Knowledge of Nursing Theory, Ethics, & Accountability

Knowledge of Nursing Theory, Ethics, & Accountability

1. The self-care theory

            The self-care deficit nursing theory is a theory that was developed in between the years 1959 and 2001 by a nurse known as Dorothea Orem. Hence the theory is commonly referred to as Dorothea Orem’s Self-care theory. The basis of the model of care is the relation between humans and their own environment. The paradigm explains the adaptation of the human to their own environment and thus the interaction in self-care (Younas 2017). It is one of the fundamentally used nursing theories that portrayed effective results in patient care in nursing through the various randomized controlled trials (RCTs). It is commonly applied in primary health care of the patients where it helps promote the use of various attributes to encouraging patients to care for their own self. It helps make the patients as independent as possible while receiving nursing care. Additionally, the theory has been applied in nursing education to help identify various students’ needs and help facilitate their improvement.

In many healthcare facilities, the goal of care is to promote independence among the patients and enable them perform most of the care their own. The theory has not only been applied in primary health care but it is also vital in rehabilitative care for the patients. Patients are encouraged to become more independent and after they have received a period of nursing care by both the nurses and the physicians. The self-care theory is a very broad theory that generally touches on many instances of nursing care.

Through the idea of Dorothea Orem, nursing has been considered as the act and process or improving self-care among the patients so as to initiate functioning and personal care even after discharge of the patients (Naranjo et al.,2017). It actually focused on all individuals abilities to perform self-care when at the care facilities and after discharge. Self-care has been defined as the ability of the patient to initiate and maintain activities that lead to the maintenance of health and personal well-being. The greatest need for nursing care is the inability of the patients to be able to support themselves and continuously maintain a high quality of self-care which is vital and therapeutic in maintaining health and sustaining life. When it comes to the application of the theory in nursing, Dorothea Orem explained that it is used when the mother or guardian of the child is unable to maintain a quality of care that is therapeutic.

• Application of theory to nursing

            In order for the theory to become applicable in nursing, Dorothea Orem made several assumptions that were put in place. One of the assumptions was that, for all human beings to stay alive and survive, they need to be in constant communication and connect with their own environment. The ability for all human beings to act and be in control is all dependent on their ability to identify their needs and actively make judgements based on them (Santos et al.,2017). The other assumption was that all mature humans experience privations depending on their needs and ability to make life sustaining and function regulatory actions. The human agency has been identified through their discovery, development, and transition to other ways and means of identifying their own needs. Human beings live in groups that are clustered to task and allocate responsibilities for care provision.

The theory of self-care is comprised of three main interrelated theories; the theory of self-care deficit, the theory of nursing systems, and the theory of self-care. The theory focuses on the activities which individuals perform in order to maintain life, health, and wellbeing. Based on the theory, there are several universal health requisites that should be achieved for human survival. Failure to which, the patients then requires the aid of nurses and health care professionals. Some of the requisites include; sufficient intake of food, water, and oxygen; provision of care that is associated with the elimination process and excrements; proper balance of activity and rest; the balance between social interaction and solitude; the prevention of various hazards to human life, human wellbeing, and human functioning; and the promotion of human functions and development among various social groups (Smith & Parker 2015).

• Self-care theory and the nursing profession

            Nursing is the art through which the nurse practitioner provides specialized assistance to persons with disabilities and most importantly care for those in need of self-care. Health is a state of complete structural being and functionality of the whole being. It encompasses the health of the individuals and the groups. Human health is the ability to self-reflect, symbolize experiences, and communication with others (da Silva et al.,2018). Nursing involves the consideration of basic conditioning factors that are important in caring for the patient. Some of the factors involved include; age, gender, developmental state, health state, health care system factors, socio-cultural orientation, patterns of living, family system factors, resource adequacy and availability, and environmental factors.

The theory focuses on the self-care demands which are the total actions required to be performed in order to enable meeting of the self-care requisites using a certain set of actions and valid methods. The delineation of self-care is achieved when the nurses appropriately act to cover the needs for the patients or children whose parents are unable to achieve that. The self-care theory comes into play when the patients become unable to perform basic functions that aid in their wellbeing. When developing this model of care, Dorothea highlighted five main methods that could be applied by the nurses to help out the patients. The methods included; teaching one another, supporting one another, acting for others and doing for the patients, and creating an environment that promotes personal development to help with managing future demands and needs (Shah 2015).

