Identify one quality improvement strategy to improve health. How could you apply it to your current nursing practice? How does the assimilation of quality improvement strategies enhance leadership?
This assignment comes in 2 parts. Part 1 is for discussions and part 2 is an assignment. In part 1 each discussion should include 250-300 words to answer the selected topic. Each question will need 2 peer responses of 150 words an 1 reference. Part 1 Discussions:
Question 1: Identify one quality improvement strategy to improve health. How could you apply it to your current nursing practice? How does the assimilation of quality improvement strategies enhance leadership?
Question 2: With the rough draft of your nursing comparison paper due this week, a focused review of the basics of APA Style is important. After you have reviewed the WCU Library guides on APA, share something you learned with your peers. Also, attach examples from your rough draft that include both an in-text citation you used when you were paraphrasing and one you used when you were directly quoting. In addition, attach the reference page from your rough draft so that you can review each other’s work and provide peer-to-peer feedback.
Part 2: THIS PART OF THE DOCUMENT HAVE TO BE EXACTLY AS THE INSTRUCTOR DESCRIBED IT.
The purpose of this assignment is to draft and submit a comprehensive and complete rough draft of your Nursing Theory Comparison paper in APA style. Your rough draft should include all of the research paper elements of a final draft, which are listed below. This will give you an opportunity for feedback from your instructor before you submit your final draft during week 7.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory.
After studying and analyzing the approved theory, write about this theory, including an overview of the theory and specific examples of how it could be applied in your own clinical setting.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 10 and 11), select a middle-range theory.
After studying and analyzing the approved theory, write about this theory, including an overview of the theory and specific examples of how it could be applied in your own clinical setting.
The following should be included:
An introduction, including an overview of both selected nursing theories
Background of the theories
Philosophical underpinnings of the theories
Major assumptions, concepts, and relationships
Clinical applications/usefulness/value to extending nursing science testability
Comparison of the use of both theories in nursing practice
Specific examples of how both theories could be applied in your specific clinical setting
Parsimony
Conclusion/summary
References: Use the course text and a minimum of three additional sources, listed in APA style
The paper should be 9–10 pages long and based on instructor-approved theories. It should be typed in Times New Roman with 12-point font, and double-spaced with 1″ margins. APA style must be used, including a properly formatted cover page, in-text citations, and a reference list. The proper use of headings in APA style is also required.
The theories selected are below.
For the comparison, I choose the Nightingale Environmental theory and the AACN Synergy Model for the grand and midrange theories. The two theories are important to me because the founder of modern nursing developed the Nightingale theory. Therefore, the theory provided the basis for future theories. It showed how nurses’ role should involve the manipulation of the environment to improve patient outcomes (McEwan & Wills, 2021). It recognizes nursing as a role that provides conducive environments for patients to recover. The AACN Synergy Model emphasizes aligning the competencies of nurses and the patient’s needs (McEwan & Wills, 2021). Therefore, the needs of patients should determine the skills that professionals will need to provide efficient care. The two theories look at nursing differently, and understanding them may help one understand how far the profession has come.
Reference
McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing. Lippincott Williams & Wilkins.
NURS_500_DE – Theory Comparison Paper Rubric
PLEASE READ THIS IMPORTANT INSTRUCTIONS. THIS PART OF THE DOCUMENT HAVE TO BE EXACTLY AS THE INSTRUCTOR DESCRIBED IT.
Example paper attached:
4 Example Grand and Middle Range Theories.docx Download 4 Example Grand and Middle Range Theories.docx
I want every one of you to be rewarded for your hard work on these papers. In order to get the best grade possible, please follow these instructions.
Step One- choose your theories. If they are listed in the reading, consider them approved, no need to send the request to me via the Journal area!!! (THEORIES HAVE BEED SUBMITTED AND APPROVED PREVIOUSLY.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 10 and 11), select a middle-range theory.
Please use these bold headings to organize your paper. You are simply comparing the two theories back and forth.
In your reading, you will find a thorough description of each component below and fully describes what you need to research about your chosen theories to fill in the section.
