A model for teaching total person approach to patient problems

Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives

“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.

Nebulous Intentioning - Acute hospital nurses' struggle to deliver core nursing care

AIM

To explore the influences on nursing practice in acute hospital care.

DESIGN

A Classic Grounded Theory study.

METHODS

Data collection (2013-2015) was through interviews and non-participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts.

RESULTS

This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub-core categories, accommodating and integrity eroding.

CONCLUSION

The theory highlights nurses' attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system.

IMPACT

The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses' attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self-image.

A Critique of the Shannon-Weaver Theory of Communication and Its Implications for Nursing

With the Joint Commission's revelation that as much as 65%-70% of the time miscommunication has been discovered to be the root cause of many sentinel events, it may be time to examine a communication theory to support practice improvement efforts. Effective communication has been shown to decrease medical errors, improve patient satisfaction, and increase adherence to treatment plans leading to better health outcomes; yet very few studies have examined communication theories and their applicability to practice. This article will examine the Shannon-Weaver Communication Theory as one theory that may support future studies examining the teach-back communication method as a means to improving patient health literacy leading to improvements in clinical practice.

Examining the Relationship between Mindfulness, Perceived Stress, and Blood Pressure in African-American College Students

College students are prone to stress, making them vulnerable to cardiovascular disease (CVD). Harmful health behaviors, such as tobacco or alcohol use, further predispose students to hypertension (HTN). African-Americans (AA) experience increased blood pressure reactivity, and weathering, due to race-related stressors. This interplay makes AA college students good targets for strategies to prevent stress and HTN disease risk. This project examined the relationship between mindfulness, perceived stress and blood pressure among a group of AA college students enrolled in an HBCU healthy heart course. Participants' systolic and diastolic blood pressure averaged 122 mmHg and 76 mmHg, respectively. The Spearman correlation revealed a negative strong relationship between mindfulness and perceived stress (r_s = -0.61, p = 0.004). The coefficient of determination indicated that 37% of the variance in mindfulness was explained by perceived stress. College health practitioners should consider integrating mindfulness into course activities and expanding its treatment modality.

Exploring Nurses' Knowledge and Experiences Related to Trauma-Informed Care

Trauma-informed care is an emerging concept that acknowledges the lasting effects of trauma. Nurses are uniquely positioned to play an integral role in the advancement of trauma-informed care. However, knowledge related to trauma-informed care in nursing practice remains limited. The purpose of this article is to present the results of a qualitative study which explored nurses’ understandings and experiences related to trauma-informed care. Seven semistructured interviews were conducted with nurses and four categories emerged from the analysis: (a) Conceptualizing Trauma and Trauma-Informed Care, (b) Nursing Care and Trauma, (c) Context of Trauma-Informed Care, and (d) Dynamics of the Nurse–Patient Relationship in the Face of Trauma. These findings highlight important considerations for trauma-informed care including the complex dynamics of trauma that affect care, the need to push knowledge about trauma beyond mental health care, and noteworthy parallels between nursing care and trauma-informed care.

Treatment recidivism in adolescents with mental illness: A focused applied medical ethnography

PROBLEM

Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness. Because the main triggers of treatment recidivism are not fully understood, the purpose of this study was to explore treatment recidivism (i) to better understand treatment recidivism from the perspectives of recidivist adolescents with mental illness, (ii) to describe major factors that contribute to treatment recidivism and how best to minimize them from the perspectives of these adolescents, and (iii) to describe their interaction with the medical culture.

METHODS

A focused applied medical ethnography was used to study 16 purposively selected adolescents. Interviews were conducted together with unobtrusive unit observation of the participants and collection of demographic and clinical information.

FINDINGS

The participants were nearly unanimous in identifying the "additional stressors" of problematic parental relations and school bullying as the main triggers of treatment recidivism over and above their "routine stressors" of adolescence and mental illness. They had mixed perceptions of treatment recidivism and described their interaction with the medical culture as positive.

CONCLUSION

Further research is needed to determine the impact of parental relations and school bullying on recidivism in adolescents with mental illness.

Neighborhood: A Conceptual Analysis

Researchers interested in measuring neighborhood-level effects should understand how "neighborhood" is defined within nursing sciences and other sciences, and the inherent strengths and weaknesses of current research methodologies. This concept analysis provides clarity around the concept of neighborhood within the context of health, analyzes the current state of development of the neighborhood concept, and proposes areas for future nursing research. Using the Rodger's Method of analysis, the concept of neighborhood within nursing and public health research is described based on existing literature. The concept's attributes, related concepts, antecedents, and consequences are given from the literature. Comparisons of the use of neighborhood are made between nursing, public health, sociology, and other sciences. The evolution of the concept of neighborhood throughout history is described, and important implications for future research are discussed.

