Take one component in the Metaparadigm of Nursing, identify and discuss the concept or concepts of Watson’s Theory of Caring that support that Watson wrote a theory of nursing based on the criteria established in the Metaparadigm of Nursing.

Metaparadigm and Nursing: The Theory of Human Caring

Metaparadigm concepts in nursing theory provide the framework upon which the nursing theory is modelled. Four main metaparadigm concepts exist that explain a nursing theory’s conceptual framework. These are the environment, nursing, the person, and health. Together, they are referred to as metaparadigm for nursing (Wayne, 2021). One of the most commonly used nursing theories to which this metaparadigm for nursing applies is Jean Watson’s Theory of Human Caring (Alharbi & Baker, 2020; Pajnkihar et al., 2017). The theory underpins the caring aspect of the practice of nursing by proposing ten carative factors or caritas factors (Providence, 2020). The purpose of this paper is to discuss one concept of the metaparadigm for nursing that is clearly present in Watson’s caring theory. This is the metaparadigm concept of the environment.  Metaparadigm and Nursing Theory of Human Caring Essay Example

The Metaparadigm Concept of Environment in Relation to Watson’s Theory of Human Caring

The concept of environment in nursing theory refers to the situation in which the patient being cared for finds themselves. This is not in reference to the external environment alone, but also the internal milieu of the patient. Understandably, the internal and external environments for the patient offer both positive and negative components. All will impact the care given to the patient and their recovery.

Externally, the physical environment is very important to the healing of the patient. That is why one of the caritas factors in Watson’s theory dictates that the selfless nurse needs to provide a caring environment for the patient so that they can be returned to wellness within the shortest time possible. The physical environment includes the physical surroundings such as the building, the bed, the tables, the lavatory, and so on. These must be kept clean at all times to prevent hospital-acquired infections. The other patients, the healthcare workers, the relatives to the patient, and visitors all also form part of the external physical environment. Their actions will have a direct impact on whether the patient recovers fast or not. For instance, relatives coming to visit the patient with lowered immunity may inadvertently being an infection that ends up getting the patient.

The care atmosphere of the external environment also has a great impact on patient recovery. This is part of the healing environment and it is the duty of the nurse according to Watson to make it conducive. In order to facilitate a healing care environmental atmosphere, the nurse demonstrates empathy, compassion, love, and selflessness. The caritas factors that mirror this metaparadigm concept are (Providence, 2020):

• Showing kindness to the patient even as one cares for them.
• Restoring hope to the patient that they will get well.
• Creating an environment that fosters healing.
• Making the patient believe in miracles that can be performed by God, including healing.

Finally, the metaparadigm concept of environment also includes the internal environment as has been stated above. This includes the patient’s psychological status, emotional status, and spirituality. As the nurse caring for the patient and basing the care on the conceptual framework of the Theory of Human Caring, one would consider these holistically. This is also what Madeleine Leininger proposes in her transcultural nursing (TCN) theory (Gonzalo, 2019). The nurse thus reassures the patient, counsels them, and encourages them to express their spirituality.

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Personal Theory Improvement

Professional nursing practice is not haphazard but organized around a set of theories that inform the practice. The theories provide the rationale or explanation (conceptual framework) concerning the interventions taken when caring for patients. Because theories are abstract with only concepts, a way has to be found to make them applicable in actual practice settings. It is not possible to use the abstract concepts in the theories just the way they are. This is where the Conceptual-Theoretical-Empirical or CTE model comes in. The CTE model helps to apply the conceptual frameworks to practice.

The practice problem of pressure injuries has persisted as a quality issue despite advances in nursing and healthcare technology. Critically ill patients as well as those that are bed-ridden for one reason or another often develop pressure sores if not turned frequently to allow for adequate blood flow (Angmorterh et al., 2019; Gaspar et al., 2019). Jean Watson’s theory of Human Caring is a grand theory that informs nursing practice with its ten carative or caritas factors. It states that the nurse must care for patients selflessly and provide a loving and healing environment for them (Alharbi & Baker, 2020; Pajnkihar et al., 2017).  Metaparadigm and Nursing Theory of Human Caring Essay Example

In the matter of pressure injuries, their development (concept A) is related to (proposition) the lack of frequent turning and pressure area care (concept B) by the nurses. A caritas factor applicable to concept A in this case is helping others by being kind to them (Providence, 2020). By frequently turning the patient and massaging their bony prominences that are susceptible to pressure ulcers, the nurse will be helping with kindness. This factor can be measured later by considering the drop in the average rate of pressure injuries in the unit/ hospital.

