NR-501 Week 5 Discussion-Analysis and Application of a Nursing Theory

NR-501 Week 5 Discussion-Analysis and Application of a Nursing Theory

Applying Theory: Person-Centered Nursing Framework

Nursing models are used as frameworks to guide practice and build on the science of nursing. Nursing models are recommended to help nurses recognize the care’s impact. “Use of such structures helps foster autonomous decision making; professional identity; job satisfaction; high-quality, consistent nursing care; improved patient and family outcomes; and interdisciplinary communication” (Chamberlain et al., 2013, p. 16). This paper will analyze the Person-Centered Nursing Framework (PCN) and discuss how it can be applied to a Family Nurse Practitioner (FNP) role. An overview of the Framework will be discussed, followed by an appraisal of how this model qualifies as a theory to serve as a theoretical framework for nursing practice. An example of how the PCN Framework can be applied to the role of the FNP will be given to show how this model can guide practice. The conclusion will include a summary of the paper and self-reflection regarding what was learned.

Overview

 “Person-centeredness” has become a massive topic of discussion within the nursing field. Nursing has always been focused on care, but the concept of person-centered care is still evolving. This concept is better understood using the PCN Framework, which directs nursing and practice into a more holistic approach to patient care. The PCN Framework was developed by McCormack and McCance (2017). The concepts were derived from years of empirical research that focused on the idea of person-centered care within nursing practice and the experience caring has in nursing (McCance et al., 2011).

According to McCance et al. (2011), there are four core concepts within this nursing theory: being in relation, being in a social world, being in place, and being with self. The PCN Framework was created from these core concepts and comprises four constructs: prerequisite care environment, person-centered processes, and outcomes (McCance et al., 2011). Each construct addresses an idea within the nursing metaparadigm: nursing, environment, person, and health (Parker & Smith, 2015). Prerequisites (nursing) focus on the nurses and their attributes, such as professional competence and interpersonal skills. If nurses are not meeting the requirements of person-centered care, then there is no point in moving further into the Framework because it starts with nurses and their commitment to care. The care environment (environment) focuses on the setting in which consideration is given. It includes things like: “appropriate skill mix, systems that facilitate shared decision making, effective staff relationships, organizational systems that are supportive, the sharing of power, the potential for innovation and risk-taking, and the physical environment” (McCance et al., 2011, para 10). The person-centered processes can begin once the prerequisites and care environment have been met. In this step, nurses and staff work alongside patients with an engaged focus on their values and beliefs. Nurses are sympathetic and empathetic, focus on holistic care, and work to include patients in the decision-making for their care. If all these steps are met, then the outcomes (health), the central component of the Framework, come to light. The products are the positive health and care results of meeting all the other steps and are obtained by giving practical, person-centered care (McCance et al., 2011)

NR-501 Week 5 Discussion-Analysis and Application of a Nursing Theory

Appraisal

 According to Melnyk (1989), theory analysis is vital because “the power of a theory can be exposed, its limitations or “blinders” identified, and its power can then be used to expand our knowledge and understanding of the phenomena that characterize the nursing situation” (as cited in Theofanidis & Fountouki, 2008, p. 17). Walker and Avant (1983) determined that a theory must contain origins, meaning, logical adequacy, usefulness, generalizability, parsimony, and testability to be considered viable and beneficial within nursing practice (as cited in McEwen and Willis, 2014). The PCN Framework meets all the criteria to validate it as a theoretical framework for nursing practice. It was developed by McCormack and McCance (2017) and originated over the last decade based on previous empirical research that used older people and their experiences of caring as the original focus for the theory. It uses its four constructs to bring meaning to person-centered practice. Mccormack and McCance (2017) define person-centered practice as: …”  an approach to practice established through the formation and fostering of healthful relationships between all care providers, service users, and others significant to them in their lives” (p. 25). It has logical adequacy in a way that defines and promotes person-centered care and involves all associated with the caring process. It has influenced many other disciplines of practice, such as strategy, policy, and healthcare, on a broader spectrum. It is also the Framework of choice for leadership development and nursing education (McCormack and McCance, 2017). The Framework is being used globally, and McCormack and McCance (2017) state that their model has influenced nursing policy nationally and internationally. It has generalizability in such a way that allows it to be used in various settings and throughout all of nursing and its disciplines. McCormack and McCance (2017) state that using this Framework in numerous locations has allowed them to identify new research areas by refining the relationships between the concepts within the Framework. The PCN model possesses parsimony in that it is simple to understand, and the four constructs make it easy to apply. McCormack and McCance (2017) agree that the concept of person-centeredness depends on how it is implemented within the context of the situation. This model can be tested, and McCormack and McCance (2017) have developed several different instruments that can be used to test its effectiveness and have been proven as practical measuring tools.

Application to Advanced Practice Nursing

 This Framework can be used as a tool for FNPs to help promote an increased awareness of person-centered care within practice. McCormack and McCance (2017) state they have more recently started using a collection of patient stories to determine the outcomes of this model to test its usefulness within practice. This method is an example of how the model could guide the FNP to determine where there needs to be improvements within the practice setting. Asking patients questions that involve satisfaction with care, if they felt involved with respect, if they felt like they were safe, and if they felt like their care was given in an environment suitable for healing can help FNPs recognize critical areas that need to be addressed, which can assist them in identifying where barriers lie and where there needs to be an improvement. If each survey states that the nurses were incompetent, then the prerequisites of the Framework can be addressed and worked on. This can help the FNP improve practice, and these improvements will radiate to each person who is involved with patient care, ultimately giving patients a holistic, person-centered experience (McCance et al., 2011).

Conclusion

 The Person-Centered Nursing Framework has been analyzed and implemented all over the world. It meets the criteria to qualify it as a theoretical model, and data suggest that positive health outcomes result from its implantation in all aspects of nursing practice. Each relationship I build with my patients as an FNP will be unique. The PCN Framework can help me acknowledge that each caring relationship is, and should be, different if it is going to be person-centered. I have found this Framework very intriguing and helpful. I see the value in its concepts, and it helps me understand how I can achieve positive outcomes through person-centered care as an FNP.

References

Chamberlain, B., Bersick, E., Cole, D., Craig, J., Cummins, K., Duffy, M., . . . Skeahan, L. (2013). Evidence-based nursing practice models: A concept analysis. 16-18. Retrieved from http://www.njha.com/media/278946/NursingMgmt1013.pdf

McCance, T., McCormack, B., Dewing, J., (2011) “An exploration of person-centeredness in practice” OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 1. doi: 10.3912/OJIN.Vol16No02Man01

McCormack, B., & McCance, T. (2017). Person-centered practice in nursing and healthcare.

Theory and practice (2nd ed.). Oxford: Wiley Blackwell

McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Theofanidis, D., & Fountouki, A. (2008). A discussion on an ambiguous concept. International Journal of Caring Sciences 1(1), 15-20. Retrieved September 27, 2018, from http://internationaljournalofcaringsciences.org/docs/Vol1_Issue1_02_Theofanidis.pdf (Links to an external site.)Links to an external site.

Parker, M. E., & Smith, M. C. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F. A. Davis.

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NR-501 Week 5 Discussion-Analysis and Application of a Nursing Theory

Using the nursing theory you selected in the Week 4 Collaboration Cafe, consider how the following
components would be included in an analysis of that theory:

1. Origin of the theory
2. Meaning of the theory
3. Logical adequacy of the theory
4. The usefulness of the theory
5. Generalizability of the theory
6. Degree of parsimony within the theory
7. Testability of the theory

What rationale can you provide which validates the selected theory as a framework for nursing practice?
Be sure to include scholarly references to support your discussion.