Theoretical Basis for Practice: Health Literacy in Heart Failure Patients

Health literacy (HL) is a critical determinant of health outcomes, particularly for patients managing chronic conditions such as heart failure (HF). In essence, health literacy is the capability of an individual to assess, understand, and utilize health-related information in order to manage their condition effectively. Concerning patients with heart failure, low health literacy results in an inability to care for oneself, lack of proper disease management and medication compliance, and increased hospitalizations: Theoretical Basis for Practice: Health Literacy in Heart Failure Patients.

This problem, however, has not been eradicated with the progress in the medical field. This paper explores the impact of health literacy on HF patients and discusses how nursing theories—specifically Orem’s Self-Care Deficit Theory and Pender’s Health Promotion Model—can guide interventions to improve patient education and self-management. Furthermore, this paper incorporates complexity science to explain the concept of health literacy as a complex adaptive system that functions through the actions of several agents and explores which of these frameworks may be utilized to address HL in HF patients to improve health outcomes, including self-management and lower hospitalization rates.

Nursing Metaparadigm: Relationship to POI

Description of the Nursing Metaparadigm and Its Origin

The nursing metaparadigm comprises four essential concepts: person, environment, health, and nursing. The metaparadigm of nursing was developed from the works of Florence Nightingale, who focused on the patient-environment relationship. Purisima et al. (2024) subsequently elaborated on these ideas to strengthen the focus on these concepts within the nursing practice. These components combine to influence patients’ conditions and the directions nursing takes in addressing them.

Relationship between the Nursing Metaparadigm and Health Literacy in Heart Failure

In the context of HF patients, the nursing metaparadigm helps explore how various factors influence care.

Person

The individual receiving care (HF patient) is central. Health literacy is important as it determines the patient’s comprehension of their condition and how to manage it. Lack of health literacy causes them to suffer in terms of medication compliance, symptom identification, and treatment compliance. Therefore, nurses should evaluate the health literacy levels of patients so as to adopt the right approach (Shahid et al., 2022).

Environment

The environment includes healthcare settings and community resources. Education empowers health literacy through an environment that is sensitive to the cultural features of society. Nurses can support policies that include funding and clear, comprehensible communications to foster health literacy enhancement (Wilandika et al., 2023).

Health

Health outcomes are significantly impacted by health literacy. Poor health literacy leads to poor disease management, higher hospitalizations, and medication errors. By improving health literacy, nurses help patients better manage symptoms and follow treatment plans, leading to better health outcomes.

Nursing

Nurses play a key role in improving health literacy. They include checking understanding, educational intervention, and utilizing tools such as plain language, diagrams, and the teach-back method. In addition, nurses support health literacy and try to make various materials and services available.

Wilandika et al. (2023) revealed that low HL impacts disease self-management and frequent readmissions among patients with HF. Such outcomes can be prevented through increases in health literacy by focusing on the nursing metaparadigm’s conceptual area, which includes aspects such as health. According to Fabbri et al. (2020), nurses are central to enhancing HL, employing items such as technology and client-tailored information. These approaches correlate with the interventions put under the nursing component, noting the need to make them specific.

Nursing Theory

Grand Nursing Theory: Orem’s Self-Care Deficit Theory

Description of Orem’s Self-Care Deficit Theory

Orem’s Self-Care Deficit Theory suggests that people have the ability to care for themselves, and when they cannot, nursing interventions are required. There are three basic premises: self-care, self-care deficit, and nursing systems. Self-care is the part of the life process individuals undertake in order to preserve their health and fitness. These entail things like being on medication, keeping illness symptoms under check, and general health management.

Second, a self-care deficit is a state whereby an individual cannot attend to personal care adequately and thus requires the assistance of a nurse. Thirdly, nursing systems are the framework through which nurses are able to address the needs of clients who are unable to attend to their personal needs on their own.

The three major types of nursing systems include the wholly compensatory, partly compensatory, and supportive-educative, which are used depending on the needs of the patient. Overall, in order to comprehend and follow the medical regimen, health literacy is vital for HF patients. Lack of health literacy compromises the patient’s ability to perform self-care tasks, therefore creating a self-care deficiency that calls for nursing involvement.

