Patient centered approaches to nursing

Theoretical Foundations For Nursing

GRAND THEORIST REPORT

Grand Theorist Report

Grand Canyon University: NUR 502

April 24, 2018

Grand Theorist Report

There are many grand nursing theories that have helped to set the foundation for the nursing profession. Faye Abdellah was one of the first pioneers for shaping nursing as a profession using her framework for Patient-Centered Approaches to Nursing. Abdellah’s theory is easy to apply to nursing practice in a healthcare institution because her framework is readable and clear (McEwen & Wills, 2014). In addition, another rationale for implementing her theory into practice at a healthcare institution is the fact that it clearly addresses the four metaparadigms—person, environment, health, and nursing. In this paper, we will discuss the theorist Faye Abdellah, her theory on Patient-Centered Approaches to Nursing, and how this theory can be integrated into practice at a healthcare institution.

Description of Theorist

Faye Abdellah was born in New York City on March 13, 1919. Abdellah decided at a very young age she wanted to pursue a career in nursing. She received her original certification in nursing from Fitkin Memorial Hospital. She continued her study of nursing at Columbia University getting her BA in Nursing along with her doctorate degree, which focused on psychology and education (Dewey, 2016).

Abdellah was highly influential in the profession of nursing. She was the Chief Nursing Officer and Deputy United States Surgeon General until 1993, and she was ranked as a Rear Admiral. She retired in 2000 from her last position as Dean of the Graduate School of Nursing at the Uniform Services University of Health Sciences (McEwen & Wills, 2014). As a whole, throughout her career Abdellah received many academic honors for her achievements in nursing. Her main focus was to reshape nursing as a profession by encouraging nurses to look past a physical illness or diagnosis and see “patients as people with a complex of emotional and psychological needs” (Dewey, 2016, n.p.). Clearly, this concept of looking at patients as more complex beings significantly helped to influence and shape her Patient-Centered Approaches to Nursing.

Category of Theory

Abdellah’s Patient Centered Approaches to Nursing is considered a grand nursing theory that is based on human needs. She believed that patients should be seen as ‘people’ who have individual unique needs that require personalized care from nurses. Furthermore, Abdellah developed her theory based on how she practiced while providing care to patients—which is what helps to make the theory highly applicable. McEwen & Wills (2014) further explain that Abdellah’s theory is applicable not only in the hospital setting, but also in the community setting.

Assumptions Underlying the Theory

Abdellah’s original theory did not have any stated assumptions; however, as time passed she did add the following six assumptions related to: 1) change and anticipated changes that impact the nursing profession, 2) the importance of how social enterprises and social problems are related, 3) how poverty, racism, pollution, education, etc. impact health and health care delivery, 4) changes in nursing education, 5) continuing education for nurses, and 6) development of nursing leaders (McEwen & Wills, 2014).

In addition, it is important to clearly define the metaparadigm concepts/assumptions underlying the theory as well. Abdellah’s Patient-Centered Approaches to Nursing is all encompassing, and the metaparadigms addressed in the theory are related to person, environment, health, and nursing.

Person

Person is defined as the patient needing care. McEwen & Wills (2014) explain that Abdellah’s theory views the patient as the “individual who needs nursing care and who is dependent on the health care provider” (p. 141). When using Patient-Centered Approaches to Nursing, it is important to know that Abdellah emphasized the significance of individualized care and knowing the person’s needs.

Environment

When using Abdellah’s theory, it is important to know that the environment from the patient’s standpoint is interconnected to include not only the physical environment, but also external factors that impact the patient such as social problems, poverty, racism, etc. These are all factors within the environment that affect the health of patients and how they approach health care delivery (McEwen & Wills, 2014).

Health

Health can be viewed as a better state of being. The purpose of Abdellah’s theory is to identify problems that are negatively impacting patients and eliminating these problems. Later we will discuss Abdellah’s 21 Nursing Problems and nursing’s responsibility to identify these problems.

Nursing

Nursing is considered “a service to individuals and families to society, which helps people cope with their health needs” (McEwen & Wills, 2014, p. 141). Nursing is expected to identify nursing problems and work collaboratively with the healthcare team to ensure that patients get desired outcomes.

