Importance of nursing theories as a basis for practice

Application of Nursing Theory

The profession of nursing would not be the same today without the development of nursing theories. Nursing theories were established to guide nurses in their daily practice and have a foundation to provide structure and organization to the nursing profession (Iskandarani, Al Hammadi, & Al Gizani, 2012). Nursing is a profession of caring and giving; it is also a profession of academic discipline and clinical practice. Nurses should be compassionate and empathetic towards patients and ones they are caring for by applying evidenced based judgment and skills. In nursing, metaparadigms are ways to describe the concepts that define the discipline of the nursing profession. They are comprised of four concepts: person, environment, health, and nursing profession. Person refers to the patient or the patient’s family members. Environment refers to external, internal, and social factors by which the patient is affected. Health signifies the patient’s intellectual, emotional, and spiritual wellness and is subjective based on the individual. The last concept in the metaparadigm is nursing (Metaparadigm Concepts, 2016). Nurses are caregivers and have a great impact on a person’s health. These four concepts are important in nursing theory and should be incorporated into nursing practice.

Nursing Need Theory

Among many grand theorists, Virginia Henderson was renowned for developing the Nursing Need Theory. She is well known for her definition of nursing, in which she defined as “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would preform unaided if he had the necessary strength, will or knowledge” (Ahtisham & Jacoline, 2015). Her theory emphasized the importance of basic human needs and individualized care to increase patient independence to promote recovery after hospitalization. Her model also emphasized on how nurses can aid in meeting patients basic human needs though nursing practice (Ahtisham & Jacoline, 2015).

This paper will discuss Virginia Henderson’s theory and its application in nursing practice. A selected issue or concern will be presented and then applied to Virginia Henderson’s Theory using one strategy in resolving the issue or concern. In this case, the issue or concern being early ambulation and mobilization after one undergoes surgery. Henderson’s theory will then be applied to this issue or concern and its application in nursing practice. This paper will then conclude with a self-reflection of the new knowledge this writer has gained about applying a nursing theory to a professional issue or concern.

Description of Issue/Concern

Patients with preexisting comorbidities are more prone to falling resulting in injury, hospitalization, and even death. A patient’s function and quality of life may even deteriorate causing health complications. One issue or concern is the effect of early rehabilitation and early ambulation after one undergoes surgery. When thinking about the recovery process, bed rest was once thought to be an important factor when it comes to healing and recovering. Pulmonary embolisms (PE), deep vein thrombosis (DVT), and pneumonia are commonly fatal complications that can occur after surgery and can prolong recovery time in hospitals. Therefore, DVT prophylaxis is needed for prevention of blood clots and other health complications while in the hospital. Thrombo-embolic deterrent (TED) hose, intermittent sequential compression devices, and pharmacological methods are examples to prevent DVT’s. Although they are commonly used preventative measures in hospitals, early ambulation and mobilization are non-pharmacological examples and are the most important prophylaxis for DVT (Ishibe & Kariya, 2011).

Although surgical patients may be in severe pain after surgery, experience some weakness, and are often afraid to move due to increased pain, early ambulation and mobilization enables patients to become independent, prevent functional decline, and avoid hospital-associated health complications. According to Pashikanti and Von Ah (2012), early mobilization improves patient outcomes associated with DVT, reduces hospital stay, and improves functional status for older patients and patients recovering from surgery. The older population is affected the most by this issue. Most of the elderly today already experience generalized weakness due to age and inactivity making recovery more difficult for elderly patients post surgery.

In the nursing profession, nurses should make it a priority to encourage postoperative patients to ambulate and start doing for themselves. Nurses should assist patients in early progressive mobility after assessing and evaluating the patient to make sure the patient is safe when ambulating for the first time. Upon discharge, patients should also be evaluated for rehabilitation and patient needs, such as physical therapy and occupational therapy. As long as the patient is in the hospital, nurses should encourage patients to increase physical activity and be as independent as possible.