Ethical considerations of doll therapy for people with dementia

The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood’s ‘malignant social psychology’ and bioethics. This article suggests that by applying a ‘rights-based approach’, healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a ‘rights holder’ and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient’s rights and needs.

Dialogue with Lois Lowry : development of the Neuman systems model. Interview by Pamela N. Clarke

The column is an interview with one of the Neuman trustees. Dr. Lois Lowry shared her experience with the Neuman systems model in curriculum development and evaluation in this dialogue. She shared insights from the development of the international Neuman conference in Holland in June.

Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized controlled trial in Canada

BACKGROUND

The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women.

METHODS

Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling).

RESULTS

Overall, those in the nurse intervention group were more likely to attend an "Early Bird" prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women.

CONCLUSIONS

Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women.

The Neuman Systems Model Institute: testing middle-range theories

The credibility of the Neuman systems model can only be established through the generation and testing of Neuman systems model-derived middle-range theories. However, due to the number and complexity of Neuman systems model concepts/concept interrelations and the diversity of middle-range theory concepts linked to these Neuman systems model concepts by researchers, no explicit middle-range theories have yet been derived from the Neuman systems model. This article describes the development of an organized program for the systematic study of the Neuman systems model. Preliminary work, already accomplished, is detailed, and a tentative plan for the completion of further preliminary work as well as beginning the actual research conduction phase is proposed.

The Living Tree of Nursing Theories

TOPIC

Three behavioral theories have been used to develop major nursing theories: interactive, systems, and developmental.

PURPOSE

To provide a symbolic image as a framework for nurses to visualize the multitude of nursing theories starting with the first nurse theorist, Florence Nightingale.

SOURCES

Published research articles, authors' experience, educational classes and workshops.

CONCLUSIONS

The Living Tree helps organize various nursing theories so a nurse can apply the theories to practice.

Health-culture reorientation of registered nurse students

There is a need for a health-culture reorientation of nurses from acute care to community-based care if the profession is to respond effectively to sociocultural, political, economic, and educational forces moving health care and decision making back into the community. Concepts from anthropology, international health, and transcultural nursing provided the basis for initiating a health-culture reorientation of acute care-oriented (RN-BSN) students enrolled in a population-based community health nursing course given in a weekend format. The course centered on developing a primary health care project from assessment data gathered via the community-as-partner model. Problems encountered, methods of evaluation, and ongoing project development are discussed.

Promoting elder wellness through a community-based blood pressure clinic

As the American population ages, we can expect to find greater numbers of older adults with chronic diseases and health concerns. Therefore the implementation of communitybased blood pressure clinics that promote elder wellness becomes increasingly important. This article will describe the development, implementation, and evaluation of a community-focused elder wellness program in a rural community using Anderson and McFarlane's (1996) Community-as-Partner model as a theoretical framework for community health nursing practice. Evaluation results of the elder wellness program suggest that blood pressure screenings provide community health nurses (CHNs) with unique opportunities to promote wellness in older adults when provided in an atmosphere that encourages nurse-client interactions.

Defining nursing interventions

Nurses are giving increasing attention to independent nursing interventions. However, numerous conceptualizations of interventions have evolved and are being used. The purpose of this essay is to examine some of the existing definitions and classification systems for interventions and to provide a rationale for a common universal language for nursing interventions. Definitions and approaches used in five intervention classification systems are examined in relation to inclusion of assessment and evaluation activities, autonomy, level of conceptualization, and inclusiveness of intervention labels. Lack of a common intervention language can deter international collaboration, development of a scientific basis for practice, and reimbursement for nursing services.

The effects of different central venous line dressing changes on bacterial growth in a pediatric oncology population

Central venous lines are now common in children who need a permanent form of intravenous access. These lines frequently become infected. This study compared the effects of different antiseptics (Hibiclens [chlorhexadine 4%; Stuart Pharmaceutical, Wilmington, DE] and Betadine [povidone-iodine, Clini Pad Corp, Guilford, CT]) used to clean the skin as well as the dressings used to cover the exit site (Tegaderm [3-M Medical-Surgical Division, St Paul, MN] and gauze) on microorganism growth on the skin in a pediatric oncology population. Sixty subjects were recruited from the oncology and bone marrow transplant units of Children's Hospital in Boston, MA. The subjects were randomly assigned to one of four dressing groups. These included: 1, Betadine and Tegaderm; 2, Betadine and gauze; 3, Hibiclens and Tegaderm; and 4, Hibiclens and gauze. Dressings were done on a Monday-Wednesday-Friday basis. Quantitative cultures were obtained before the first and after the fifth dressing changes. There were no significant differences in incidence of bacterial growth between dressing groups (F = 1.05, P = .377). Redness (F = 3.01, P = .037) and swelling (F = 2.75, P = .051) were more frequently seen in Betadine groups. Boys were more often infected than girls. (Chi 2 = 4.075, P = .044).