Introduction
Overview of your chosen grand theory
Overview of your chosen middle range theory
You will have a separate paragraph in each section, one for your grand range theory and one for your middle range theory.
Background of the theories
(Grand theory chosen)-
(Middle range theory chosen) –
Philosophical Underpinnings
(Grand theory chosen)-
(Middle range theory chosen) –
Major assumptions, concepts, and relationships
(Grand theory -)
(Middle range theory -)
Clinical applications
(Hint: usefulness/value to extending nursing science testability)
(Grand theory-)
(Middle range theory -)
Application to nursing practice
(Hint: Comparison of how to use of your theories in nursing practice)
(Grand theory-)
(Middle range theory -)
Application to my practice
(Hint: Specific examples of how both theories could be applied in your specific clinical setting)
Grand theory-
Middle range theory –
Parsimony
(Hint: how simple or complex are the theories?
Grand theory-
Middle range theory
Conclusion
Every formal paper must have a formulated conclusion!
Four References: Course text and a minimum of three additional sources.
The paper should be 9–10 pages long- not including your Cover and Reference pages.
Times New Roman,12-point font, and double-spaced with 1″ margins.
APA format (7th ed.) a properly formatted cover page and reference list. See the link below for 7th edition APA updates!
APA 7th Edition Update (1).pdf
IMPORTANT: Even though this is titled a rough draft- it means you will complete the entire paper- not just sections or outlines of the content. A completed paper- the more work you put into now, the better grade you will receive on the rough draft and you will have very little work to do on it when you submit your final paper in week 7.
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeContent
90 to >73.8 pts
Meets Expectations
Content is clear, thorough, and organized effectively. Main points well supported. All specific portions of the assignment have been addressed. Meets all the criteria of the written assignment
73.8 to >67.5 pts
Approaches Expectations
Content is somewhat clear, thorough, and organized effectively. Most of the specific portions of the assignment have been addressed. Some points well supported. Meets most of the criteria of the written assignment
67.5 to >53.1 pts
Falls Below Expectations
Content is generally unclear, not thorough, and organized ineffectively. Some of the specific portions of the assignment have been addressed. Main points not well supported. Meets only a few of the criteria of the written assignment
53.1 to >0 pts
Does Not Meet Expectations
Content is generally unclear, not thorough, and organized ineffectively. Some of the specific portions of the assignment have been addressed. Main points not well supported. Meets only a few of the criteria of the written assignment
90 pts
This criterion is linked to a Learning OutcomeWriting Style
15 to >12.3 pts
Meets Expectations
Writing is professional with no spelling or grammatical errors and has been carefully proofread. Captures and maintains reader’s interest
12.3 to >11.25 pts
Approaches Expectations
Writing follows normal conventions and has minor spelling, punctuation and grammatical errors throughout. Efforts made to capture and maintain reader’s interest
11.25 to >8.85 pts
Falls Below Expectations
Writing does not consistently follow appropriate style of format with frequent spelling, punctuation and grammatical errors. Do not capture or maintain reader’s interest
8.85 to >0 pts
Does Not Meet Expectations
Writing does not consistently follow appropriate style of format with frequent spelling, punctuation and grammatical errors. Do not capture or maintain reader’s interest
15 pts
This criterion is linked to a Learning OutcomeClarity & Coherence
22.5 to >18.45 pts
Meets Expectations
Writing flows smoothly from one idea to another. Writer has taken pains to assist the reader in following the logic of the ideas expressed
18.45 to >16.88 pts
Approaches Expectations
Sentences are mostly structured to communicate ideas clearly. Transitions between paragraphs make the writer’s points easy to follow
16.88 to >13.27 pts
Falls Below Expectations
Sentence structure and word choice sometimes interferes with clarity of content and distracts the reader
13.27 to >0 pts
Does Not Meet Expectations
Poor sentence structure, sentences do not make sense to the reader, no clarity evident in the paper
22.5 pts
This criterion is linked to a Learning OutcomeReferences
7.5 to >6.15 pts
Meets Expectations
References included throughout paper in APA format
6.15 to >5.63 pts