POI within the Framework of Orem’s Theory

Education as an element of health literacy is a strong component of Orem’s model. In cases where patients with HF lack adequate literacy skills to understand information concerning their conditions, they are left with a self-care deficit. Thus, in interaction with the patient, the nursing personnel would have to evaluate the literacy level and use appropriate educational supportive approaches to help the patient obtain effective tools for self-management of the disease (Fabbri et al., 2020).

Middle-Range Theory: Pender’s Health Promotion Model

Description of Pender’s Health Promotion Model

The Pender Health-Promoting model aims to understand what contributes to the behaviors it focuses on enhancing. It is centered on personal characteristics, cognitive etiology, perceived barriers, and enablers of behavior. It all points to the fact that the model of health is fundamentally based on the ability to do something whose opposite is construed to be bad for health.

POI within the Framework of Pender’s Health Promotion Model

In Pender’s model, the focus is placed on the impact of health literacy on patients’ readiness to perform positive behaviors in regard to health, such as the proper use of medications or understanding symptoms. High health literacy promotes a patient’s ability to recognize the advantages of self-care and introduces positive changes to their lifestyle. On the other hand, when the community has low health literacy, it ensures that there are added barriers that result in such behaviors, such as medication adherence or even symptom recognition, as many are discouraged (Chen & Hsieh, 2021).

Integration of Orem’s Self-Care Deficit Theory and Pender’s Health Promotion Model

Orem’s theory of self-care deficit aids in differentiating when nursing interventions are required because of a self-care deficiency, whereas Pender’s health promotion model encourages patients to alter behaviors that are beneficial for health. These theories work hand in hand to fulfill the need for intervention as provided by the Orem Self-care Theory and the motivation needed for behavior change as supported by the Pender Health Promotion Model to improve health literacy in patients with HF.

Complexity Theory

Description of Complexity Science and Complex Adaptive Systems

Complexity science is the study of systems with many interacting components that evolve over time. It concerns itself with relativity and the manner in which a modification in one step of the structure can cause enormous variations in other related levels. A complex adaptive system (CAS) is a system that comprises several individual parts/components that are versatile throughout, having feedback from other components and also from their surroundings (Glover et al., 2020).

CAS displays several properties, such as non-linearity, self-organization, and the ability to emerge exogenous behaviors. Healthcare complexity science has the ability to establish how factors, which include health literacy, patient behavior, and interactions with healthcare providers, imprint patient outcomes.

POI within the Framework of Complexity Science

Health literacy in HF patients is a physiologic and organizational CAS. From a physiologic perspective, health literacy determines the ability of a patient to take care of themselves. Organizationally, it is the relationship between the patient, the health system, and providers that shape health literacy and process.

This system develops according to the experiences of these constituents. For instance, a nurse can enhance communal health literacy to enhance personal health and reduce hospital readmissions. Complexity science shows that when small initiatives are made in the aspect of going through the healthcare system, such as communications, then there will be a great improvement in the outcome of the patient.

CAS within the POI and Discussion of Complexity Science Principles

A specific CAS in health literacy is the nurse-patient interaction, where the nurse provides education, feedback, and support to the patient. Complexity principles such as non-linearity, emergence, and self-organization apply.

Non-linearity

Small changes, like using simpler language or visual aids, can lead to significant improvements in patient outcomes.

Emergence

Health literacy is an emergent property of the interactions between patients, nurses, and the healthcare system. It evolves as patients receive ongoing education and adapt their behaviors.

Self-Organization

Patients adapt their behaviors over time as they gain understanding and confidence, improving their ability to manage HF.

According to Rosário et al. (2024), complexity science can explain how the process of enhancing the concepts of health literacy can bring positive results for patients. Nilsen et al. (2020) support the previous arguments, stressing that the healthcare systems creating an environment for effective and meaningful communication between the provider and the patient encourage patients to engage in self-care, as an explanation of the principles of emergence and self-organization.

Conclusion

The degree of health literacy is a critical factor in self-management, requiring enhancement for patients with heart failure to prevent frequent hospitalization and to improve the quality of their lives. Therefore, by applying the nursing metaparadigm of mobility, interaction, person-environment fit, and human flourishing, as well as Orem’s Self-Care Deficit Theory, Pender’s Health Promotion Model, and complexity science, nurses can establish a framework to engage in interventions to address health literacy.

