Writer Choice
40928For this assignment, you will be further defining your Phenomenon of Interest within a theoretical and scientific framework.
The same Phenomenon of Interest (POI) identified in your first written paper should also be used for this assignment.
You will begin this paper by providing a concise description of your POI, this information should be a short summary of the information presented in your first paper.
Next, you will discuss the Fawcett’s Meta-paradigm of Nursing and relate the paradigm directly to your POI.
Then, you will select both a Grand nursing theory as well as a Middle range nursing theory. Take time to review several examples of each type of theory as the selected theories need to “fit” your POI…and work well together.
Grand theory discussion: identify and discuss the inter-related concepts from your selected theory. What aspects of the nursing meta-paradigm are addressed by your grand theory? Then provide information about how you will view your POI through the lens of the grand theory. How does the theory guide your assessment of the POI? How does the theoretical framework chosen categorize or define your POI? How does the theoretical framework effect your perception of the POI?
Middle range theory discussion: identify and discuss the inter-related concepts within the middle range theory. What aspects of the nursing meta-paradigm are addressed in the mid-range theory? How will this theory guide your assessment/perception of the POI? How does this mid-range theory relate to your grand theory?
Complexity science: how does complexity science relate to your POI? Depending on the nature of your POI, this conversation may have different foci for different students. For example, if your POI is glycemic management of the peri-operative patient, this discussion would center on the complex responses of the human body as a Complex Adaptive System. If your POI is focused on a policy change issue, the focus may be on organizational complexities with communication, change, etc. You must identify a Complex Adaptive System that relates to your POI in this section.
You will then discuss the ethical principles and an ethical framework to guide you advance nursing practice.
Ethical/bioethical principles: Describe the ethical principles that relate to your identified phenomenon of interest.
How will rach principle direct your advanced nursing specialty practice?
Describe the difference in a moral conflict and a moral demimma.
Ethical Framework: Identify an ethical framework that will direct your advanced nursing practice.
Which ethical principles are included in the ethical framework?
Why was this ethical framework selected? Describe its relevance to you.
Conclusion: This section should not contain any new information but should only provide a summary of what was discussed in the paper.
A few important points:
Since you are going to be discussing theories within this paper, it is very important to provide the PRIMARY source when referencing the theory either in text and on the reference list.
Who wrote the theory? And when was it published? Answer those questions and that is who the citation should be. For example, Roger’s theory of unitary beings should be cited to Rogers, not to a textbook or journal article that discusses the theory. If you are having problems locating the original source for the theory, refer to the reference lists with articles or in books that you are reviewing. You will almost certainly find the original source referenced within the article or textbook.
This is a scholarly assignment which means it should be liberally referenced with peer-reviewed literature. Support what you say with evidence from the literature. There are a number of potential references provided for you in the Required readings and resources of this Lesson’s Unit. This should be a great start, but searching the literature for further resources is also required.
The grading rubric and assignment transparency are provided below for your review.
Nursing Theory
Nursing theories are constructed as a framework of knowledge that is applied in a pattern to guide and facilitate thought.
Grand Nursing Theory
Among the core beliefs of nursing is the idea that nursing should be founded on the best empirical evidence, incorporate the beliefs of patients and families, and be guided by disciplinary theory (Pipe, 2013).
Beginning in the 1950’s multiple theories of nursing were developed; some scholars believe the first nursing theory was postulated by Florence Nightingale when she published her “Notes on Nursing” in 1860. As we discussed in an earlier Unit, concepts are the building blocks of theory.
A theory that defines the relationship between two or more concepts; conceptual models of nursing are typically called “Grand nursing theories”. Grand theories are quite abstract and usually do not provide specific instruction for nursing actions (Kenney, 2013).
While there are a number of grand nursing theories, a few will be briefly discussed here.
Grand Nursing Theory Paradigms: Nursing as a professional discipline evolves and transforms with scientific discoveries, technological advances, and in response to changes in the health care delivery system. Nursing theory has evolved as new paradigms arise, although the theoretical foundations may remain unchanged.
1. Integrative/Interactive Paradigm: View of the patient as an individual that interacts and is integrated with the environment that impacts health as a larger system (Smith & Parker, 2015).