Approaches Expectations
References included throughout paper but not all are in APA format
5.63 to >4.43 pts
Falls Below Expectations
References included but unclear which references are direct quotes and which are paraphrased
4.43 to >0 pts
Does Not Meet Expectations
No references included in the body of the paper and writing indicates none were used
7.5 pts
This criterion is linked to a Learning OutcomeCover page & Reference Page
7.5 to >5.93 pts
Meets Expectations
Cover page and reference page are in APA format with appropriate number of references included
5.93 to >5.63 pts
Approaches Expectations
Cover page and reference page are in APA format with some references included
5.63 to >4.43 pts
Falls Below Expectations
Cover page and reference age are mostly in APA format with few references included
4.43 to >0 pts
Does Not Meet Expectations
Cover page and reference page are not in APA format or no cover or reference page included
7.5 pts
This criterion is linked to a Learning OutcomePresentation
7.5 to >5.93 pts
Meets Expectations
Paper is presented professionally, word –processed, double spaced, 12 point font, 1” margins on all sides
5.93 to >5.63 pts
Approaches Expectations
Paper is word- processed but contains only minimal errors in spacing, font or margins
5.63 to >4.43 pts
Falls Below Expectations
Paper is word-processed but does not appear professional with errors in two areas of spacing, font or margins
4.43 to >0 pts
Does Not Meet Expectations
Paper is word-processed but does not appear professional with errors in all area of spacing, font or margins, or it is hand-written
7.5 pts
Total Points: 150
Requirements: as instructed
Student Name
West Coast University
NURS 500; Theoretical Foundations of Nursing
Dr. Kendrick
Date
The purpose of this paper is to review two selected nursing theorist one grand and one middle range theory. Throughout this paper the grand theory of Florence Nightingale’s environmental theory and the middle range theory of Kristen Swanson’s theory of caring will be discussed, reviewed, and compared.
Florence Nightingale’s environmental theory has five important elements, pure water, pure air, efficient drainage, light and cleanliness. Thus, producing a healthy atmosphere crucial for healing (Zborowsky, 2014). Her theory in considered a grand theory because it has a broad scope. It presents general concepts that are good for directing, explaining, and predicting nursing situations (McEwen & Wills, 2017). The grand theories are relevant to all areas of nursing yet may not be beneficial to detailed research questions because of its broad scope.
Kristen Swanson’s theory of caring is a middle range theory with five caring processes, knowing, being, doing, enabling, and maintaining belief (Jarvis, 2019). This theory supports nursing care as a process that develops from the nurses’ beliefs, knowledge, and relationship with the patient. This is a middle range theory that is narrower in scope than grand range theories and assist in guiding nursing practice and research (McEwen & Wills, 2017). Middle range theories are therefore more straight forward and limited to an area of practice. Swanson’s theory originated around pregnancy issues.
Background
According to Zborowsky (2014). Florence Nightingale was born on May 12, 1820 in Florence Italy. She was born into an affluent family however never felt comfortable with socializing. She had a classical education and early on was interested in ministering to the poor and ill. She felt nursing was her purpose and calling. Her parents were not supportive of her desire to pursue nursing training. In 1851, she received her educational and clinical training in Germany. In 1854 she served as a nurse in the Crimean war, then went to London. There she was awarded money from the British government. She took that money and started a school for nurses in 1860. Her goal was to teach what was needed to be done and how to do it. She also taught about symptoms of diseases and what they meant. In 1859, her famous book, Notes on Nursing, was published she distinguished nursing separate from medical knowledge and taught on the purpose of nursing duties (McEwen & Wills, 2017). She improved statistics analysis with her observations and aided the military hospitals in efficient restructuring of services. She died August 13, 1910 spending her life preventing disease and providing safe and compassionate care to the impoverished and suffering. Florence Nightingale has been seen as the originator of nursing theory and certainly one of the most prominent nurses throughout history (Zborowsky, 2014).