1. Contribution of two historical figures in the 19^th and 20^th century

            Clara Barton was a nurse who was born in Massachusetts in 1821. During her pre-war life she worked as a teacher who started her own school, Bordentown New Jersey. However, she decided to resign when the post of the principal was given to a male counterpart instead with a belief that men were more qualified. After her career she was hired in the US patent office in 1854, Washington DC. During this period she was actively involved in the civil war to help out men who were wounded from the war. The men from the city of Baltimore were sent to the city and hence Clara Barton was able to recognise some as her students and fellow acquaintances. After noticing the lack of supplies such as food and medicine, she decided to help out with the distribution. Due to the close association, she was allowed to the battle field where she helped with additional care and support even though she was not a trained nurse. Due to her help and delivery of supplies, she became known as the “Angel of the Battlefield” (Strickler 2018).

Florence Nightingale was born in 1820, May 12 in Italy. She was a social reformer and statistician who, was credited for being founder of the modern nursing. She was born in a well off family but very humble and charming. Her greatest contribution to nursing was during the Crimean war. On October 1854, 21^st Nightingale and her staff that she had trained were sent to care for the wounded soldiers of the Ottoman Empire (Cook 2018). Before her arrival at the war, the death toll of the wounded was very high but after the Nightingale and other 34trained staff members got there, there was a significant reduction in the number of deaths.  According to her belief, she attributed the vast deaths to the lack of supplies, poor nutrition, stale air, and soldiers who were overworked.

• Comparison of the two historical figures

            Even when Clara Barton had decided to return home, she realised that her work was not yet done. At the end of the war in 1865, she received letters from the soldiers who were in search of their families lost during the war. At that point she became appointed by President Lincoln for the office of the correspondence with friends of missing men of the US army. Within a period of 4yrs, she was able to help locate 13,000graves for union soldiers and 22,000 missing men in response to 63,000 letters. After there she decided to relax in Europe, she became also involved in the Franco-Prussian War where she became introduced to the international Red Cross. Due to the excitement, she decided to introduce it back in her home, the US. After her return she championed for the Red Cross in US. In 1881, her efforts bore fruit and she founded the American Association of the Red Cross in which she became the president. In the year, 1882, it was joined to the international Red Cross. She resigned as the president in 1904, and formed the National First Aid Association of America which trained people for emergency preparedness and first aid kits provision (Goff 2015). She was the president of the organization that became part of American Red Cross and she died in 1912, at her home.

After Florence Nightingale returned back home she did studies and collected data on the issues of death of soldiers that she presented to the Royal Commission with the aim of resolving all of them. Due to the experience in the Crimean War, she gained enough experience that built her career to levels of strong advocacy for proper sanitation among the soldiers. Through her efforts and commitment, she gained her nickname “The lady of the Lamb”. They believed even when the soldiers were fast asleep deep in the night, she could be seen moving around and checking the patients with her lamp in the hand. In 1857, Nightingale founded the Nightingale Fund that served the purpose of training nurses as a form of her recognition for the work that she had done in the Crimean war (Bostridge 2015). Nightingale used 45,000euros to open the Nightingale Training School at St. Thomas’ Hospital. The school is currently known as the Florence Nightingale School of Nursing and Midwifery. Nightingale died in the year 1910, on August 13^th at the age of 90yrs.

• Contributions of the two historical figures

            Clara Barton is the founder of one of the most important components of nursing in the US. Basic care support and first aid care are very vital for supporting of the patient’s recovery. Basically, she is the mother of fist aid in the US, even though she was not a nurse by training. She gained the experience and position by merit, hard work, and commitment to helping out the soldiers during the war. Through her efforts, American Association of the Red Cross and the National First Aid Association of America were formed (Egenes & Vlasses 2016). Today they have recruited nurses and have saved many lives through commitment.

