Personal Theoretical Framework for Advanced Practice Nursing Essay

Personal Theoretical Framework for Advanced Practice Nursing Essay

As a Master’s prepared nurse, I have had ideal opportunities to familiarize myself with the theoretical underpinnings of the nursing profession, as well as in-person interactions with patients. Interactions with patients and an in-depth knowledge of theoretical perspectives have significantly influenced my nursing philosophy. In this sense, my nursing perspective entails the art and science of caring for vulnerable people who do not necessarily possess or exhibit the level of health literacy as nurses. Based on the knowledge discrepancies between patients and nurses, it is essential to bridge such chasms to improve health literacy, enhance care quality, and eliminate challenges that compromise care utilization. Caring for people with different health challenges requires nurses to employ scholarly knowledge, skills, and experience, especially amidst the vigor to incorporate the best evidence into nursing practices and decisions.

Although the nursing profession should primarily focus on caring for patients, improving their health and wellness, and safeguarding their safety, nurses should be conversant with the current dynamics in the healthcare sector. Nilsen et al. (2020) contend that technological advancements, changing disease patterns, ever-changing political reforms and health initiatives, aging populations, and discoveries for disease treatment are the primary drivers of the constantly changing health environment. As a result, nurses should update their knowledge, skills, and competencies to match the intricacies and demands of the current healthcare systems. For example, they should familiarize themselves with technological modalities and systems that support quality care delivery, ethical standards that advocate for professionalism and morality, and changing disease patterns. To comply with these requirements, nurses should have access to reliable and life-long learning and career development opportunities.

Consistent with the prevailing changes in the healthcare landscape, utilizing advanced technologies and incorporating the best available scientific knowledge can improve care quality and efficiency by enhancing accuracy, reducing delays, and facilitating the adoption of evidence-based decisions. However, the primary concern associated with recent changes in healthcare environments is the likelihood of ignoring care’s human and social aspects. According to Nilsen et al. (2020), the organizational obsession with change results in adverse ramifications, including loss of productivity, work-related stress, emotional exhaustion, burnout, and a high prevalence of procedural errors. Further, over-emphasis on the technical and technological aspects of care ignores the essential concept of caring practice; the humanistic perspective of nursing.

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Based on a comprehensive reflection of my experience as a Master’s prepared nurse against the prevailing changes in healthcare, my nursing philosophy inclines towards the need to focus on the humanistic and social aspects of care. In this sense, I perceive nurses as a social support system for patients, family members, and the community needing health services that cut across various domains, including emotional, psychological, and behavioral well-being. Secondly, nurses should endeavor to establish meaningful relationships with the affected patients and family members to improve their resilience and enhance recovery. Molina-Mula & Gallo-Estrada (2020) argue that meaningful nurse-patient relationships improve care quality by strengthening patients’ participation in care processes, reducing the days of hospitalization, and promoting satisfaction. Also, a close nurse-patient relationship is central to the patient-centered care (PCC) model that entails respecting and understanding a patient’s values, preferences, needs, and priorities.

The humanistic care approach allows nurses to understand the patient’s perspective of health, suffering, and needs. Yang et al. (2022) contend that patients grappling with life-threatening health issues such as diseases may lack crucial disease insights and are susceptible to panic, irritability, depression, and emotions. Equally, families of the affected patients demonstrate panic and anxiety amidst diseases like cancer, hypertension, and even clinical procedures, such as angioplasty and cardiopulmonary resuscitation (CPR). As a result, developing meaningful relationships with patients and families by demonstrating empathy, providing information and emotional support, and incorporating spirituality into clinical practice can strengthen a sense of safety and hope for patients and families. Other benefits of creating interpersonal relationships with patients are improved compliance with treatment options, the likelihood of initiating self-care education, and trust. Nurses can sustain interpersonal relationships with patients by providing professional assistance, resisting negative emotions, addressing implicit biases, establishing rapport, incorporating active listening skills, and ensuring openness when sharing information.

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My nursing philosophy aligns with various underlying assumptions of the theory of interpersonal relationships by Hildegard Peplau. Peplau published the interpersonal relationships theory in 1952 after drawing inspiration and influence from other reputable theorists, such as Henry Stack Sullivan, Abraham Maslow, Neal Elgar Miller, and Percival Symonds. According to Gonzalo (2023), Peplau’s theory emphasizes a common nursing goal of providing the incentive for a therapeutic process and environment where nurses and patients respect each other and are open to ongoing learning through interactions. The underlying assumptions of Peplau’s interpersonal relations theory are: (1) nurses and patients can interact and relate to each other, (2) the patient and nurse grow and learn through therapeutic interactions, (3) communication and interviewing skills are essential nursing tools, and (4) nurses must understand themselves to promote patient’s growth and diversify their choices (Gonzalo, 2023). Nurses should adopt a sequential framework to establish strong interpersonal relationships with patients.

