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NR 510 Week 2 Discussion 2
Karen is still not convinced that Theory has any place in APN practice. Provide a specific example of how theory is relevant to APN practice in one of the four specialties (CNM, CNP, CRNA or CNS). Provide evidence to support your arguments.
As a future CNP, Karen will establish relationships with patients and colleagues. She is a primary care provider who will deal with patients of all ages. Karen will be trained to individually assess health problems and risk factors and to develop treatment plans. She may decide to collaborate with other health providers and colleagues to identify patients’ health problems and implement the appropriate interventions. Karen’s overall goal is to improve the health of the individual and family. To foster a strong relationship between herself, her patients, and other healthcare providers on her patients’ healthcare teams, Karen must master the art of interpersonal communication. This is the process that allows people to exchange information and feelings through verbal and non-verbal messages (Lee & Doran, 2017). Interpersonal communication is face-to-face communication that determines how well patients and CNPs understand each other and work together to reach health goals (Lee & Doran, 2017).
Psychiatric nursing pioneer, Hildegard Peplau’s Theory of Interpersonal Relations model points out four sequential phases, the primary areas of communication essential to the nurse/patient relationship: orientation, identification, exploitation, and resolution (Nursingtheory.org, 2016). These frameworks help nurses understand their behavior in relation to listening to patients describe their health problems and working with other health providers. Peplau describes nursing as a “therapeutic, healing art” that becomes an interpersonal process because of the interaction between the NP, patient, and other healthcare providers (Arora, 2015). Interpersonal communication guides the way NPs create treatment plans and set health goals for patients and their families. Positive, open, and respectful interpersonal communication help the nurse and patient work together to become mature, knowledgeable partners in the care process (Arora, 2015).
In my experience, patients often feel nervous and anxious around medical personnel. Many patients become defensive, passive-aggressive, shy, or uncomfortable all because they do not want to be perceived as uneducated about their health or the diagnosis/treatment information being relayed. Patients feel nurses and doctors talk at them instead of with them. I have heard patients complain that nurses are rude just because the patient did not understand what the nurse said about a diagnosis or treatment. Karen can use Peplau’s theory to engage in better ways to communicate with patients and help them feel valued. Undergraduate nursing school taught me best practices in creating a solid patient-nurse relationship. In Peplau’s model, this begins with the orientation stage. First, I should introduce myself to the patient then state my credentials and the role I will play. I should ask the patient his or her preferred name. I want to relieve the patient’s anxiety, so I ask the patient if there are any recent health changes he or she would like to discuss with me. I want to normalize the situation, so I may even ask about family life, hobbies, talk about the news, etc. There are so many ways for me to help the patient feel comfortable talking to me. The point is to let the patient know through verbal and non-verbal communication that I am here to help.
Arora, S. (2015). Integration of nursing theories in practice. International Journal of Nursing Science Practice and Research, 1(1), 8-12. Retrieved from https://www.researchgate.net/publication/283319003_Integration_of_Nursing_Theories_in_Practice
Lee, C. T., & Doran, D. M. (2017). The role of interpersonal relations in healthcare team communication and patient safety: A proposed model of interpersonal process in teamwork. Canadian Journal of Nursing Research, 49(2), 75-93. Retrieved from https://doi.org/10.1177/0844562117699349
Nursingtheory.org. (2016). Hildegard Peplau Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/peplau-theory-of-interpersonal-relations.php
Most theories revolve around one concept, caring. Whether it is through empathy, staff empowerment, compassion, or education the MSN always relies on a theory of some sort to provide the appropriate care. It takes a proper understanding of nursing theory to know how to apply theories to improving patient care outcomes. Your example of Peplau’s theory shows a great understanding of this concept.
I truly believe the concept of care or caregiving is central to the role of the FNP. I agree with your point that nursing theories provide a foundation for nurses to refer to in regard to improving patient outcomes and carrying out treatment plans. Care and compassion go hand-in-hand. Nurses are obligated and have a duty of care to apply these elements when serving patient populations, but nurses should also remember to apply the concepts of care and compassion to themselves. I sometimes feel nurses are expected to be perfect, which is unrealistic. Brandford and Reed (2016) state nurses suffer from depression more than other professionals due to job stress. There is a shortage of nurses because they do not feel valued or respected. When nurses continue to work through their depression caused by a lack of compassion and empathy from patients, colleagues, and other medical professionals, nurses make mistakes due to trouble concentrating (Brandford & Reed, 2016). Nurses then begin to show less compassion to patients and colleagues. It is also important for nurses to receive emotional and professional support.