The second caritas factor that would apply to concept B and the need for the patient to get better is assisting others to change their beliefs and practices (Providence, 2020). This will be achieved by educating the patients (those that are conscious) and the nurses on identification of pressure ulcer risk and the need to take action. The measurement of this can take place by using a Likert-scale type questionnaire to survey patient satisfaction with nursing care.

Measuring Effectiveness or Empirical Evidence

Effectiveness of the preventive measures undertaken to stop the occurrence of pressure ulcers can be measured by calculating the average rate of pressure ulcer development. This is done by taking the total number of patients with pressure injuries and dividing by the total number of patients then multiplying by a factor of 100 to get the percentage rate of prevalence. The other measurement of empirical evidence will take the form of a patient satisfaction survey using a Likert-type questionnaire. It will be filled by inpatients that have been confined to the bed in the hospital for a number of days (more than three days). This will give an indication of their satisfaction with the care given to them.

There are other interventions in the utilization for the prevention of pressure ulcers aside from frequent turning and massage. The evaluation of the patient’s nutritional status, the use of pyramidal mattress to allow for repositioning, and the overall patient physical examination are to be assessed for determining risks for pressure injury (Macena et al., 2017).

The empirical indicators for are the methods used to conduct a research study (Eustace, 2019). In evaluating a patient’s risk for developing pressure injury, there are different tools to help the nurse identify which patients that are at high risk. We’re familiar with the Braden scale, which measures six factors (activity, mobility, sensory perception, moisture, nutrition and friction/shear) in averaging the risk for a patient in developing pressure injuries (Macena et al., 2017). Similarly, other scales can be used to evaluate a patient’s risks for pressure injury. The Norton scale incorporates the factors of the physical condition, incontinence, mental status, activity and mobility (Macena et al., 2017). The Waterlow scale takes account for body mass index, skin type, nutrition, sex, age, continence, mobility, neurological deficiency, major surgery or trauma, and medications (Macena et al., 2017). These scales can be used as empirical indicators to measure the patient’s risks for developing pressure injuries.  Metaparadigm and Nursing Theory of Human Caring Essay Example

Personal Theory

Nursing theories usually explain the main pillars that guide nursing practice. Theoretically, all relevant evidence-based therapies used by nurses in the course of patient care should be sound. Conceptual frameworks, which are found exclusively in nursing theories, supply them. As a result, conceptual frameworks serve as the foundation for solid evidence-based practice, or EBP. Nursing theoretical concepts guide, direct, and steer practice in the same manner that a lighthouse at sea guides, directs, and steers a ship to avoid hazards and obstructions that may render interventions inefficient and useless. There are three types of nursing theories, each with its own level of abstraction in terms of concepts. All nursing theories, according to Wayne (2020), will be grand theories, mid-range theories, or practice-level theories. Grand theories are the most abstract of the three, while practice-level theories are the least abstract. Practice-level theories are simple and direct, but middle-range theories are narrower in scope and are the most common type of nursing theory (Risjord, 2018). Environmental Theory, Transcultural Nursing (TCN) Theory, Self-Care Deficit Theory (SCDT), and Watson’s Theory of Human Caring are some of the most well-known and frequently discussed nursing theories (Alharbi & Baker, 2020; Gonzalo, 2019a; Gonzalo, 2019b; Pajnkihar et al., 2017; Borji et al., 2017 ). This paper presents a theory about the formation of pressure ulcers (concept A) and the causality relationship that this has with the actions of nurses providing care (concept B), while giving the correlative proposition linking the two together at the same time.

In my area of practice, I have observed that rates of pressure ulcer development usually go down when particular measures are practiced consistently over time by the nurses. The theory I have come up with is that a positive relationship exists between performing these acts and obtaining favorable patient outcomes. This is a relationship of causality because these actions by nurses directly result in improved quality of care and reduced hospital stay. The actions include:

• Elevating the head of the bed at an inclination of less than 30° (Burk & Grap, 2012).
• Keeping everything clean and dry, proper diet and hydration to keep skin healthy and frequent repositioning
• Using appropriate pressure-relieving support surfaces such as special mattresses, and
• Performing pressure area care (massaging and applying baby powder) every two hours for bed-ridden patients (Angmorterh et al., 2019; Gaspar et al., 2019; Nixon et al., 2019; Baron et al., 2016).

