How Can I Think Differently? Nursing Theories Applied to Practice Scenario

How Can I Think Differently? Nursing Theories Applied to Practice Scenario

How Can I Think Differently?

Carper's knowing knowledge the most important epistemological nursing stances developed. The development of this stance was very significant because it has provided a framework that can be used to guide nurses in their practice. This argument will focus on how I relate with Carper's knowing, as discussed by Thorne (Thorne, 2020).

Carper's 4 Types of Knowing

• Empirical knowing is based on the senses, and it is objective. The nurse uses this when utilizing scientific knowledge.
• Aesthetic knowing is based on feelings and impressions. The nurse uses this when interacting with patients.
• Ethical knowing is based on morals and values. The nurse uses this to guide practice to promote the patient's well-being  (Thorne, 2020).
• Personal knowing is based on self-awareness, insight, and understanding. The nurse uses this to grow professionally and personally.

This is my epistemological stance:

My epistemological nursing stance is derived from my Knowing. I must be aware of myself and how I feel and the patient and how they feel. Knowing myself allows me to feel the patients' emotions and needs when I am aware of myself. If I am having a bad day, I need to be aware of my stress or emotions to not affect my patient care. To have a true sense of the patient’s needs, we must build a relationship with trust and respect. The nurse must remain attentive and open to listening to maintain this relationship  (Thorne, 2020).  Being aware of oneself can increase self-esteem by knowing one's value in the profession. I believe that knowledge is a combination of personal and communal experiences. We have to have personal experience with something to commit it to memory, we must experience something ourselves, but we must also rely on others' experiences to stand on the shoulders of giants and add the information they have found through their own experiences.

Personal knowing is individuals' knowledge through their experiences, relationships, and emotional responses. It helps nurses improve their interpersonal relationships with patients. Nurses can develop personal relationships with patients because they can access and understand their experiences. A nurse who relates with a patient personally will create a relationship based on trust and understanding. Through personal knowing, nurses can develop relationships with patients to understand some of the issues that affect them in their lives. Thorne (2020) also argues that nurses should pay attention to 'existential knowing' as described by Carper. According to Thorne, existential knowing will help nurses understand how patients perceive their existence in the world. Existential knowing also helps nurses develop a sense of meaning about what they do in their practice.

Conclusively, Carper’s fundamental ways of knowing in nursing is a philosophy that was developed to help nurses be more aware of the knowledge and skills they use when providing care for their patients. This philosophy has four components: empirical, ethical, personal and aesthetic. These four ways of knowing are equally important in providing the best patient care possible. According to Carper, empirical refers to the knowledge gained from scientific research, ethics is based on moral principles, personal is based on intuition or subjectivity, and aesthetic is based on a sense of beauty in people, places and things. I can relate to all four of these components in my nursing practice. I am an evidence-based nurse who uses research findings to help guide me in making decisions about patient care. I also try to act ethically by treating my patients with respect and dignity while providing them with the best care possible. In addition, I believe that I have good interpersonal skills because I can build trustful relationships with my patients, which helps them feel more at ease while under my care. Lastly, I believe that the aesthetics of a healthcare facility plays an important role in patient satisfaction and overall well-being.

Nursing Theories Applied to Practice Scenario

Transcultural Nursing Theory

Leininger’s theory of transcultural nursing focuses on a patient’s culture, religion and ethics; it also acknowledges the importance of the individual. It considers the patient's personal preferences and needs, and cultural beliefs for the best possible outcomes when caring for a patient. Practical applications include looking at a person's culture, religion and ethics to provide patient-centered care (Ansuya, 2012).  An individual's ethical values may differ from an institution or organization's. If a nurse takes these differences into account, there is a higher chance of providing effective care. Cultural and religious beliefs can impact their attitude towards certain treatments or procedures. For example, many Muslim men are circumcised soon after birth. However, in some cultures, circumcision is not common practice.

Application/utility of the theory

Transcultural nursing theory provides a framework for nurses to understand clients' cultural practices and needs across different cultures. It is important for nurses to fully understand how their own culture and values influence their perception of other cultures. Nurses can use this theory in various ways, including clinical practice to develop effective communication with clients, assessment tools to identify patients’ needs, teaching methods during education and research activities (Ansuya, 2012).

Strengths

• This theory identifies many of the elements that impact cultural care and provide a framework for investigating the effects of culture on the nurse-patient interaction.
• The theory is a systematic way to identify and analyze factors involved in providing quality care to patients from different cultural backgrounds. It is based on empirical research, which makes it scientific and objectives (Ansuya, 2012).
• It offers a holistic view of nursing as it recognizes the importance of understanding the patient’s culture, ethnicity, values and beliefs.

Limitations

Although this theory seems easy to understand, it can be challenging for nurses to apply it in practice. This may lead to stereotyping or assumptions about a patient’s culture and tradition, resulting in culturally inappropriate care.

Significance of the Theory to Nursing Role.

The knowledge from Leininger’s theory is helpful in my current nursing role because it teaches that every client has unique care needs. Understanding diverse cultures are essential to providing holistic health care to clients. The cultural care diversity and universality theory emphasize that all individuals deserve to respect and uphold their cultural values by healthcare professionals. Providing culturally competent care enables nurses to understand clients' values, beliefs, and practices. I must be aware of my own culture and how it may influence my practice with clients of different cultures. For example, in my current role working with children with disabilities in an educational setting, many cultures are represented within our school community, including newly arrived migrants or refugees to Australia (Ansuya, 2012). This can impact the level of confidence families have towards healthcare professionals.