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Brandford, A. A. (2016). Depression in registered nurses: A state of the science. Workplace Health and Safety, 64(10), 488-511. Retrieved from https://doi.org/10.1177/2165079916653415
So true! Nurses definitely need support. When I started looking for a job as an NP, I really looked at how much the supervising MD supported the providers. I wanted to make sure I had his support and he would have my back.
Great choice of theory. In my experience as a nurse, effective communication is the most important thing to patient care and collaboration with all the staff involved in a patients care. A simple greet of the day and calling them by their last name in the first introduction usually establishes a rapport. After a rapport is established, we can begin to ask patients what they prefer to be called. I always take advantage of the first introduction to establish a rapport. If patients feel uncomfortable, asking them how they are feeling is a very simple way to give them the opportunity to open up to you. If they remain uncomfortable, I let them know to call me if there is anything they need. And when they call for something, I ensure I accomplish it. Doing this almost always reduces anxiety and creates a strong rapport between me and my patient and family members.
Theory in communications will help us improve holistic care. Far too often, I have patients coming into the hospital with inadequate information after leaving a doctor’s office, which boggles my mind. This is also common in the hospital setting, where doctors leave the patients room and they don’t have a clue what the doctor said to them in regards to medications and treatment plans. This just tells me that, holistic care is not being taught because acute care continues to dominate health care. I hope that one day, holistic care dominate health care and health care education.
I think that Karen hasn’t opened her mind to what nursing theories can do and have done for us as nurses. There are so many that have brought us to be the nurses that we are today. I honestly didn’t think they were that important, until taking the theories course a few months ago. I had taken multiple theory classes before this. I just never had thought deep enough about their importance.
I like to describe Katharine Kolcaba’s comfort theory when discussing nursing theories. I especially like this theory because it describes holistic care to patients. The patient can be an individual, a family, a community, or institutions who are in need of healthcare (Lima, Guedes, Silva, Freitas, & Fialho, 2017). This will be especially true for CNS, as we will be treating not only a certain patient. Education always involves more than that patient. Family is generally involved. Community prevention is also extremely important such as childhood obesity or mental health education. The numbers of those suffering from these two particular diagnosis are on the rise, and education to the community may be helpful in the prevention of them.
Kolcaba also describes the different types of comfort that can be utilized. The human needs are addressed as relief, ease, and transcendence (Merkel, 2007). Most patients that present will have some form of pain. One way of providing comfort is to decrease the amount of pain that the patient is experiencing. Pain can be acute or chronic, in which cases the pain may not be completely relieved, but if the patient can get back to doing their everyday life activities, then they have been treated appropriately. Different types of pain relief could be non medicinal, such as a warm blanket or a hand to hold. Sometimes these patients need something simple like that, but it means more to them than we think. As a CNS, providing comfort to patients is the key to a successful diagnosis.
Lima, J., Guedes, M., Silva, L., Freitas, M., Fialho, A. (2017). Usefulness of the comfort theory in the clinical nursing care of new mothers: critical analysis. Scientific Electronic Library Online, 37(4). doi:
Merkel, S. (2007). Comfort theory: A framework for pain management nursing practice. Retrieved from www.aspmn.org (Links to an external site.)
As MSNs we are expected to take a more holistic approach than other medical providers. Do you think other specialties apply nursing theory as well to use a more holistic approach than a biomedical approach?
I believe that different medical professionals use different types of approaches. I honestly believe that anybody with nursing backgrounds use a more holistic approach. Few physicians that I have worked with seem to use a holistic approach. Through different research and courses, I have found that holistic care dates back to Florence Nightingale times, which isn’t generally taught to those that don’t take nursing courses. I think it is important for all providers to remember that physical care isn’t all that patients need. Emotional, spiritual, and mental health is also very important when treating and diagnosing patients. The patient may be physically being treated, but unless they are mentally prepared for the treatment course, such as cancer, then the patient isn’t getting the total continuum of cares that they need.
Technically, as providers, we also need to be using holistic care to care for ourselves. There have been instances in the ER when I leave after a day of work, that my legs ache, and I break down into tears because I am emotionally drained. We need to be sure to use holistic cares for ourselves, not only the patients.