Development of the Dynamic-Patient Relationship Theory
Nursing theories offers guidance for nursing practice by formulating theoretical frameworks which helps to expand the discipline through research and knowledge. “Nursing theory is a set of ideas, experiences and observations regarding how and why we , as nurses engage in certain activities and exhibit various behavioral attributes in caring for our patients. Through research, these attributes and activities are tested for validity”. (Pryjmachuk,1996.p. 679).Therefore, theories provide pillars for the foundation of nursing practice by inculcating research methodologies which would advance the discipline . The main goal of nursing theories is to develop knowledge which can be tested, which in turn provides a framework, guides practice with the ultimate end of ensuring safe and effective nursing practice. The process is cylindrical in that, theory advances research and the evolution of more theories. Hence the reason that our practices as nurses can progressed using our own discipline and not that of the medical model of care as it was in the past. (Dunlap. K. 1998). The purpose of this assignment is to explain how Ida Jean Orlando, developed her theory using nursing concepts, applying them to evidenced based practice by testing its validity and evaluation of its applicability to care in the persona of the Ms. Orlando.
THEORY DEVLOPMENT
First Stage.
I, looking through the window on cold December morning at the university campus, began pondering that human beings attached meanings to situations and that as nurses, we as a profession most be concerned with the needs of patients who cannot meet their own. Through my experiences and observations, I had an “aha” moment in that, I wondered that as nurses it is our responsibility to respond to humanity in times of helplessness or illness and that in order for this process to occur, a dynamic nurse -patient relationship must be established and developed. (Petiprin,2016). Therefore, it is essential that I research and formulate a nursing practice theory that demonstrates, nursing care from a holistic perspective by meeting the needs of the patients we serve.
The role of the nurse is to question and meet the needs patients’ immediate needs in every situation. Nurses need to be aware that each patient’s situation is as unique as the nurse’s reaction to it, and that everyone presents behavioral patterns which may be a sign for help may be a mirage with regards to type of assistance needed. Thus, it is here that I realized that nurses need to use their perceptions, thoughts intuition and knowledge in alignment with their own thoughts and perception in order to map the patients meanings behind their behavior. This need lead to , defining the nurse -patient process and from by experiences over time I observed that “nursing care was governed by organisational rules rather than attention to clients needs”. (Butts&Rich. 2018. P. 90).
My observations in conjunction with the metaparadigms of nursing lead to me applying meaning to the concepts of health, environment, human beings and nursing to the application of my theory titled “ The dynamic nurse-patient relationship”. The concept of health can be defined as a sense of adequacy, fulfied needs and a sense of comfort which stimulates the need for nursing care. next, the term human being focuses on individuality and dynamism. Environment, revolves around the patients experiences and immediate reality and finally, nursing which is responsive to individuals in times of need and suffering by applying knowledge and practice to meet or anticipate needs and alleviate suffering in order to restore or improve one’s health . (Nursing Theories, 2012).
These concepts formed the building blocks to my theory, which focuses on patient participation, meeting the immediate needs and reducing the stress of patients by promoting health and healing. In determining the patients needs based on behavioral attributes, it is essential for nurses to treat patients as individuals which is an alternative to traditional medical model methods of ascribing care for all regardless of personal characteristics. This lead to me to progress my theory to the second stage of development which is the actual process nurses can use to identify needs and formulates treatments for care.
Second Stage
I coined the term the deliberative nursing process, which has been set in motion by the exhibiting behavior of the patient. Ultimately, the nurse-patient relationship is the product of the nursing process which I divided into three elements, the patients behavior, the reaction of the nurse and the nurses action which is designed to benefit the patient. I believe that nursing actions can either hamper or foster patient participation in their care and that a “ caring nurse is one who is responsive to the patient as a unique individual , perceives his or her feelings and maintain human dignity”. (Dunlap. K. 1998. P.20). Thus the deliberative nursing process present a scientific process in which those needs can be net. The process involves five stages. Assessment, nursing diagnosis, planning, implementation and evaluation.
I will attempt to explain the processes as follows, the assessment phrase involves using the nursing framework to gather objective and subjective data in a holistic manner to meet needs. Nursing diagnosis uses the nurses clinical judgement about the patient’s health issues. It forms a bridge between characterises an related forces identified during the assessment. Next, the nurse begins her planning phrase where each problem identified in the diagnosis is addressed. Each problem is goal specific and has achievable outcomes through implementation nursing interventions and finally, we have the evaluation stage, where the nurse monitors progress of the patients goals, which can be adjusted depending on progression or regression of patients health status.