In addition, these theories not only apply to nursing actions but also demonstrate how different aspects are related to the complicated process of patient care. As such, the described approaches are instrumental in enhancing the quality of life and health of HF patients by enabling nurses to help patients regain control over their condition.

References

Chen, H.-H., & Hsieh, P.-L. (2021). Applying Pender’s health promotion model to identify the factors related to older adults’ participation in community-based health promotion activities. International Journal of Environmental Research and Public Health, 18(19). https://doi.org/10.3390/ijerph18199985

Fabbri, M., Murad, M. H., Wennberg, A. M., Turcano, P., Erwin, P. J., Alahdab, F., Berti, A., Manemann, S. M., Yost, K. J., Rutten, L. J. F., & Roger, V. L. (2020). Health literacy and outcomes among patients with heart failure: A systematic review and meta-analysis. JACC: Heart Failure, 8(6), 451–460. https://doi.org/10.1016/j.jchf.2019.11.007

Glover, W. J., Nissinboim, N., & Naveh, E. (2020). Examining innovation in hospital units: A complex adaptive systems approach. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05403-2

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses, and assistant nurses. BMC Health Services Research, 20(147), 1–8. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4999-8

Purisima, E. M., Arde, B. O., Nero, F. D., Locsin, R. C., & Montayre, J. (2024). Reframing the environment domain of the nursing metaparadigm: Exploring space, place, and technology. Belitung Nursing Journal, 10(6), 614–623. https://doi.org/10.33546/bnj.3458

Rosário, J., Raposo, B., Santos, E., Dias, S., & Pedro, A. R. (2024). Efficacy of health literacy interventions aimed to improve health gains of higher education students—A systematic review. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-18358-4

Shahid, R., Shoker, M., Chu, L. M., Frehlick, R., Ward, H., & Pahwa, P. (2022). Impact of low health literacy on patients’ health outcomes: A multicenter cohort study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08527-9

Wilandika, A., Glorino, M., & Yusuf, A. (2023). The roles of nurses in supporting health literacy: A scoping review. Frontiers in Public Health, 11(1022803). https://doi.org/10.3389/fpubh.2023.1022803

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Theoretical Basis for Practice Paper

Purpose: Integrate nursing science with knowledge from psychosocial, biophysical, philosophical, analytical, and social sciences to form the basis of clinically effective advanced nursing practice. The student will discuss the meta-paradigm of nursing, grand and middle range nursing theories, complexity science appropriate to the identified phenomenon of interest and pertinent to advanced nursing practice specialty

Skills: The purpose of this assignment is to allow you to practice the following skills that are essential to your success in this course as well as your academic and professional practice.

• Understanding and explaining the meaning of abstract disciplinary theories.
• Applying learned knowledge to a phenomenon of interest.
• Critically examining individual elements or deconstructing issues related to ethical, theoretical, and analytical sciences.
• Critiquing and evaluating philosophical and theoretical concepts and ideas.

Knowledge: This assignment will also help you to become familiar with the following important content knowledge:

• Relationship of the nursing meta-paradigm to nursing theory.
• Impact of selected nursing theories on the identified phenomenon of interest within an advanced nursing practice specialty.
• Differences in a grand nursing theory and middle-range nursing theory as applied to the selected phenomenon of interest.
• Understand the effect of complexity science and complex adaptive systems on the identified phenomenon of interest within the advanced nursing specialty.
• Apply graduate level scholarship.

Tasks:

• Review required and recommended resources.
• Conduct a literature search and review of the literature to support ideas and concepts.
• Identify a grand nursing theory and middle range nursing theory that are aligned and relevant to the selected phenomenon of interest.
• Appraise the impact of selected nursing theories on advanced nursing practice.
• Discuss complexity science specific to the identified phenomenon of interest.
• Develop a scholarly paper that adheres to the requirements outlined in the rubric.
• Demonstrate graduate level scholarship as outlined in the rubric.

Transparent Assignment_Theoretical Basis Paper-1 (1) Page 2 of 2

Criteria for Success:
• The student will use the rubric as a guide to understanding expectations and performance levels for this scholarly paper
• The student will adhere to the highest level of requirements in the rubric to meet or exceed expectations.
• The student will contribute original work, as demonstrated by the Turnitin

Originality/Similarity Report.
• The student will access support services from the Biomedical Library and USA Writing Center as needed to develop graduate-level scholarship skills.
• The student will submit the paper by the assignment due date.