Major Concepts of the Theory

The major concepts related to Abdellah’s theory involve using ten steps to identify and develop treatment to nursing problems related to patients. Abdellah explains that there are 21 basic nursing problems related to patients, and it is important for nurses to know these identified nursing problems so they can use them while trying to identify what needs to be the plan of care. Below is an abbreviated version of Abdellah’s 21 Nursing Problems.

Abdellah’s 21 Nursing Problems

Maintenance of Hygiene and Comfort

Recognition of physiological responses to conditions

Maintenance of Nutrition for Body Cells

Promotion of activity, exercise, rest, etc.

Maintenance of normal body functions

Achievement of spiritual goals

Promotion of Safety

Appropriate sensory function

Maintenance of Therapeutic Environment

Maintenance of Proper Body Mechanics

Identification and acceptance of positive and negative expressed and reacting appropriately

Awareness of physical, emotional, and developmental needs

Appropriate Oxygenation

Understand relationship between emotions and illness

Acceptance of optimal goals despite physical & emotional limitations

Appropriate Elimination

Maintenance of appropriate verbal and nonverbal communication

Willing to use community resources

Maintenance of Fluid & Electrolyte Balance

Development of positive interpersonal relationships

Recognition that social problems impact illness

(McEwen & Wills, 2014)

Clearly, it is very important to know the 21 Nursing Problems because these are the problems nurses must link to their findings while using the ten steps for identification and development of a nursing care plan. The ten steps build upon each other from learning about the basics of a patient, then getting more specific to identify the exact nursing problem(s) that need to be addressed. Below are the ten steps that nurses must follow to successfully develop a plan of care and reach expected patient outcomes.

Ten Nursing Skills to Identifying Problems & Developing a Treatment Plan

1. Get to know the patient

6. Validate conclusions with patient

2. Define relevant and irrelevant information

7. Observe and Evaluate Patient

3. Develop generalizations

8. Evaluate patient & family reaction to plan— incorporate family in care if possible

4. Identify a therapeutic nursing plan

9. Nursing’s perception of patient’s problems

5. Test generalizations and modify plan if needed

10. Discuss & develop a nursing care plan

(McEwen & Wills, 2014)

Understanding how to use the 21 Nursing Problems along with the Ten Nursing Skills is important for nurses to grasp in order to see the full potential of this nursing theory for patients. Each of the Ten Nursing Skills needs to be followed so nurses can individualize care plans and work collaboratively with the patient and family to improve the patient’s state of health.

Major Propositions

The major proposition of Abdellah’s theory focuses on looking at the patient as a human being, not an illness. While her theory touches on many factors, it primarily focuses on patient centered care (McEwen & Willis, 2014). Due to its broad nature, it is testable in principle such as patient satisfaction and nursing care.

How has it been used?

In the past, Abdellah’s theory has been used in nursing education and nursing research. In nursing education, her theory has been used to organize lectures and curricula by categorizing nursing problems based on the patient’s needs and developing a classification of nursing skills and treatment (McEwen & Willis, 2014). Abdellah’s nursing theory has also been used in research such as patient-centered approach to nursing, evolution of nursing, perspectives on nursing theory, public policy impacting on nursing care of older adults, and preparing nursing research for the 21st century to name a few (McEwen & Willis, 2014).

Action Plan

It would behoove this institution to adopt Abdellah’s theory as a foundation of practice. The following action plan could be used as daily practice for all nurses to not only hone their critical thinking skills, but to also give more person centered care (PCC). PCC is important and has been a focus for many healthcare institutions for years. In 1969, Edith Balint described person centered care as “understanding the patient as a unique human being” (Santana et al., 2017, p. 430). Many healthcare systems are adopting a PCC to help gauge high quality care.

This action plan would focus around the Person-Centered Nursing (PCN) Framework developed by McCormack and McCance. The PCN Framework comes from research focusing on PCC with older people and the experience of caring in nursing (McCance, McCormack, & Dewing, 2011). The PCN Framework is comprised of four steps.