Application of Theory to Issue/Concern

Virginia Henderson’s theory can be implemented to resolve the concern described above. Henderson focused on the patient as an individual and the relationship between the patient and the nurse, rather than focusing on a task being preformed. Henderson proposed fourteen components of basic needs that are implemented into nursing. Breathe normally, eat and drink adequately, eliminate body waste, maintain postures, sleep and rest, dress and undress, maintain normal body temperature, keep well groomed, avoid dangers, communicate, worship, work for accomplishment, play, and learn (Ahtisham & Jacoline, 2015). The four metaparadigms are addressed in her theory as well; being conscious of the patient as an individual, the environment, the health of the patient, and providing as a nurse for the care needed. Her description of a nurse included doing for the patient, helping the patient, and working with the patient to overcome an obstacle and accomplish doing for him or herself. Nurses who abide by these roles assist with patient independence (Ahtisham & Jacoline, 2015).

A strategy used to resolve the concern of early rehabilitation and early ambulation post surgery would be the implementation of in-hospital mobility programs. A study was conducted that resulted with evidence of positive outcomes of in-hospital mobility during hospitalization. Participants were assessed at their baseline, on admission, and two week after discharge, based on their mobility, function, and comorbidities. During the trial, patients were assisted in sitting, standing, and ambulating, focusing on their strength and ability to function on their own. Patients were encouraged to walk and attempt to preform activities of daily living (ADL) while in the hospital. Goals were also set for patients to preform in out of bed activities (Brown et al., 2016).

Henderson’s theory can resolve the issue of early ambulation and mobilization by developing multidisciplinary mobility teams in healthcare facilities. Utilizing mobility programs in hospitals are very beneficial for patients and can aid in the recovery process after surgery. Also, these programs will decrease secondary health complications, the length of hospitalization, and promote positive patient outcomes (Saunders, 2015).

Conclusion

In conclusion, nursing theories are applied to the nursing profession on a daily basis. Nursing theories were developed to provide a framework to guide the practice of nursing to improve patient care, patient outcomes, and nurse-patient communication. This paper discussed Virginia Henderson’s theory and its application in nursing practice. The concern for mobilization and early ambulation post surgery was applied to Virginia Henderson’s Theory using one strategy to resolve the concern. Her theory stressed the importance of patient independence, individuality, and promotion of health. An example of her theory and its application would be comparing the human body to a racecar. The car needs to be prepared for race day by getting the engine checked, changing the oil, and making sure that the car is running properly without any malfunctions. The car races on the track, training and practicing its course days prior to the race. During the race, the car may experience glitches that need to be checked and fixed. Once the car passes inspection, the car is ready to continue the race. The human body is the same. An injury occurs, surgery takes place, and then it is recovery to the finish line.

Learning about the grand theorist Victoria Henderson and her theory, made it more understandable and easier to be able apply her model in practice. This writer works at a hospital where a mobility program is established. A mobility aide works 8am-5pm Monday through Friday assisting patients with ambulation two or three times throughout the day. This I believe incorporates Henderson’s theory into daily nursing practice for patients to become as independent as possible and be able to preform ADL once again after surgery.

Reference

Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and Process into Practice; Virginia's Henderson Need Theory. International Journal Of Caring Sciences, 8(2), 443- 450.

Brown, C. J., Foley, K. T., Lowman Jr, J. D., MacLennan, P. A., Razjouyan, J., Najafi, B., & ... Lowman, J. J. (2016). Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients: A Randomized Clinical Trial. JAMA Internal Medicine, 176(7), 921. doi:10.1001/jamainternmed.2016.1870

Ishibe, M., & Kariya, S. (2011). Deep venous thrombosis after mini-posterior total hip arthroplasty in Japanese patients. Hip International, 21(6), 684-687. doi:10.5301/HIP.2011.8825

Iskandarani, L. S., Al Hammadi, A. M., & Al Gizani, R. A. (2012). Importance of nursing theories as a basis for practice. Journal Of King Abdulaziz University: Medical Sciences, 19(1), 115-123. doi:10.4197/Med.19-1S.8

Metaparadigm Concepts. (2016). Retrieved April 2, 2017, from http://nursing.tcnj.edu/about/mission-and-philosophy/meta-concepts/

Pashikanti L, & Von Ah, D., (2012). Impact of early mobilization protocol on the medical- surgical inpatient population: an integrated review of literature. Clin Nurse Spec 26(2), 87-94. doi: 10.1097/NUR.0b013e31824590e6.

Saunders, C. B. (2015). Preventing Secondary Complications in Trauma Patients With Implementation of Multidisciplinary Mobilization Team. Journal Of Trauma Nursing, 22(3), 170-175. doi:10.1097/JTN.0000000000000127