Dorothy Johnson’s Behavioral System Model
Dorothy Orem’s Self-care Deficit Nursing Theory
Imogene King’s Theory of Goal Attainment
Sister Callista Roy’s Adaptation Model
Betty Neuman’s Systems Model
2. Unitary/Transformative Paradigm: View of the patient as a human being that is part of the environment; with the human being and environment changing together through a mutual pattern (Smith & Parker, 2015).
Martha Rogers Science of Unitary Human Beings
Rosemarie Rizzo Parse’s Humanbecoming Paradigm
Marget Newman’s Theory of Health as Expanding Consciousness
3. Care or Caring Paradigm: View of care and caring as central to the discipline of nursing (Smith & Parker, 2015).
Madeleine Leininger’s Theory of Culture Care Diversity and Universality
Jean Watson’s Theory of Caring
Anne Boykin and Savina Schoenhofer’s Theory of Nursing as Caring
References
Fawcett, J. (1984). The meta-paradigm of nursing: Current status and future refinements. Image: Journal of Nursing Scholarship. 16, 84-87. Retrieved from: http://www.nursingsociety.org/Publication
Griffin, M.T.Q., & Landers, M.G. (2014). Extant nursing models and theories: Grand and middle range theories in nursing. In J. Fitzpatrick & G. McCarthy (Eds.). Theories guiding nursing research and practice. (pp 15-31). New York: Springer.
Moran K., Burson, R., & Conrad, D. (2017). The doctor of nursing practice scholarly project. Burlington, MA: Jones & Bartlett Learning.
Smith, M.J., & Liehr, P.R. (2018). (4th ed). Middle range theory for nursing. New York: Springer.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (2nd ed.). Philadelphia, PA: FA Davis Company.
Middle Range Nursing Theories
In contrast to Grand Nursing Theories, middle range theories are focused, and therefore apply more descriptive and predictive models to a phenomenon of interest. Each middle range theory seeks to address a particular experience and typically focuses on only one of the nursing meta-paradigm concepts. Many times, middle range theories have evolved from a grand theory of nursing or have resulted from nursing research (Chism, 2013; Tracy, & O’Grady, 2019; Smith & Liehr, 2018).
Examples of Middle-range Theories include (Smith & Parker, 2015):
Katharine Kolcaba’s Comfort Theory
Pamela Reed’s Theory of Self-Transcendence
Patricia Liehr and Mary Jane Smith’s Story Theory
The Community Nursing Practice Model
Rozzano Locsin’s Technological Competency as Caring in Nursing
Marilyn Anne Ray’s Theory of Bureaucratic Caring
Troutman-Jordan’s Theory of Successful Aging
Barrett’s Theory of Power as Knowing Participation in Change
Marlaine Smith’s Theory of Unitary Caring
Kristen Swanson’s Theory of Caring
It is very important that the middle range theory you select work well with the Grand Nursing theory you have chosen. You want these two theories to work together to give you a fuller understanding of the patient situation, environment, or problem you are encountering.
References:
Chism, L.A. (2013). The Doctor of Nursing Practice: A guidebook for role development and professional issues. Burlington, MA: Jones & Bartlett.
Tracy, M.F., & O’Grady, E. T. (2019). (6th ed). Advance practice nursing: An integrative approach. St. Louis, MO: Elsevier.
Smith, M.J., & Liehr, P.R. (2018). (4th ed). Middle range theory for nursing. New York: Springer.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (2nd ed.). Philadelphia, PA: FA Davis Company.
Complexity Science
Complexity science is not a single theory but rather an emerging interdisciplinary paradigm.
Complexity science incorporates elements of multiple fields of study including chaos theory and non-linear mathematics.
While this sounds complicated (and it is!), the basic tenet of Complexity Science is that “the whole is more than the sum of its parts” which is also the basic tenet of nursing.
Complexity science is being applied to multiple areas of study including Organizational and Systems Analysis, Healthcare Systems, even medical research (Butts & Rich, 2018).
The identification of Complex Adaptive systems is an offshoot of complexity science.
Examples of complex adaptive systems consist of such things as a school of fish, a flock of birds, and the human body.
In 2001, the Institute of Medicine (IOM) referred to health care facilities in this context (IOM, 2001).
All complex adaptive systems are composed of individual parts or “agents” who are connected to one another is some way, but who act independently and unpredictably at times.
