Theory-Guided Practice Paper Assignment
I. Practice Story
This real practice story is that of a geriatric patient with a neurocognitive disorder (NCD) I cared for some time back in my clinical practice. A neurocognitive disorder is a condition such as dementia and Alzheimer’s disease that cause cognitive impairment to the affected person and makes them unable to take care of their persons needs (APA, 2013; Sadock et al., 2015). These needs include activities of daily living or ADLs including feeding, grooming, bathing, and personal safety amongst others. NCDs usually affect the elderly. The patient was a 72 year-old Caucasian male. He presented with amnesia or forgetfulness, language problems (aphasia and apraxia), inability to recognize family members (agnosia), and poor motor coordination.
What mattered most to this patient was that there was someone that would help him with his ADLs and that would make sure that he was comfortable and safe. His past medical history showed that he has a history of arthritis, type II diabetes, and hypertension. In other words, these are the comorbidities that he had at the time of admission. He had undergone surgery for a torn right meniscus at the age 28 years. He had been a soccer player and this was a sport injury. He had a wife with whom he had been married for 42 years and two grown sons living within the same state. He was a social drinker taking at least two beers every day until he was 70 years old. He also smoked a pack of cigarettes every day accumulating 40 pack years and was still smoking at the time of admission. His father had died of myocardial infarction and his mother died of hypertensive stroke. He depended on help from his sons and social security payments. Theory Guided Practice Paper Assignment
His primary diagnosis was dementia (major neurocognitive disorder). Investigations done on him showed that he did not suffer from any physical illness. Some of the laboratory tests done were a full blood count that did not show leucocytosis and indicated that he had a Hb level of 13.8 g/dL. A chest X-ray only showed mild cardiomegally with no consolidation in the lungs. A CT scan of the head indicated no traumatic brain injury that could have explained his symptoms. Physical examination performed on him showed that he was alert and concious although he was confused with speech that was neither coherent nor goal-directed. His vital signs were within normal limits.
The socio-cultural implications for this patient were that he was lonely since he could not be cared for at home and had to be put in a residential care facility. The fact that the United States does not have Universal Health Care meant that he depended on Medicare and help from family (Cai et al., 2020). This was having a toll on the family’s finances since he also had to be treated for the comorbidities. This was the impact of health systems and policies (Sultz & Kroth, 2018). Health promotion and health literacy activities aimed at helping him centered on safety (because he was at a high risk of accidental falls), cessation of smoking, exercise, and diet. The prevention of falls was significant because treatment of falls injuries suffered by patients is not reimbursed by the Center for Medicare and Medicaid Services or CMS (Fehlberg et al., 2017). The reason is that this is a sentinel event that should never happen as it is preventable.
In summary, this was a geriatric patient with a NCD that required round-the-clock care and monitoring. Since he also had co-existing chronic conditions, there was also need to effectively manage these other conditions so that they were not worsened by the cognitive impairment brought about by the dementia.
II. Middle Range Nursing Theory
Nursing theories can be grand, middle range, or practice-level theories. The distinction is usually in the level of abstraction within the theory. Middle range theories are usually the most used because they are neither too simple nor too abstract to be applied effectively in practice (Risjord, 2018). The middle range theory chosen as befitting the patient above in his situation is the Self-care deficit theory (SCDT) or Orem Model of Nursing by Dorothea Elizabeth Orem (Borji et al., 2017; Gonzalo, 2021). The theory states that individuals such as those with cognitive impairment who cannot help themselves suffer from a deficit of self-care ability.
The purpose of the SCDT is to inform nurses that they need to be care agents for patients with a self-care deficit in order that they are then able to meet their daily needs such as the ADLs. The development of the theory took Dr. Orem many years from 1959 to the year 2001 (Gonzalo, 2021). Its philosophy is to help others who are in need as the fundamental underpinning principle of nursing as a caring profession. According to Gonzalo (2021), major concepts in the theory are self-care, self-care agency, self-care deficit, and nursing agency. Self-care is the ability of the patient to initiate the performance of tasks geared towards his wellbeing and self preservation (such as ADLs) with no external help. Self-care agency is the natural ability of human beings to take care of themselves. The difference between the demand for self-care and self-care agency is the concept known as self-care deficit. Lastly, nursing agency is the vocation concerned with helping others care for themselves. The theory application to the practice experience for the SCDT is that it underpins and informs care given by nurses to patients such as the one in the practice story above with a self-care deficit due to dementia.
