Theoretical And Scientific Foundations Of Nursing
Introduction/ Practice issue
There exist various nursing issues in my Practice, but the one that stands out the most is end-of-life decision-making, which requires the healthcare workers, patients, and families to decide about treatment plans that will benefit the patient. End-of-life decision-making is a varied contextual phenomenon that is highly influenced by subjectivity (Murali, 2020). As healthcare providers, our mission is to care for our patients to the point of recovery, but we sometimes find ourselves in positions where the patient dies. Working in a step-down unit, we have patients on ventilation, some with tracheostomy, tube feeding, chest tubes, and many other high-risk cases, and depending on their prognosis, a meeting is held for the patient, family members, and nurses responsible for their care to revisit their care plan and make decision as to their current state and it becomes challenging when we are not on the same page about the next step to their care.
Middle Range Theories
Middle-range theories provide a better basis for generating testable hypotheses and addressing client populations, and they provide a middle reality view and, more specifically, generalized practice areas for nurses (McEwen & Wills, 2019). Two middle-range theories that are most valuable in addressing end-of-life decision-making are Watson’s theory of human caring and Kolcaba’s theory of Comfort. With end-of-life decisions, healthcare workers focus on providing Comfort, especially with hospice patients, and being there for the patients to give medications and assist them with their daily activities is a way of human caring, as Watson identifies in his theory.
Kolcaba’s theory of Comfort aligns with end-of-life decision-making because optimal end-of-life care begins with an honest discussion of disease progression and prognosis. By coordinating the care with the family and a hospice program, terminally ill patients can achieve relief of pain and other unwanted symptoms, leading to a good quality of life during their remaining days (Lee D, 2002). It is important for healthcare providers to respect the patient’s decision in relation to their care and be focused on providing Comfort with medications, food, drinks, repositioning, and other factors that may influence Comfort. Helping them with their daily activities like showers, dressing, and feeding are forms of Watson’s theory of human caring. It is important to respect patient decisions and give them the opportunity to decide for themselves if they can.
References
Lee D. H. (2002). Approach to end-of-life care. The Ochsner journal, 4(2), 98–103. McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
Chapter 10, “Introduction to Middle Range Nursing Theories” (pp. 207–222) [PDF] Theoretical Basis for Nursing, 5th Edition by McEwen, M.; Wills, E. Copyright 2019 by Wolters Kluwer. Reprinted by permission of Wolters Kluwer via the Copyright Clearance Center. Licensed in 2020.
Murali K. P. (2020). End of Life Decision-Making: Watson’s Theory of Human Caring. Nursing Science Quarterly, 33(1), 73–78. https://doi.org/10.1177/0894318419881807
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Question 
NURS – 8114C
Theoretical and Scientific Foundations of Nursing
EXPLORING EBP QUALITY IMPROVEMENT
Continue working on your Module 3 Assignment to complete this week. Keep in mind that the key requirements are to identify a hypothetical practice problem as the focus of an evidence-based quality improvement project, a hypothetical healthcare setting for the project based on investigating actual sites, stakeholders for project approval and implementation within healthcare settings; and a presentation outlining the basic steps of a specific framework/model for translating research and evidence to improved practice.
Theoretical And Scientific Foundations Of Nursing
Although “hypothetical” is the watchword for this Assignment, the substantial effort you have invested and the information and insights obtained can pay real dividends as you begin your DNP project in earnest.
THE ASSIGNMENT
Part 1: Key Project Elements
Complete your paper of 6–8 pages, plus a cover page and references page, explaining your investigation of three hypothetical practice sites for an EBP QI project.
Part 2: Implementation Science Presentation
Complete your PowerPoint presentation of 3–5 slides, plus cover and reference slides, to inform hypothetical stakeholders.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.