The first is prerequisites, which focuses on the professional competence of the nurse and his or her commitment to their job. The nurse needs to be able to demonstrate their beliefs and values and know himself or herself before they can move on. The second step is the care environment. This includes if the nurse and the service line are an appropriate fit, making sure the nurse is equipped with the skills and the knowledge to take care of patients. It is important that the heath care system is organized and can offer a supportive system for its employees so that they can safely deliver patient care and have effective relationships with one another. Third is person-centered process, which can be thought of as one of the most important steps. This step includes care that is focused on cultural competence, employee and patient engagement, staff being present, and providing holistic care. The fourth and final step is outcomes. This is known as the central component of the PCN Framework and where we can tie it all together. This includes patient and nurse satisfaction, feeling of well being, and obtaining a therapeutic work environment (McCance et al., 2011).

Integration

A PCC Team would need to come together to develop current data within their hospital. Data would include patient satisfaction scores, nurse satisfaction scores, readmission rates, and a basis of patient-centered care knowledge among nurses by developing a questionnaire for them to fill out. The PCC Team would them form a class for all currently employed nurses with an in depth explanation of the PCN Framework and what each step includes. Role-playing and case studies could be used in order to help staff put PCC into play in a practice setting. This portion would be integral to the roll out of PCC because it helps nurses to see the importance of person-centered care within their own healthcare setting and would help them to deliver higher quality care (McCance et al., 2011). Once staff is completely trained, leaders will be able to put the PCN Framework into action. According to McCance et al., “using the Framework ‘in action’ within the workplace as a tool to evaluate care during handovers or during analysis of critical events, both positive or negative; and using the Framework to assess the experience of patients being cared for in each site” (para. 17) we can evaluate the outcomes listed previously: patient satisfaction scores, nurse satisfaction scores, and readmission rates. It would be important to reevaluate the nurses after one year with the same questionnaire that was handed out at the beginning of the PCN Framework roll out. The PCC Team would be able to assess their effectiveness in delivering the information and the data from the satisfaction scores and readmission rates would give them the ability to verify how well the PCN Framework works.

After data is collected, the PCC Team would move forward in presenting the information to all new hire nurses and developing a curriculum for preceptors to be able to teach the PCN Framework and to help to develop new nurses within it. It would be important to continue with the PCC knowledge questionnaire so the PCC Team can continue to evaluate the efficiency of their team. After one year of new hire education, the team will then collect satisfaction scores and readmission rates to submit to the Board of Directors for the healthcare institution so that the PCN Framework can be presented as a standard of practice in all hospitals within the healthcare institution.

In conclusion, health care costs are rising at an exponential level and due to this rise; patients and their insurance companies are expecting higher-grade care. Nursing as profession needs to move towards a more patient centered approach. Without this approach, nursing is just assumed to be medicine and patients will continue to feel that they have no place in their care team. Currently, patients are being told what medications they should take, when they should take it, and who will be overseeing their care. In order to reduce readmission rates and subsequently cut costs, patients need to have ample say in their treatment plan and should be able to have open conversations with their caregivers about how they feel about their illness and their plan of care. If they feel their nurses are competent in their skills and that they truly care about their wellbeing, patients will feel safer and more willing to speak up when they do not understand something and will trust in their care plan to continue it after discharge, thus reducing their risk of readmission.

References

Dewey, J. P. (2016). Faye Abdellah. Salem Press Biographical Encyclopedia. Retrieved from

http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=4&sid=b8238afd-f12d-4800-89ca-ff4e2c58d36d%40sessionmgr101&bdata=JnNpdGU9ZWRzL

WxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=113931050&db=ers

McCance, T., McCormack, B., & Dewing, J. (2011, May 2). An exploration of person-centeredness in practice. The Online Journal of Issues in Nursing, 16. http://dx.doi.org/10.3912/OJIN.Vol16No02Man01

McEwen, M., & Willis, E. M. (2014). Theoretical Basis for Nursing (4 ed.). Philadelphia: Lippincott Williams & Wilkins.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2017, September 30). How to practice person-centred care: A conceptual framework. Health Expectations, 429-440. http://dx.doi.org/http://dx.doi.org.lopes.idm.oclc.org/10.1111/hex.12640