Using a healthcare facility for an example of a complex adaptive system, the facility itself may be thought of as the “whole”, the “agents” would include the various departments such as Nursing, Environmental services, Social Work, the Business office, etc.
Breaking this down even further, within the Nursing department, each individual nursing unit would be an “agent”, and so on down to the level of the individual nurse, unit secretary, or nursing assistant.
A hallmark of complex adaptive systems is that oftentimes, small changes can have large effects throughout the system; actions taken by one “agent” often have profound effects on others within the system (Butts & Rich, 2018).
References:
Butts, J.B. & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. (3rd ed). Burlington, MA: Jones & Bartlett.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academy Press.
Overview
Ethics is a philosophy based on beliefs of what is considered morally acceptable, and morally unacceptable. Therefore, it is considered a moral philosophy.
Ancient Greek philosophers such as Socrates, Plato, and Aristotle applied a philosophical inquiry to behavior for rational clarification and justification of beliefs.
The term ‘bioethics’ is derived from ancient Greek with ‘bios’ meaning ‘life’, and ‘ethikos’ meaning ‘ethics’. Today, bioethics is a systematic study of moral dimensions in healthcare.
We begin our discussion about Ethical frameworks by considering the relationship between ethics and morality.
There is no philosophically significant difference in ‘ethics’ and ‘morality’, and the terms are often used interchangeably in the literature (Johnstone, 2015). ‘Ethics’ is derived from the ancient Greek term ‘ethikos’, which was ‘pertaining to custom or habit’; and ‘morality’ which is derived from the ancient Greek term ‘moralitas’ also pertains to ‘custom or habit’.
Ethics is considered to be a body of knowledge that tries to make sense of what is “right” and what is “wrong”.
An ethical system or framework is based on ethical principles, such as autonomy, nonmaleficence, beneficence, and justice (Beauchamp & Childress, 2013).
Moral rules guide ethical behavior and are more focused than ethical principles. Examples of moral rules would be ‘do not lie’, ‘do not kill’, and so forth (Johnstone, 2015).
Going back to our earlier discussion on Ways of Knowing, Carper (1978) states that the ethical component of knowing focuses on what “ought” to be done.
The development of ethical knowledge comes from who we are and what we believe; knowledge development is generated when we ask “Is this right?” or “Is this the responsible way to deal with this situation?” (Chinn & Kramer, 2015).
Ethical knowledge can take many forms: rules, statements of duties, the development of “rights” such as the Patient’s Bill of Rights, theories, and laws. Many professional organizations, such as the American Nurses Association (ANA) have developed a code of ethics, this too is a type of ethical knowledge development (Chinn & Kramer, 2015).
A link to the ANA Code of Ethics is supplied to you in the required readings and resources section of this Unit. Please take the time to read over this code.
Moral Disagreement
Moral courage is the courage to act based on moral beliefs in the face of fear (Savel & Munroe, 2015), and a moral community of nurses sharing ethical commitments creates a bond that may strengthen moral courage (Wocial, 2018).
Moral conflicts may arise when choosing between two or more actions, in which neither is fully acceptable (Johnstone, 2015)
Moral distress is an internal conflict that arises when an individual knows what is right, but is prevented from taking the right action (Johnstone, 2015).
A moral dilemma is an internal conflict that arises when there is no action that is fully or wholly acceptable (Johnstone, 2015).
Core Ethical principles
Core ethical principles were included into the Belmont Report, now known as the Common Rule that governs the ethical guidelines for research that utilizes human participation (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). Beauchamp and Childress (2013) have expounded on this report as the principles relate to nursing practice:
Autonomy- this principle holds that each person has worth in their own right, each person should have the unrestricted freedom to make choices for themselves; this principle is at the core of the informed consent procedure.
Non-maleficence- requires the avoidance of harm. Patients have the right to expect that the health care provided to them won’t do them further harm. An easy clinical situation to apply this principle to is hand washing. Again, every healthcare professional knows hand washing is the most effective way to limit the spread of hospital-acquired infections. Does everyone who comes into contact with the patients in your facility comply with the hand washing policy every time? Do you?
Beneficence- this principle holds that each action undertaken should be done for the benefit of others. It is often times linked with non-maleficence. A classic example of this type of ethical decision would be to consider the process of allowing a natural death to occur versus the act of euthanasia.