Kristen Swanson was born January 13th, 1953 and received her baccalaureate degree in 1975 from the University of Rohde Island. In 1978 she received her master’s degree in nursing from the University of Pennsylvania and then her Ph.D. from the University of Colorado (Swanson, 1991). According to Amendolair (2012), her doctoral dissertation was focused on caring for patients having a miscarriage (spontaneous abortion). She was influenced by Dr. Jean Watson’s grand theory of Human Caring Theory developed in 1970. Then in 1991 Swanson developed her theory encompassing the five processes of caring. She was also interested in socially at-risk mothers. Currently she is the Dean and Professor at the Seattle University College of Nursing and is on the board of the American Association of Colleges of Nursing (AACN). Her theories help patients deal with miscarriages and cover helpful counseling, her theories encompass physical and emotional healing. She is also an alumnus of the Robert Wood Johnson Executive Nurse Fellows Program, this is a progressive leadership resource for nurses in upper level administrative roles who purpose to lead changes in the United States healthcare system (Swanson, 1991).
Philosophical Underpinnings
According to McEwen & Wills (2017) Florence Nightingale theory is thought to be a wide-range viewpoint yet her work is a foundational philosophy. Her fundamental principle was healing and consequent to it are the principles of leadership and worldwide action. Together these principles are needed to provide healing. The environmental theory has inspired the nursing profession and education for over 150 years. Nightingale did not think that nurses were meant to be submissive to doctors. She saw nursing as an individual vocation all its own. Florence Nightingale’s educational model teaches nurses to be aware of patients’ needs, meet patients’ needs and know how to carry out the professional actions of a nurse. Nightingale’s philosophy came about over years of providing nursing care and study. It is an intellectual and factual philosophy and is categorized as a grand theory.
The philosophical underpinnings and contributions of Swanson’s theory of caring can also be reviewed by the four concepts of the nursing metaparadigm, person, health, environment, and nursing (Jarvis, 2019). The person being the most essential part of Swanson’s theory this emphasis on the caring process as the philosophical underpinnings. The viewpoint of Swanson’s theory is that nurses are educated through scientific information and learning through clinical practice, humanities and cultural values (Peterson & Bredow, 2019). Each person is unique and made up of their own feelings, ideas and behaviors. The nurse not only addresses the patient but family and society. The environment should be therapeutic for the patient. The concept of caring especially in the instance this theory was derived, is clearly powerful and beneficial to the wellbeing of the patient both physically and emotionally.
Major Assumptions, Concepts, and Relationships
Florence nightingale’s theory has the straightforward and understandable ideas of health and wellness. She also defines it as “the act of utilizing the environment of the patient to assist him in his recovery” (Nightingale, 1992, p.41). Therefore, the environment is an external factor that can affect the patient’s health. The five environmental factors are the foundation of the theory. The nurse is accountable to adapt and assess the environmental setting so that it will improve the patient’s health. The concepts of Nightingales’ theory are fresh air, pure water, effective drainage, cleanliness, and light (Zborowsky, 2014). According to Selanders & Crane (2012) the concepts can be branched out into heading that expand on the five environmental factors. First the health of the house, construction should ensure air is not stagnant. Next ventilation and warming, supplying fresh air without odors. Then the need for direct sunlight and a quiet environment, never waking a patient intentionally. Variety is expanded upon as Nightingale would rotate paintings, provide activities, and read and write with the patient so they were not bored. The bed and sheets were to be in the sun light and the bed not to be shaken or sat on. Personal cleanliness is encouraged as the nurse is to wash her hands often. Nutrition was encouraged in small frequent feedings and the nurse was not to distract them when they were eating. Socially is was encouraged to support the patient and talk with them. Nightingale wrote over 150 books and reports on healthcare topics and she is credited with producing one of the first forms of the pie chart. Hospitals are cleaner because of Nightingales early work and education of nurses, making them a safer place to be.