III. The Borrowed Theory
The Theory of Psychosocial Development by Erik Erikson is the borrowed theory to be juxtaposed with the SCDT by Orem (McLeod, 2018). It is borrowed from the discipline of Psychology and its purpose is to explain the developmental stages of a human being and the accompanying behaviors from childhood to senescence.Theory Guided Practice Paper Assignment
It was developed by the developmental psychologist and theorist Erik Erikson in 1959. It is ironical that Dorothea Orem also developed her SCDT in the same year as seen above. The philosophy in this theory is that humans go through several psychosocial stages as their chronological age advances. The major concept in this theory with regard to the patient in the practice story is what Erikson called the stage of Ego integrity vs. Despair (McLeod, 2018). This is the last stage in the theory by Erikson and applies to the elderly persons aged 65 years and above. The concept holds that if the elderly person feels they have achieved enough in their lifetime they will have a strong ego and high self-esteem. If they think they have failed they will be in despair. The application to the practice situation of this theory is that as the nurse cares for the geriatric patient they need to find out if they are in the ego stage or despair and intervene accordingly.
IV. Evaluation of Selected Theories
The strengths of the SCDT include practicability and simplicity. The strengths of Erikson’s theory include being detailed and being practically applicable too. A weakness of the former is that it may prolong rehabilitation as the patient is helped with everything. A weakness of the latter is that it is complicated t understand. Some of the benefits to utilizing the theories in practice are the provision of rationale and also evidence for evidence-based practice or EBP. Barriers include complexity of understanding and patient factors such as cultural preferences. From a Biblical worldview, the two theories rhyme with the parable of the Good Samaritan by Jesus (Luke 10:25-37, NIV). The priest who was a Jew found the injured man by the roadside and this man was unconscious hence lacked self-care agency and there was a self-care deficit. He helped him in the way a nurse would help a patient. We could compare the injured man’s status as being in despair from Erikson’s standpoint.
V. Implications to Nursing Practice
The SCDT or Orem Model of Nursing is applicable to nursing practice as nurses use it to inform their care to patients with reduced or absent self-care agency. The Theory of Psychosocial Development is similarly used by nurses to understand the stage of development of geriatric patients so that they can tailor their nursing care to either ego or despair. This is in terms of health education and promotion.
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American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Borji, M., Otaghi, M. & Kazembeigi, S. (2017). The impact of Orem’s self-care model on the quality of life in patients with type II diabetes. Biomedical & Pharmacology Journal, 10(1), 213-220, http://dx.doi.org/10.13005/bpj/1100
Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
Gonzalo, A. (March 5, 2021). Dorothea Orem: Self-care deficit theory. Nurseslabs. https://nurseslabs.com/dorothea-orems-self-care-theory/
Luke 10:25-37, NIV (The Holy Bible)
McLeod, S. (2018). Erik Erikson’s stages of psychosocial development. Simply Psychology. https://www.simplypsychology.org/Erik-Erikson.html
Risjord, M. (2018). Middle-range theories as models: New criteria for analysis and evaluation. Nursing Philosophy, 1-10. https://doi.org/10.1111/nup.12225
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9th ed. Jones & Bartlett Learning. Theory Guided Practice Paper Assignment
Theory-Guided Practice: Paper Assignment Instructions
The Theory-Guided Practice: Paper Assignment provides you the opportunity to identify and present an actual practice experience, restrospectively evaluated through the lens of middle-range theory. You will describe a nursing and borrowed middle-range theory and discuss the application of each theory to the identified practice experience. You will evaluate selected theories for substantive foundation, structural integrity, and functional adequacy. Furthermore, you will discuss the implications of the selected theories on nursing practice within the Christian worldview. The grading rubric serves as a guideline for the Theory-Guided Practice: Paper Assignment. The Theory-Guided Practice: Paper Assignment will be submitted in NURS 715 and reviewed by nursing faculty. The student is to revise the Theory-Guided Practice: Paper Assignment according to nursing faculty recommendations and upload it into his or her professional portfolio.