Peplau identified ideal stages for initiating and sustaining strong interpersonal relationships with patients. According to Arabaci & Tas (2019), these stages are orientation, identification, exploitation, and resolution. During the orientation stage, nurses should support patients in identifying the problem and reducing the anxiety associated with the underlying health conditions. Patients ask questions and discuss preconceptions, expectations, and needs. Nurses should effectively respond to patients’ concerns by identifying problems, using the available resources, including evidence, and deciding the most appropriate care interventions.

During the identification phase, nurses focus on planning care models and interventions and determining the desired outcomes of care plans. They involve patients in planning and coordinating care processes by explaining goals, setting expectations, and allowing them to channel their emotions and explain their desires, needs, and priorities (Arabaci & Tas, 2019). This stage represents the starting point for a good relationship between the nurse and the patient.

Suppose nurses successfully establish a good relationship with the patient. In that case, they can enlighten the client about the available care options, provide professional assistance, and model services to fit patients’ needs and interests. These activities occur during the exploitation stage. Gonzalo (2023) identifies other activities and requirements for sustaining interpersonal relationships during exploitation. They include applying appropriate interview techniques to explore, understand, and deal with the underlying health problems, professional cooperation, timely communication, and developing a therapeutic relationship.

Regardless of the closeness of an interpersonal relationship between the nurse and the client, there is a need to resolve the relationship at the end of professional services or the client’s stay in the hospital. During the resolution phase, the patient no longer needs professional services and demonstrates self-efficacy. Therefore, they can terminate their therapeutic relationship and dissolve interpersonal links by demonstrating a healthier emotional balance (Gonzalo, 2023). When resolving the relationship between the nurse and the client, it is essential to eliminate dependency and ensure that the patient demonstrates self-care competencies.

Although Peplau’s theory of interpersonal relations aligns with my nursing philosophy by focusing on the humanistic perspective of caring, the framework may conflict with my philosophy in various contexts. For instance, my philosophy emphasizes the need to balance the technical aspects of care and the humanistic dimensions of caring amidst changes in healthcare environments. However, Peplau’s theory primarily focuses on developing strong interpersonal relationships with patients. It fails to provide adequate information about the technical aspects of nursing, including the need to incorporate technology in care practices.

Secondly, the interprofessional relations theory may be deficient in supporting nursing practices for clients with self-care deficits and those requiring continuous care, including people with mental health conditions. Infants and older adults may lack the skills and knowledge to develop meaningful relationships with nurses. As a result, healthcare professionals must identify appropriate mechanisms for incorporating the humanistic perspective of caring into nursing practices targeting infants and older adults who are occasionally incompetent to make informed decisions or collaborate in care delivery. Finally, people with mental and neurodegenerative disorders, including schizophrenia and post-traumatic events disorder (PTSD), require special attention, frequent monitoring, and frequent mental status examination, meaning they depend on nurses. Consequently, Peplau’s interpersonal relationship theory does not provide a plan for caring for patients who demonstrate self-care deficits, prompting me to obtain insights from other theoretical frameworks to enhance my nursing philosophy.

References

Arabacı, L. B., & Taş, G. (2019). Effect of using Peplau’s interpersonal relation nursing model in the care of a juvenile delinquent. Journal of Psychiatric Nursing, 10(3). DOI: 10.14744/phd.2019.54366

Gonzalo, A. (2023). Hildegard Peplau – interpersonal relations theory. Nurseslabs. https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-4999-8

Yang, X.-H., Wu, L.-F., Yan, X.-Y., Zhou, Y., & Liu, X. (2022). Peplau’s interpersonal relationship theory combined with bladder function training on patients with prostate cancer. World Journal of Clinical Cases, 10(9), 2792–2800. https://doi.org/10.12998/wjcc.v10.i9.2792

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You have spent six weeks exploring theories of nursing. These represent the “how” of what we do as nurses. This week we enter a higher level of thought and explore the “why” of what we do. Present a personal nursing philosophy. Apply what you have read throughout the course and explore the literature on nursing philosophy. While Fawcett was not a nursing theorist, she is a nursing philosopher and her Metaparadigm of Nursing approaches philosophy over theory. Once you have discussed your philosophy, identify a theoretical framework (not the middle-range theories but the underlying assumptions in that framework) that fits your philosophy. Compare and contrast your philosophy and the chosen framework. Describe a possible situation in which the framework may conflict or not fit your philosophy. While it is an important skill to be able to match a theory with a situation, it is also critical to understand when a theory or framework does not fit a situation.

 

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