Swanson’s theory of caring is based on her research and practice. According to Amendolair (2012) Swanson classified five activities that nurses used to improve patient care and meet their needs. These practices include knowing, being with, doing for, enabling, and maintaining belief. To improve nursing care and foster the patients’ health both physically and emotionally, the nurse incorporates these five activities and makes a personal, patient centered plan of care. In doing this the nurse also expresses dignity and importance of the patient. Swanson focused on pregnancy issues in her theories and reports that nurses are natural caregivers. Her theories have been used in obstetric education. The caring theory’s first component of caring is knowing, here the nurse avoids assumptions, does a detailed assessment and looks for cues. Being with, denotes enduring with the patient, sharing, but not burdening the patient. Doing for, is comforting, protecting, anticipating needs, and preserving the patient’s dignity. Enabling or informing, would be validating the patient’s feelings, advocating, explaining and giving back. In maintaining belief, the nurse would offer realistic hopefulness, believing in the patient and helping the patient to find meaning. In practice the nurse should utilize all five caring process steps. Swanson is still practicing and publishing today using her theories to improve healthcare and nursing.
Clinical Applications
The clinical applications of Florence Nightingales’ environmental theory put the responsibility of the patient on the nurse’s assessment skills and ingenuity. Even though the nurse can be busy and have many sick patients it is their responsibility to prevent bedsores, report and treat a fever, make sure the patient is nourished and warm and monitor their vital signs, lab results and environment for safety. The nurse should identify and reduce patient distress. She called nursing an art not a science and detailed many nursing tasks are still pertinent today (McEwen & Wills, 2017). Research today has reinforced her ideas on noise in the patient care area and environmental cleanliness and safety (McEwen & Wills, 2017). Therefore, today the clinical application of Nightingales theory stands true in healthcare and has stood the test of time.
Swanson theory of caring includes physical and emotional care for women who have miscarried, neonatal intensive care unit (NICU) caregivers, and mothers considered socially at risk (Jarvis, 2019). According to Kavanaugh, Moro, Savage, and Mehendale (2006) her clinical applications are relevant not only within those specific care settings but also in other delicate topics that involve vulnerable patients. This includes parents who had suffered the death of their infant or were engaged in making a life support decision because of possibly giving birth to a very premature infant less than 26 weeks gestation. In this study the caring characteristics and the trusting relationship that was formed by following Swanson’s caring theory produced a more productive and positive outcome perceived by the patient. Therefore, the clinical applications of Swanson’s caring theory are relevant and remain useful in clinical practice.
Application to Nursing Practice
An example of how Florence Nightingale’s theory is used today in nursing practice would include advocacy. Nursing is a complex profession and although Nightingale did not address specifically nurse advocacy, all her theories support this idea. In her publications she was a voice advocating for equal human rights, involving religion, sex, status, and the right to a peaceful death (Selanders & Crane, 2012). In this way Nightingale was ahead of her time and remains relevant today. In her environmental theories a good example of an application today could be seen in home health evaluations and care. Nurses are trained to look for unhealthy and unsafe living conditions, identify them and improve them. This would be the approach set forth in Nightingale’s theory.
In Swanson’s theory of caring the successful use of the five caring processes, knowing, being, doing, enabling, and maintaining belief would help a family cope after a miscarriage (Jarvis, 2019). The first thing a nurse would do is to give compassion, provide time and space for the family and be a good listener when they talk. Form a patient nurse relationship, touch her hand, and let her know how sorry you are for their loss. Assist the patient and encourage them to do what they normally do for themselves and provide privacy. Placing a rose or a sign on the door that fetal demise has happened to alert staff to be respectful and sympathetic. Provide a journal for the family to write down their feelings, information on the healing process, and support groups. Lastly provide closure by offering the family to hold the baby. Step by step going through the process will provide support for the family and will help the grieving patient move on.
Application to My Practice
In my nursing practice Nightingale’s theory is very relevant. Working with the elderly I encourage sunlight and walks outside on sunny days. I urge patients to eat healthy and offer healthy snacks. I am assessing the situation and environment to improve the comfort of the patient and safety of the environment to prevent injuries. The room must be kept clean and orderly, and patients have the option to request a quiet room at night, and not be disturbed. Patients are also engaged during the day with activities and religious services. This theory provides patients with a happy and healthy living environment.
