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 a 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 a 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.
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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Theoretical and Scientific Foundations of Nursing
OBSERVATION OF EVIDENCE-BASED PRACTICE
This is a graded discussion: 60 points possible
As a DNP, you will have a significant voice in your healthcare setting to advocate for evidence-based nursing practice. Understanding how evidence can inform better nursing care and patient outcomes is fundamental to successful advocacy, as are examples of where, why, and how evidence-based practice is needed.
For this activity, you will essentially observe for evidence to support evidence-based practice. You will write and post a blog in which you identify examples of evidence-based practice in your healthcare organization and/or examples of the need for the application of evidence-based practice. Although the blog functions like a Discussion Board, the aim is to be somewhat more informal in sharing your perspectives. Colleagues will respond to your blog as you will respond to theirs.
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