Florence Nightingale, is known as the mother of nursing because of very two important contributions; through Nightingale, nursing education was developed and founded up to date and she is the founder and champion of proper hygiene and good sanitary among nurses (Gourlay 2017). Currently, nurses are being trained yearly globally with various options of upgrading and enhancing their education to levels they prefer. Proper hygiene and sanitation is the backbone of patient care to prevent cross contaminations and hospital acquired infections. Without proper sanitation, nursing can never be achieved.

1. Functional differences

The state board of nursing is a state specific organization that is founded and stipulated to work within a specified jurisdiction of the respective state. They ensure the licensing of the nurses, they determine the scope of practice, and set the standards of nursing practice for all they employed nurses. They additionally, provide licensing to qualified nurses and ensure renewal for the expired ones. The various state boards of nurses have combined together to make up the National Council of State Board of Nursing (NCSBN). The board ensures the setting and distribution of licensing examinations for all state nurses as required by the state regulations. The types of examinations offered include; examinations for the registered nurses including the advanced nurses practitioners NCLEX-RN exam and licenced or vocational nurses NCLEX-PN exam (Libner & Kubala 2017).

The American Nurses Association (ANA) is a body that was formed for the protection of the nurses upholding their rights and standard of protocols. It is an organization formed to advance and protect the nursing profession. It began in 1896 as the Nurses Associated Alumni and later renamed to ANA in 1911.

• Roles

The roles of the state board of nursing include; evaluating the applications of the nurses who want licenses, issuing and renewing of the nursing licences, taking necessary disciplinary actions against nurses when necessary, ensuring the authorization of licensing examinations, approving the nursing educational programs that meet the criteria, offering legal advice for the legislation responsible for the scope of nursing practice, and regulating the nursing aides, nursing assistants, medication aides, and medication assistants.

The ANA is an organization that is responsible for the development of mechanisms that result to guaranteed professional accountability. The ANA mains objective is to ensure the achievement of quality healthcare for the patients within the health system (Powers & Ramdeo 2017). Additionally it plays the role of; timetable setting and establishment of qualifications for those who want to enter the nursing practice, providing a credential coherent system, creating systems that ensure accountability within healthcare, and providing expansion for improvement of nurses through education.

• Influence to nursing

The State Board of Nursing and the ANA ensure that the nurses act in a specified manner within a certain scope of practice. Through the two organizations, the nursing profession has been improved to greater levels. Nurses can now advance their education up to master and doctorate level. The advanced nurse practitioners are nurses who are highly skilled and trained to perform more advanced nursing care. Accountability and great responsibility is part of good nursing which is upheld through the efforts of the State Board of Nursing and the ANA.

• Professional licence renewal

For nursing professional licence renewal in the state of Texas, the nurse is required to complete 20hrs of continuing nursing education, they are also required to complete at least two hours of nursing in contact with the nursing jurisprudence and ethics for every license renewal for the third time. Additionally, the nurses who work in the emergency room setting, there is a requirement of two hours of contact that are related to forensic evidence collection. For those who manage the elderly patients, two hours of contact with the geriatric care department is required. Basically, renewal of licence is dependent on the department and improvement of education.

• Consequences for failed renewal

Apart from disciplinary action being taken for the nurses who fail to renew their licences, it is also taken for the nurses who violate the code of conduct. Some of the disciplinary measures taken include; probation, reprimand, limited or restricted practice, suspended practice, and revocation of the license.

• Comparison in a compact state vs a non-compact state

Nurses who hold licences in compact states are allowed to practice in their respective states and as well they can practice in other states that are part of the licensure compact. For a nurse to be responsible for a multistate licence they should declare the compact state as their primary residence (Ashton 2016). They should have passed the NCLEX and clean of any indisciplinary acts and they should also pass a background check. For the nurses that are licenced in non-compact states, they are only allowed to work in their licenced states alone. If they move to another state, they should apply for a licence in that state and ensure that they fulfil the requirements for practicing in the new state.