However, there are cases where the theorist's ideas might not be helpful to you in your current nursing role. In terms of transcultural nursing theory not being helpful to me in my current nursing role, it is difficult to apply this theory when you are the only nurse looking after such a diverse patient group as it takes time for the nurse and patient to build trust together and for the nurse to adapt all aspects of their care according to the patient’s needs. It could be argued that this theory could be limiting for the nurse as it does not consider other aspects of care, such as how well you can provide physical care for your patients. It focuses solely on how well you can cater to your patient’s cultural needs. There may be instances where a nurse’s cultural background isn’t suitable for certain patients, leading to tensions between the two parties.

Conclusively, Leininger's theory of culture care diversity and universality provides the essential framework for delivering nursing care services to individuals, families, groups and communities. Her theory is based upon the belief that culture plays an extensive role in making decisions about healthcare. The ability to communicate with patients from culturally diverse backgrounds may assist nurses in identifying cultural aspects that may impact the delivery of care. For example, some cultures may be accustomed to family members being involved in discussions about the patient's health (including treatment options), whereas others may prefer discussing sensitive issues with female nurses only. Awareness of these differences allows nurses to form a therapeutic relationship with patients through appropriate communication for their individual needs.

The Theory of Comfort

The theory of comfort created by Katharine Kolcaba takes a holistic approach to the nursing field. The theory is based on the idea that all people have a basic human need for comfort and that the nurse should strive to meet this need when providing care. Kolcaba does not believe that the nurse should solely focus on the physical needs of patients but rather should also focus on their spiritual needs and social and emotional needs. These four aspects of a person’s being are referred to as “comfort care” (Kolcaba, 2003). The key elements in her theory include:

• Comfort: a feeling of relief or ease of a patient’s mind, body, or spirit
• Holistic Comfort: being free from all forms of discomfort. Having peace and harmony in one’s life.
• Comfort Line: the relationship between two measures directly related to comfort. A vertical line is drawn between these two measures.

Application/utility of the theory

This theory has been applied in many different ways, such as nursing, psychology, education, and counseling. A few examples of this would be within the nursing research. Studies have used Kolcaba’s theory to comfort patients with cancer or kidney disease. Another study showed how the Theory of Comfort could improve patients’ experience with pain management. Studies show that comforting people can reduce their stress within psychology, a coping mechanism for stressful situations. In education, Kolcaba’s theory has shown how teachers can provide comfort and support for students who are not performing well academically (Kolcaba, Tilton, Drouin, 2006). Lastly, Kolcaba’s Theory of Comfort has been used within counseling to show how therapists can use comforting words to provide a more positive interaction with their clients.

Strengths and Limitations of Theory

Strengths:

• Kolcaba is a nurse who has provided patient care and comfort. She has applied her theory to research and practice.
• Her theory is based on the nursing metaparadigm: person, health, environment, and nursing.
• Her theory can be used in any specific setting (home or hospital).
• The model is easy to understand for nurses. But, its use will depend on the knowledge and skills of nurses (Kolcaba, Tilton, Drouin, 2006).
• It provides a framework for nurses to assess how comfortable patients are and determine what will make them more comfortable.

Limitations:

• A nurse created the theory for a nursing environment. Due to this fact, Kolcaba’s work does not fit well into other professional disciplines like medicine, therapy or social work.
• The theory does not address holistic care at all. For example, she does not discuss nutrition or exercise as contributing factors to patient comfort.

Significance of the Theory to a Nursing Role

Kolcaba's theory would be helpful in my current nursing role because it offers a holistic approach to patient care. With the ever-increasing understanding of medical patients seen in acute care hospitals, nurses often forget about the basic human needs of their patients. The theory allows nurses to focus on all aspects of comfort, thus offering more holistic care. Comfort can reduce patients' stress levels, enabling them to recover faster. In addition, patients feel encouraged when they are comfortable and more willing to follow treatment plans created by their physicians (Kolcaba, Tilton, Drouin, 2006). Therefore, Kolcaba's theory is useful in any setting where nurses provide patient care. The theory applies to patient populations in hospital settings, home health care, long-term care facilities, rehabilitation centers and hospice facilities.

However, the ideas of the theorists could, in some cases, become unhelpful in my role as a nurse. When providing care to a client experiencing pain, this theory would not be helpful. The theory states that comfort is when an individual’s physical, psychological and social needs are fulfilled for a specific period (Kolcaba, 2003). When an individual is experiencing pain, their physical and psychological needs are not being fulfilled; therefore, they cannot experience comfort. To address the pain, a nurse must focus on the client’s physical and psychological needs and provide treatment such as medication to manage the pain and other interventions to improve their psychological state.

References

Ansuya, A. (2012). Transcultural nursing: cultural competence in nurses. International Journal of Nursing Education, 4(1), 5-7.

Kolcaba, K. (2003). Comfort theory and practice. Springer Publishing New York NY.

Kolcaba, K.; Tilton, C.; Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. Journal of Nursing Administration, 36(11), 538-544.

Thorne, S. (2020). Rethinking Carper's personal knowing for 21st-century nursing. Nursing Philosophy, 21(4), e12307.