The main point of discussion is the theory that the omissions and commissions of nurses are responsible for the causation of pressure injuries. As the above evidence stated portray, that there are evidence-based interventions that will prevent the development of pressure ulcers if nurses implement them consistently. This deduction is made from the proposition that a correlation exists between the actions/ inaction of nurses and the formation of the pressure injuries in bed-ridden patients.

Concept A: Nurses perform pressure area care every two hours to bed-ridden patients., keeping skin dry and clean. Proper nutrition / hydration. They also turn the patients, make them lay on comfortable support surfaces, and elevate the head of the bed (Angmorterh et al., 2019; Gaspar et al., 2019).

Concept B: Pressure ulcer rates drop significantly as a consequence of the actions of the nurses as outlined in concept A (Nixon et al., 2019; Baron et al., 2016).

Proposition: The actions in concept A by the nurses have a clear bearing on the reality in concept B. The actions result in the reduction of the number of bed-ridden patients developing pressure sores (Kottner et al., 2019). In other words, there is a direct relationship between the actions of the nurses and the improvement in the quality of nursing care.

The concept explained above is drawn from clinical practice and informed by what has been observed. Pressure ulcers are one of the occurrences that put a dent in the quality of care. Finding a theory that explains their prevention is therefore important for evidence-based practice. Concept A is related to concept B and the proposition in-between has been clearly explained.

References

Alharbi, K.N., & Baker, O.G., (2020). Jean Watson’s middle range Theory of Human Caring: A critique. International Journal of Advanced Multidisciplinary Scientific Research, 3(1), 1-14. https://doi.org/10.31426/ijamsr.2020.3.1.3011

Angmorterh, S. K., England, A., Webb, J., Szczepura, K., Stephens, M., Anaman-Torgbor, J., … & Hogg, P. (2019). An investigation of pressure ulcer risk, comfort, and pain in medical imaging. Journal of Medical Imaging and Radiation Sciences, 50(1), 43-52. http://dx.doi.org/10.1016/j.jmir.2018.07.003

Baron, M. V., Reuter, C. P., Burgos, M. S., Cavalli, V., Brandenburg, C., & Krug, S. B. F. (2016). Experimental study with nursing staff related to the knowledge about pressure ulcers. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/1518-8345.1134.2831

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

Burk, R.S., & Grap, M.J. (2012). Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations. Heart & Lung: The Journal of Acute and Critical Care, 41(6), 536–545. https://doi.org/10.1016/j.hrtlng.2012.05.008

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. http://dx.doi.org/10.1111/iwj.13147

Gonzalo, A. (2019a). Madeleine Leininger: Transcultural nursing theory. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/

Gonzalo, A. (2019b). Florence Nightingale: Environmental theory. Nurses Labs. https://nurseslabs.com/florence-nightingales-environmental-theory/#:~:text=The%20Environmental%20Theory%20by%20Florence,health%2C%20and%20that%20external%20factors

Kottner, J., Cuddigan, J., Carville, K., Balzer, K., Berlowitz, D., Law, S., … & Sigaudo-Roussel, D. (2019). Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. Journal of Tissue Viability, 28(2), 51-58. https://doi.org/10.1016/j.jtv.2019.01.001

Nixon, J., Smith, I. L., Brown, S., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., … & Henderson, V. (2019). Pressure relieving support surfaces for pressure ulcer prevention (PRESSURE 2): Clinical and health economic results of a randomized controlled trial. EClinicalMedicine, 14, 42-52. http://dx.doi.org/10.1016/j.eclinm.2019.07.018

Pajnkihar, M., McKenna, H.P., Stiglic, G., & Vrbnjak, D. (2017). Fit for practice: Analysis and evaluation of Watson’s theory of human caring. Nursing Science Quarterly, 30(3). https://doi.org/10.1177/0894318417708409

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

Wayne, G. (2020). Nursing theories and theorists. Nurses Labs. https://nurseslabs.com/nursing-theories/#:~:text=There%20are%20three%20major%20categories,%2C%20and%20practice%2Dlevel%20theory    Metaparadigm and Nursing Theory of Human Caring Essay Example