Practice Story: Introduce an actual practice experience, clearly defining “what mattered most to this patient”. A story has a beginning, middle, and ending. Include pertinent clinical presentation including relevant demographics, past health, surgical, social, and family history, primary diagnosis, laboratory, imaging and diagnostic procedures, and a physical exam. Discuss nursing considerations including socio-cultural implications, impact of health systems and policies, health promotion, and health literacy. Write this section in narrative format, focusing on the most important clinical considerations. It is not necessary to include every lab value and physicial exam finding. Tell the patient story with enough detail to paint an accurate picture of the most important aspects and what will be important as you apply theories to the case in later sections of the paper. Conclude with a brief summary of case analysis. Limit: 3 pages.
Middle-Range Nursing Theory: Description of the middle-range nursing theory. Describe the purpose, development, philosophical, and major concepts of the theory. Discuss application of the theory to the practice experience. Limit: 2 Pages.
Borrowed Theory: Description of the middle-range borrowed theory. Describe the purpose, development, philosophical, and major concepts of the theory. Discuss application of the theory to the practice experience. Limit: 2 Pages
Evaluation of Selected Theories: Discuss the strengths and weakness of the nursing and borrowed middle-range theories, including benefits and barriers to utilizing the theory in practice. Discuss selected theories through a biblical worldview. Include biblical reference. Limit: 3 Pages.
Implications to Nursing Practice: Discuss biblical, theory-guided nursing practice implications for the presented practice experience. Limit: 2 Pages
- Paper should be at least 10 but no more than 13 pages, excluding cover page and references.
- Utilize current APA format and LU guidelines for graduate level APA papers.
- Use at least 10 scholarly references.
- You do not need to include an abstract.
- Use headings to separate sections of your paper.
- This is a formal paper and first person should not be used. It’s important to have correct grammar, spelling, and paragraph formation. Theory Guided Practice Paper Assignment
Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.
Theory-Guided Practice: Outline Assignment Instructions
An outline is an excellent way to prepare to write a lengthly and detailed paper. It helps organize your thoughts, references, and sections of the paper. An outline also provides your instructor with a way to quickly preview what you intend to do with a paper and provide feedback. To prepare for writing the Theory-Guided Practice: Paper Assignment, you will develop a detailed outline addressing elements of the paper.
Before starting the outline, carefully read the assignment instructions for the Theory-Guided Practice: Paper Assignment and have them handy as you write your outline. You will want to cover the points detailed in the assignment instructions in your outline. Take this opportunity to search the Jerry Falwell Library for source material. You need a minimum of 5 sources for the outline. You may have sources older than 10 years if necessary to paint a complete picture of the theories you have chosen. The outline must follow this general outline format:
- Practice Story—include enough information for understanding of the clinical picture and clearly define “what mattered most” to the patient. Use an outline format as you develop this section.
- Put main points here and use numbering as below to expand on information as needed. You may use 1–2 sentences if needed but try to keep points brief as this is an outline. Be sure to put a citation next to points from source material. You will have points under the other main headings as well—this is just an example for format.
- Middle-Range Nursing Theory—When choosing a theory be sure it is one developed specifically for nursing. Address points as detailed in the instructions for the Theory-Guided Practice: Paper Assignment. Use an outline format as you develop this section.
III. Borrowed Theory— This must be a theory developed from a discipline besides nursing but one that nursing uses (i.e. Maslow, Theory of Coping, etc.). For both theories, be sure to apply it to the initial patient scenario you provided. Address points as detailed in the instructions for the Theory-Guided Practice: Paper Assignment. Use an outline format as you develop this section.
- Evaluation of Selected Theories— Be sure to include both theories and incorporate a Biblical worldview. Address points as detailed in instructions for the Theory-Guided Practice: Paper Assignment. Use an outline format as you develop this section.
- Implications to Nursing Practice— Apply the theories to nursing practice in general, with an emphasis on advanced nursing practice. Address points as detailed in instructions for the Theory-Guided Practice: Paper Assignment. Use an outline format as you develop this section.
- Use an outine format but provide enough detail to understand the patient story, theories, and application. This is not to be written as a paper but should pertinent information and include citations. Points will be deducted if an outline format is not used.
- Utilize APA format for citations and include a reference page. Include a cover page but not an abstract
- At least five scholarly sources should be utilized in writing the outline.
Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.
Theory Guided Practice Paper Assignment