or strengths allows the nurse manager to have insight on what is needed to be improved or praised. Being with them to observe care or just talk about comfort levels with the floor/unit and job/skills confirms any thoughts of concerns that need to be addressed. Doing for could include alleviating stressful assignments by knowing weakness or providing task related to improvement. Enabling them, is to make sure staff member have the tools and instruction needed to be better in weaker areas and continue to excel in stronger areas. Lastly maintaining belief can be shown by continued performance reviews allowing praise for things done well and improved.
References
Parker, M. E., & Smith, M. C. (2010). Nursing theories and nursing practice (3rd ed.). Philadelphia, PA: F. A. Davis Company.
Wilson, C. B., Martin, K., & Esposito, J. (2015). Embracing the Difference Caring Makes: Implementing Caring Groups in a New Graduate Orientation Program. International Journal for Human Caring, 19(1), 27-32.