Swanson’s theory of caring in my practice is useful although I could only find one reference to this theory in the elderly. I know I have used the process with grieving patients or patients that have received a poor prognosis. According to Yin-Tzu, Sin-Rong, and Chi-Yin (2019) utilizing the five steps in an elderly patient with vasculitis, unable to walk and delayed discharge from the hospital provided the patient with hope and positive beliefs about the future. When disease and lack of mobility in the elderly cause a feeling of hopelessness, working through the five steps of caring is a way to form a trusting and caring relationship with a patient and provide emotional support.
Parsimony
Nightingale concisely stated how important the environmental theory was to care for sick patients. She has condensed her thoughts into small volumes and included information about nursing treatment, patient needs, good structures where the patients can be treated, and the management of hospitals (McEwen & Wills, 2017).
Understand parsimony is to observe that the description with the least number of steps is often the strongest. Swanson’s theory can be simplified into two steps, see figure 1. The five steps of her theory can be condensed to maintain the parsimony of her idea: nursing philosophies and experience nursing will produce acts of caring and in the end, patient wellbeing (Swanson, 1993).
Conclusion
This review and assessment have been an opportunity for me to understand and be grateful to the nurse theorist who have made such a vast contribution to the nursing profession and healthcare industry. Nightingale theory is developed around simple and familiar concepts that are easy to utilize and practice. Today healthcare has so many amazing advancements and technology, yet if Nightingale’s basic principles are followed disease will be prevented. Likewise, Swanson’s theory has a simplicity of caring that is clearly healing when a patient is hurting physically and emotionally. The caring theory of being emotionally present for the patient, respecting the patient’s dignity, maintaining a knowledgeable practice, being objective and meeting the needs of the patient as a unique person, gives patients the ability to express themselves and improve their wellbeing. This piece has encouraged me to further understand nursing theory and improve my nursing care and make it more of an art.
References
Amendolair, D. (2012). Caring Model: Putting research into practice. International Journal of Human Caring, 16(4), 14-21. DOI:10.20467/1091-5710.16.4.14
Jarrin, O. F. (2007). An integral philosophy and definition of nursing. School of Nursing Scholarly Works. 47. https://opencommons.uconn.edu/son_articles/47
Jarvis, K. (2019). Swanson’s theory of caring: An application to the role of nursing Education. International Journal for Human Caring, 23(3), 266-271. DOI: 10.20467/1091-5710.23.3.266
Kavanaugh, K., Moro, T. T., Savage, T., & Mehendale, R. (2006). Enacting a theory of caring to recruit and retain vulnerable participants for sensitive research. Research in Nursing & Health, 29(3), 244-252. https://pubmed.ncbi.nlm.nih.gov/16676343/
McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.
Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Lippincott Williams & Wilkins.
Peterson, S., & Bredow, T. S. (2019). Middle range theories: Application to nursing research and practice. Lippincott Williams & Wilkins.
Selanders, L., & Crane, P. (2012). The voice of Florence Nightingale on advocacy. The Online Journal of Issues in Nursing, 17(1). https://pubmed.ncbi.nlm.nih.gov/22320877/
Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166. https://pubmed.ncbi.nlm.nih.gov/2030995/
Wojnar, D. M., & Swanson, K. M. (2007). Phenomenology: An exploration. Journal of Holistic Nursing, 25(3), 172-180. DOI:10.1177/0898010106295172
Yin-Tzu Chen, Sin-Rong Lin & Chi-Yin Kao. (2019). Applying Swanson’s theory of caring to manage powerlessness in an older patient with vasculitis. Journal of Nursing, 66(3), 112–119. DOI: 10.6224/JN.201906
Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. https://doi.org/10.1177/193758671400700404
Swanson’s Theory of Caring
Figure 1. The Structure of Caring displayed in its original format from Swanson (1993) “Nursing as Informed Caring for the Well-Being of Others”, (p.355).
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