The application of the Neuman systems model to intensive care

Willingness to explore different ideas and initiate change as part of the search for better ways of providing care is essential in intensive care nursing. For a number of years now there has been discussion of the possible benefits of using an explicit model of nursing as a framework for practice and many such models have been developed and described in nursing literature, however there have been some difficulties in using them in practice. In this paper a brief account of some of the characteristics of intensive therapy units (ITUs), the possible merits of using nursing models, the nursing process, and nursing care plans in them is followed by a summary description of the Neuman systems model of nursing. A description of the process of choosing and using this model in one unit includes the 'Nursing philosophy for ITU' and nursing documentation which were developed.

The Neuman System Model applied to mental health nursing of older adults

As we move into the 21st century, nurses are facing the challenge of contributing to the health care of a society with an increasing proportion of ageing persons. This group of people become more heterogeneous as they age, bringing with them an extended life history of experiences of wellness and illness. They have been faced with numerous stressors and losses and have made successful or unsuccessful adaptation to those life experiences. One of the disconcerting stressors of the elderly is the promotion and maintenance of mental health. In this paper we will examine the application of the Neuman System Model to the mental health nursing of older adults.

The selection by ward managers of an appropriate nursing model for long-stay psychiatric patient care

The Northern Ireland National Board of Nursing, Midwifery and Health Visiting has stipulated that models of nursing must be utilized on psychiatric nurse training wards. However, since there are approximately 40 such frameworks available to the practicing nurse a problem of choosing an appropriate one arises. The philosophical basis for this research centres around the assumption that all nurses regardless of specialty possess values and beliefs concerning four essential elements. These are: nursing, health, the person, and the environment. In addition the literature reveals that each of the recognized nursing models are also constructed around these four concepts, forming in many cases the very foundations of the model. Within this study it was possible to ask 95 ward managers from 49 long-stay psychiatric wards to view how different models deal with the four elements and to choose a model which best reflects not only their personal beliefs about nursing, health, person, and environment, but also the needs of their patients.

The human needs model of nursing

Nurses in the United Kingdom spend much time attempting to fit British nursing practice into the theoretical framework of American nursing models. This is often a manipulative process in that it seeks to establish positive links with a care delivery system totally unlike our own. In the present paper the authors detail the process of establishing a new nursing model which integrates nursing curricula, education and practice to meet the needs of patients, staff and students within their own health district. An over-emphasis on lower levels of human need is common within nursing practice, which, although often blamed upon lack of human and financial resources, is also due to practitioners' misconceptions. The latter are invariably the result of a lack of an adequate or overt, practice orientated, conceptual framework. The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such a conceptual framework for practice. It places equal emphasis on those patient problems which arise as the result of unmet needs at higher levels as well as those at lower levels, thereby acknowledging the holistic and dynamic nature of man.

Conceptual frameworks and the nursing curriculum

In this article the author discusses the meaning of a conceptual framework in the curriculum, the advantages of a conceptual framework, the relationship of curriculum design to the conceptual framework and some types of conceptual framework used in nursing curricula. The conceptual framework in the curriculum process and the relationship of nursing theory to the conceptual framework are also discussed. This article presents some results of a survey of Australian post-basic clinical nursing courses and a content analysis of curricula for these courses. Such curricula are often perceived as based on nursing theory but in reality most appear to be heavily orientated to the medical model.

Development of models and theories on the concept of nursing

This paper shows how models can be used by practitioners of nursing as a practical tool to analyse their own practice, in particular to assess needs and to plan, implement, and evaluate care. It is argued that the impact of existing work in theory development has been relatively small, at least in the UK, because the theories are not sufficiently specific to everyday nursing activities and the models are over elaborate and not universally applicable. A simple model of nursing, based on a systems approach is presented and applied to one particular field of nursing practice, i.e. health visiting. The model, which can be used in any field of nursing, stresses the reciprocity of the nurse-patient relationship, and the significance of the environment in determining the concepts of nurse, patient and nursing.