Justice- this principle states that all care should be distributed in an equitable and fair manner. Any care that violates this principle (think lack of access to specialty care in rural or underserved populations) can be a potential ethical issue for the APN to address in some way.
Overview of theoretical perspectives and frameworks that inform ethical practice:
Ethical frameworks serve to inform, or guide practice, and as such, may be divided into three (3) broad categories;
Consequentialist framework (consequentialism) is concerned with the future effect, or ethical consequences of an action.
Duty framework is concerned with the duties and obligations in a situation, and ethical conduct is doing what is right.
Virtue framework is concerned with positive or negative character traits that may motivate an action.
This section is not intended to be a full discussion of the perspective and frameworks; rather, it is intended to provide you with a basic description as a starting point.
Virtue Ethics- focuses on the mind and character and the type of person you want to be rather than on specific actions.
Five focal virtues of healthcare workers have been described as compassion, discernment, trustworthiness, integrity, and conscientiousness (Beauchamp & Childress, 2013).
Natural Law theory- based on Judeo-Christian ethics and principles. This work is most often attribute to St. Thomas Aquinas and defines rules of basic human behavior.
Deontology- this theory focuses primarily on the concept of duty and rules. The nature of the act (good or bad) is judged on the act itself…not the outcome. (the end does not justify the means)
Ethical Principlism- places emphasis on rules and duties, this type of framework includes the principles of autonomy and beneficence discussed. It is recognized as a foundation for Bioethics and such documents as the Patient’s Bill of Rights.
Moral Rights Theory – a ‘rights’ view of ethics that is included in professional codes of ethics and bills of patient rights.
Utilitarianism- all actions are judged by their utility. In other words, what worked the “best” and did the least amount of harm?
Casuistry- each situation is examined separately when evaluating ethical decisions, past “cases” similar to the one currently being considered are evaluated for history, precedent, etc.
Narrative ethics- focuses on inter-life narratives (stories) and how they impact with other inter-life stories. You would consider the person’s “background” before making an ethical judgment on their actions. (Butts & Rich, 2018)
Finally, we will consider the core ethical competencies for Advanced Practice Nursing as outlined by Tracy and O’Grady (2019). As a future APN, you are required to master the following skills relating to ethics:
Knowledge Development: the APN should explore and discuss core ethical theories and principles and apply them to clinical situations.
Knowledge Application: the APN should apply the acquired knowledge to their personal area of specialty practice through their actions and the delivery of advanced nursing care.
Creating an ethical environment: the APN is expected to serve as a role model for others through their own ethical behavior. The APN should also take an active mentoring role to foster ethical knowledge development.
References
American Nurses Association [ANA]. (2015). Code of ethics for nursing with interpretive statements. Silver Spring, MD.
Beauchamp, T. & Childress, J. (2013). Principles of biomedical ethics. (7th ed). New York: Oxford University Press.
Butts, J.B., & Rich, K.L. (2018) Nursing ethics: Across the continuum and into practice. (2nd Ed.). Sudbury, MA: Jones and Bartlett.
Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science. 1(1): 13- 24. Retrieved from: http://journals.lww.com/advancesinnursingscience/
Chism, L.A. (2013) The Doctor of Nursing Practice: A guidebook for role development and professional issues. Burlington, MA: Jones and Bartlett.
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier, Australia: Elsevier Health Sciences.
Savel, R. H., & Munro, C. L. (2015). Moral distress, moral courage. American Journal of Critical Care. doi: http://dx.doi.org/10.4037/ajcc2015738
Tracy, M.F., & O’Grady, E.T. (2019) Advanced practice nursing: An integrative approach. (6th ed). St. Louis, MO: Elsevier.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). Ethical principles and guidelines for the protection of human subjects of research. Retrieved from: http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm
Wocial, L. D. (2018). In search of a moral community. Online Journal of Issues in Nursing, 23(1), 7-7. doi:10.3912/OJIN.Vol23No01Man02
NOTE THIS A SIX PAGE PAPER, I AM ORDERING 5 BECAUSE I HAVE A ONE PAGE DISCOUNT FROM LAST TIME I ORDERED. THANK YOU
Zaccagnini, M.E., & White, K.W. (2011). The doctor of nursing practice essentials: A new model for advanced practice nursing. Sudbury, MA: Jones and Bartlett.
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