1. Functional difference between food and drug agency and Center for Medicare and Medicaid services

The Food and Drug Agency (FDA) is a major branch of the US Department of Health and Human Services (HHS) with its main regulatory role being overseeing the safety of both locally produced food and imported food in the US. It handles 80% of the domestically foods except for; meat, poultry, and processed eggs. The Center for Medicare and Medicaid Services is also a branch of the US department of HHS that ensures overseeing of many programs such as involvement of the health information technology for example the electronic health records (HER) and the meaningful use incentive program. Additionally, the Medicare is a federal health insurance program for the elderly and Medicaid is a federal health needs program to help with medical costs. Hence, the CMC administers the children health insurance program (CHIP), the health insurance portability and accountability act (HIPAA), and also key portions of the Medicare access and chip reauthorization act (MACRA) law of 2015.

1. Nurse Practice Act (NPA)

All states have the legislated Nurse Practice Act (NPA) that formulates the board of nurses (BON) which has the ability to develop rules and regulations that govern the nursing roles and make them more specific. They are responsible for determining the rules and thus they should as per the NPA for respective states. Before enactment of the rules, they should undergo public review as the role of the NPA is to protect and safeguard the interests of those receiving nursing care. The safety and effectiveness of nursing is grounded on the legislation and laws set by the NPA.

1. Role classification

Scientists conduct various studies and research focused on nursing that ensure data collection, gathering, analysis, and reporting of the results. Detectives ensure the assessment and evaluation of the services provided by the nurses within any healthcare settings. The role of the healing environment manager is to ensure that there is a good environment for the recovery is the patient and stress reduction for the nurses.

1. Provisions from the ANA code of ethics

One of the provisions is that the nurse should practice with compassion and integrity and inherent dignity, the primary concern is commitment to the patient whether individual, family, or group; they should protect and advocate for the rights and safety of the patients; they should make decisions and act responsibly when taking action and making decisions; and through individual and collective efforts they should work hard to ensure they maintain and improve the ethical environment for the patients and fellow members.

1. Leadership qualities

All nurse leaders are expected to portray specific leadership qualities in order to ensure proper and effective delivery services. Some of the qualities include; critical thinking, emotional intelligence, dedication to excellence, communication skills, respect, mentorship, and professional socialization (Scully 2015).

References

Ashton, L. M. (2016). Compact state licensure: Take the “fast lane” to nursing practice.    Nursing2018, 46(12), 50-54.

Bostridge, M. (2015). Florence Nightingale: the woman and her legend. Penguin UK.

Cook, E. T. (2018). The Life of Florence Nightingale (Vol. 1). BoD–Books on Demand.

da Silva, F. P., Paiva, F. D. A. S., Guedes, C. P., da Silva Frazão, I., Vasconcelos, S. C., & da      Costa Lima, M. D. (2018). Nursing Diagnoses of the Homeless Population in Light of Self-care Theory. Archives of psychiatric nursing, 32(3), 425-431.

Egenes, K., & Vlasses, F. (2016). Clara Barton: Angel of the Battlefield. Nursing’s Greatest         Leaders: A History of Activism, 71.

Goff, B. M. (2015). Book Review: The American Red Cross: From Clara Barton to the New        Deal by MM Jones.

Gourlay, J. (2017). Florence Nightingale and the Health of the Raj. Routledge.

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Naranjo Hernández, Y., Pacheco, C., Alejandro, J., & Rodríguez Larreynaga, M. (2017). The       self-care deficit nursing theory: Dorothea Elizabeth Orem. Gaceta Médica Espirituana,            19(3).

Powers, R., & Ramdeo, C. (2017). Keeping Nurses Safe: Creation of a Safe Patient Handling and            Mobility Program.

Santos, B., Ramos, A., & Fonseca, C. (2017). Training to practice: Importance of Self-Care         Theory in Nursing Process for improving care.

Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and    attributes to secure a positive future for the profession. Collegian, 22(4), 439-444.

Shah, M. (2015). Compare and Contrast of Grand Theories: Orem’ s Self-Care Deficit           Theory and Roy’ s Adaptation Model. International Journal of Nursing Didactics,   5(01), 39-42.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. FA Davis.

Strickler, J. (2018). Clara Barton: Angel of the battlefield. Nursing2019, 48(3), 43-45.

Younas, A. (2017). A foundational analysis of dorothea orem’s self-care theory and evaluation of            its significance for nursing practice and research. Creative nursing, 23(1), 13-23.