NR 501 Week 1 Discussion-Importance of Theory in Nursing

NR 501 Week 1 Discussion-Importance of Theory in Nursing

“Nursing theory is a set of concepts and principles that define the scientific basis of the nursing profession.” (Iskandarani, Al Hammadi, and Al Gizani, 2012, 115). It provides the knowledge and understanding needed to provide patients with evidence-based care. Theory provides organization to the practice and aids in developing critical thinking skills. The continuation of research helps to allow improvements to healthcare practice and patient outcomes. The evidenced-based practice would not be possible without it. Theory can help explain different events in nursing by explaining nursing concepts, clarifying relationships, and predicting specific outcomes. Many researchers use some theories as a basis for their research ideas to improve health outcomes. Florence Nightingale was one of the first nursing theorists. She created the foundation and provided her ideas on nursing care. Most of her work focused on establishing the meaning of nursing and deciphering what was needed within the practice to allow it to improve the patients’ health effectively. This paper will describe Imogene King’s middle-range theory of goal attainment. The following topics will be explored: the importance of nursing theory, a summary of the goal attainment theory, and the nursing theory’s application to nurse practitioners.

Importance of Nursing Theory

 Including theory in a master’s program is essential because it provides an understanding of the early development of principles and concepts that provide the basis of knowledge needed for any advanced practice career path. The Essentials of Master’s Education gives nine essential concepts that should be included in master’s education. The first eight essentials all include some theory as a sample of content that can be included in education to meet the standards of that essential. One example is Essential I, which involves a background in practice in science and humanities. One of the sample content examples listed under this category was theories in bioethics cha,  OS theory, and complexity science. (AACN, 2011). Iskandarani, Al Hammadi, and Al Gizani (2012) explained that “Nursing theories enhance students’ understanding of the principles, values, and meanings of the nursing profession.” (Iskandarani, Al Hammadi, & Al Gizani, 2012, p115).

NR 501 Week 1 Discussion-Importance of Theory in Nursing

Theories are helpful in nursing because they provide essential knowledge and help nurses understand their role in healthcare. “It also supports nurses in caring for clients holistically in assessing, planning, and implementing professionally.” (Iskandarani, Al Hammadi, and Al Gizani, 2012, p 116). Nursing theory helps to explain why nurses do what they do. It provides structure to the practice and clarification on treatment and possible outcomes and guides research. Nursing theories can help separate nursing from other professions because nursing focuses mainly on care and outcomes. Since nurses primarily create the theories, the content will mainly focus on concepts pertaining to nursing. Other health professions have theories that focus on the patient but may not consider holistic views on patient care or outcomes. One example is to compare them to medical theories aiming to diagnose and treat the patient; nursing theories aim more at caring for the patient and assisting them with improving their health outcome. One concern with implementing theory into nursing practice is how frequently theories are modified. The healthcare profession changes frequently. New research is always added, so the theories accepted into practice may need to be modified periodically to reflect new research and evidence to base practice on. If there is no modification of theories, nurses risk not practicing effectively enough to provide quality care based on current evidence from research.

Summary of the Goal Attainment Theory

“Dr. Imogene King developed King’s theory of goal attainment in 1981 to describe the interpersonal relationship systems in which a person develops and grows to accomplish personal life goals.” (Schubs, 2016). It is classified as a middle-range theory and was developed based on her conceptual model, which contained three interacting systems: personal, interpersonal, and social. (Goal Attainment, 2016). The concepts included in the personal system are perception, self, growth and development, body image, space, and time. (“Goal Attainment”, 2016). The interpersonal system covers the concepts of interaction, communication, transaction, role, and stress. (“Goal Attainment”, 2016). The social system concepts are organization, authority, power, status, and decision-making. (“Goal Attainment”), 2016). It concludes that goal setting between the patient and the nurse will be based on the assessment performed by the nurse, how effective the communication is between the two, and the patient’s functional status. “King also focuses her theory on the nursing process and the steps that include assessment, diagnosis, planning, implementation, and evaluation.” (Caceres, 2015, p. 153). These steps allow the nurse to formulate a plan, establish a goal, evaluate the outcome, and revise the goal if needed. I selected this theory because it supports the patient’s involvement in planning their care.

This theory should be utilized in the nurse practitioner field because it provides knowledge on achieving a healthcare goal involving the patient’s input. This is very important in planning care for a patient because you want to set realistic goals for care, and involving the patient helps them feel like they have some control and are working with the practitioner as a team. It also gives ideas of different things to assess when treating the patient, which is essential for a more holistic approach towards care. Improved health outcome is the goal of care, and following the concepts in this theory will help practitioners achieve that goal. King’s theory defined the four meta paradigms are described in this manner. Health is a dynamic life experience of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living. (“Goal Attainment”, 2016). Nursing is a process of action, reaction, and interaction whereby nurses and clients share information about their perceptions of the nursing situation. The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal. (“Goal Attainment”, 2016). Individuals are social beings who are rational and conscious. Persons exhibit common characteristics such as the ability to perceive, think, feel, choose between alternative courses of action, set goals, select the means to achieve goals, and make decisions. (“Goal Attainment”, 2016). The environment is the background for human interaction that includes internal and external. The internal environment transforms energy to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal organizations. In this model, the nurse is part of the patient’s environment. (“Goal Attainment”, 2016).