I t is important for nurses to know that once problems has been highlighted they can be corrected and the process starts over. (Petiprin, 2016). . The nurse by this stage has formulated a nursing care plan. This model, allows the nurses actions to be goal -specific rather automatic, which translates to patients getting Care that is directed toward a specific need at that time. Thus, making my theory universal in nature.
Third Stage
My theory progresses the importance of the reciprocal relationship between patient and nurse through the application of the nursing process identified in the previous section. While teaching at Yale university, my theory was applied as a foundation for their graduate psychiatric nursing program. This qualitative research process entailed, seventy-five senior students from an associated degree program and a bachelor nursing program. The purpose of the study measured whether the type of educational program or the patient’s problems affected the student’s responses to the patients they cared for. Participants used video tapes of patients exhibiting pain and other forms of emotional distress to answer questionnaires formulated on the concepts of my theory. Eight response categories were scored and findings demonstrated that 42 % of the interactions did allow the student nurses to identify with the patients distress and that the type of nursing degree did not influence or persuay their responses
. Based on these findings, I noted that nurses must be able to distinguish between observations and inferences or else their practice would be based on assumptions which are incorrect. Since, then my model has been used by educators and student alike to demonstrate how to the both parties should relate to each other. Thus, actual behavior may not necessarily dictate type of need. This osmolality between need and care response may reflect as somatic pain for example vs. emotional care. (Faust, 2002).
Fourth Stage.
M y colleagues in the operation room applied my nursing process to the three phrases of surgical intervention and noted that, “perioperative nurses no longer perceive patients as unstable beings in need of repair: they are viewed as individuals with unique social, physical and psychological needs.(Vance & Davidhizar, 1992). A completely different approach from the application of the medical model of care. Which viewed nurses as means to an end, by helping surgeons perform task to reduce the work volume. As nurses in the OR one colleague wrote in a peer reviewed article that Jean’s model of Dynamic Nurse-patient relationship, gave us the ability to provide care through our nursing actions in an individualistic manner-based trust, respect, addressing familial concerns, displaying patience, providing a calm environment all which displayed empathy and the importance of sharing the patients surgical experiences. (Dunlap. K, 1998).
My theory was applied using a qualitative approach to determine which nursing characteristics displayed excellent care. The findings found was that, patients saw excellent nursing care from the perspective of good communication, professionality, knowledge, skill and being treating holistically. Thus, patients needs and wants to be treated as indivual being able to actively participate in their plan of care with the nurse-patient relationship revolving around trust, care and respect.
Conclusion.
My philosophical beliefs coupled with observation, experiences and inducive and deductive reasoning ability gave me as nursing profession to devise a theory that was formed based on need, meeting those need in a scientific format with the advent of the nursing processes. Which has been tested for validity and implemented into nursing practice in the areas of education, practice and even in the treatment of social /psychological disorders . The model has allowed advance practice nurses to foster a sense of commitment to society by promoting the expansion of research, knowledge through having a theoretical framework in planning and implementing nursing practice by promoting a caring relationship which harnesses health and healing. (ANA, 1995).
References.
American Nurses Association, (1994). Code for Nurses with interpretative statements. Washington, DC. Author. Retrieved from http://search.ebsocohost.com.libauth.purdueglobal.edu/login.aspx?
Butts, J.B. & Rich. K. L. (2018). Philosophies and Theories: For advanced Nursing Practice. (3rd.ed). Burlington, MA: Jones and Bartlett Learning.
Dunlap, K (1998). The practice of nursing theory in the operating room. Today’s surgical nurse,205 (5), 18. Retrieved from http://search.ebsocohost.com.libauth.purdueglobal.edu/login.aspx?
Faust, C. (2002). Orlando’s deliberative nursing process. A practice application in an extended care facility. Journal of gerontological nursing. (28). 7. 14-8. Retrieved from http://search.ebsocohost.com.libauth.purdueglobal.edu/login.aspx?
Nursing Theories. (2012). Retrieved from http://currentnursing.com/nursing_theory/Orlando_nursing_process.html
Petiprin, A. (2016). Nursing Process Theory. Retrieved from http://nursing-theory.org/thoeries-and-models/Orlando-nursing process.
Pryjmachuk. S. (1996). A nursing perspective on the interrelationships between theory, research and practice. Journal of Advanced Nursing: 24. P.679-684. Retrieved from http://search.ebsocohost.com.libauth.purdueglobal.edu/login.aspx?
Vance. A & Davidhizar. B (1992). The element of care in the operating room. Today’s OR Nurse. 14 p. 14-27. Retrieved from http://search.ebsocohost.com.libauth.purdueglobal.edu/login.aspx?