NR 501 Week 1 Discussion-Importance of Theory in Nursing

Application of the Goal Attainment Theory to Nurse Practitioner

 Using theories to guide and structure the care they provide is essential. “King’s theory focuses on the major concept of transaction that describes the transfer of values, aspirations and wants between the nurse and the patient.” (de Leon-Damare, MacDonald, Gregory, Katz, & Halas, 2015, 632). The concepts outlined in this theory would help guide the structure of patient interaction to achieve a desired goal for the patient and the practitioner. Sangster-Gormley, Frisch, & Schriber (2013) believe that the “Use of mid-level theories can provide patient-centered outcomes that are sensitive to NP practice, potentially altering the dominance of provider-centered discourses around evaluation.” (Sangster-Gormley, Frisch, & Schriber, 2013, 1.657). In the longitudinal study conducted by de Leon-Damare et al. (2015), NP encounters with patients were taped over three sessions and then coded using the concepts in the theory of goal attainment. (de Leon-Damare et al, 2015, p. 631). The purpose of the study was to describe the interactions of patients and NPs in a primary care setting to further the understanding of these interactions using the theory. (de Leon-Damare et al, 2015, p. 631). Their results proved consistent with concepts presented in King’s theory regarding transactions and their positive relation to reaching a mutual goal with the patient. They concluded that the theory exemplifies respect for patients and emphasizes information exchange, goal setting, and patient-centered care. (de Leon-Damare et al, 2015, p. 635). Another example is an encounter I experience in the workplace daily. On the skilled/rehab unit, an NP works on the floor regularly and does rounds on patients during the week. At discharge, she talks to the patient about going home and discusses what will be required to manage their condition at home. The patient is allowed to present any obstacles that may get in the way of being able to maintain at home. Examples of these may include the need for oxygen at home, lack of wheelchair accessibility, or lack of income to purchase medications. Once the issues are identified, the NP consults with the social worker, doctor, and other team members to explore resource options to help the patient return home. Using the patient’s input to structure the discharge increases the possibility of success for the patient upon leaving the hospital. This process of including the patient in the planning of care to achieve the mutual goal of the patient returning home represents some of the concepts outlined in this theory.

Conclusion

 In conclusion, theory is essential to the nursing profession. It provides the structure and knowledge base to guide our practice. Without it, there would be no way to justify care practices or predict care outcomes. The theory of goal attainment outlines the steps necessary in a patient encounter to achieve an obtainable goal in their healthcare. It addresses all four paradigms according to the theory and focuses on the nurse and patient interactions. This theory can be applied to the nurse practitioner role because patient encounters are a significant part of how the practitioner provides care. Utilizing the concepts presented in this theory will help the NP establish a rapport with the patient and create a reachable goal that will help improve the patient’s health outcome. I learned from this assignment that theory is necessary for the nursing profession for several reasons. The most important thing is that it provides the structure for the nursing practice. I learned about many theories developed over the years and how relevant they are to practice today. I couldn’t imagine my job and how it would be without structure. I also gained a better understanding of the role of the NP. The focus of my assessments will be different in my new role, so using the concepts outlined in this theory will help me structure the focus of my assessment to achieve the desired outcome for the patient and me. I will use all the things I learned to guide my practice and provide quality care to improve health outcomes.

References

American Associations of Colleges of Nursing (2011). The essentials of master’s education in nursing. They were retrieved from http://www.aacn.nche.edu/education- resources/MastersEssentials11.pdf.

Caceres B. (2015). King’s theory of goal attainment: Exploring functional status. Nursing Science Quarterly, 28(2), 151–155. doi: 10.1177/0894318415571601

De Leon-Demare, K., MacDonald, J., Gregory, D. M., Katz, A., & Halas, G. (2015). Articulating nurse practitioner practice using King’s theory of goal attainment. Journal of The American Association of Nurse Practitioners, 27(11), 631-636. doi:10.1002/2327- 6924.12218

Goal Attainment (2016). Retrieved from http://www.nursing-theory.org/theories-and- models/king-theory-of-goal-attainment.php

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

Sangster-Gormley, E., Frisch, N., & Schreiber, R. (2013). Articulating new outcomes of nurse practitioner practice. Journal of The American Association of Nurse Practitioners, 25(12), 653.

Schub, T. B. (2016). King’s Theory of Goal Attainment. CINAHL Nursing Guide,

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NR 501 Week 1 Discussion-Importance of Theory in Nursing

For many students enrolled in NR501, this is an initial course for nursing theory. So, let’s have a debate. Is nursing theory critical to the nursing profession? If you believe that it is essential, explain why it is functional. If you do not believe it is valid, explain why nursing theory is unnecessary to the profession. Be sure to provide an example demonstrating your opinion and a scholarly reference (not using the required textbook or lesson) supporting your opinion.