Literature Review Draft
Running Head: APPLICATION OF THEORY 1
Application of Theory
Grand Canyon University: DNP-815
Scientific Underpinnings
June 5, 2017
Application of Theory
Nursing theories development is an emerging field with relatively contemporary incidences. For a long time there has been a controversy in nursing such that there is no consensus on the meaning and interpretation of certain concepts. This is mainly regarding whether a single model or multiple theories should be used to explain nursing concepts since the background varies a great deal. Middle range theory and ethical theory will in this case be analyzed and used to explain a nursing problem by presenting solutions to existing gaps and insufficiencies. An evaluation of research instrument will be made regarding how it is applicable to problem solution. Nursing just like any other field of study usually has a knowledge base. Theoretically, nursing has areas of agreement which include client comfort enhancement, environment, health and person attributes.
Literature Review
Since nursing has its own body of knowledge, there are various models and theories exclusive to nursing that can be used to analyze a case problem and come up with substantial solutions. Both the models and theories explain the scope of nursing, goals and functions of nursing as well as the nursing practice principles. Nursing concepts that build up the models and theories borrow from other disciplines but eventually come up with independent results regarding the theories. There are four categories of nursing theories. First, they are categorized based on needs such that they help patients meet their physical and mental needs. Second, there are those based on the interactions that arise from nurses and their patients. Third, those based on outcome rely on the nurses being the driving force towards change such that the patient copes with their condition. Lastly, humanistic category relies on the ability of a person to be unique and achieve self-actualization.
Middle range theories have been known to be more specific and direct since they target a phenomenon like pain or stress. Although they are limited in scope, they encourage further studies and research hence flexibility and open to improvements (Warren, 2016). They support empirical testing and deal with operational concepts. They are known to be simple and easy to apply and understand in nursing hence widely used. Middle range theories are applicable in various situations and should be flexible to both the patient and the nurse such that they do not only allow the health practitioner to contribute towards general wellness (Warren, 2016). Its propositions are easily measurable and the assumptions fit the theory.
Ethical theories on the other hand are important to clinicians in managing real life patient conflicts ethically without violating the stipulated code of ethics in the field. They usually inform our critical thinking and influence our decision making. This way ethical dilemma and the manner to deal with it is possible by the guidance of the four major ethical theories since they give one an insight on the most appropriate approach to adopt clinically. To achieve efficiency and contain a patient condition, a nurse could possibly adopt some ethical practices like keeping promises, telling the truth and acting in good faith always. These actions form the basis of nursing concepts and prepositions that support ethical theories. There are four main ethical theories which are consequentialism, virtue ethics, deontology and principles. Consequentialism purports that the correct moral conduct leads to positive outcome and results. Virtue ethics is based on four moral attributes of prudence, temperance, justice and fortitude. Deontology is based on individual intentions since patients have their own rights which should be respected. Ethical principles assist the provider in obtaining a solution to an issue. There are six ethical principles that exist, they are autonomy, beneficence, fidelity, non-maleficence, justice, and paternalism. These principles guide the provider to provide the best service for the patient.
Summary of the Case Scenario
The case study involves a patient who has been admitted to a health center with alcohol use disorder. The man, George Livingstone, who is forty-six years of age, started using alcohol when he was a teenager. His abuse could be attributed to the fact that he grew up in a family whose father was an addict of alcohol. According to his medical history, the father would bring home with him alcohol after which he would get violent and batter his mother. The family lived in distress for many years and the father drained the family capital through alcoholism. George on the other hand started stealing alcohol from his father in small bits since his peers in school also took alcohol. Peer pressure also attributed to his addiction. After high school, he had become an addict and would seek manual jobs to sustain his alcoholic behavior. George took longer in college as his studies were interrupted by absenteeism owing to alcoholism.
He has ever since tried to secure jobs many of which he got fired due to adverse effects of alcoholism. This has affected him psychologically, financially and socially. The patient has found it hard to withdraw even when the alcohol abuse has caused him severe health risks. George’s condition is severe since it interrupts with his day to day activities. Treatment of the condition is not only based on drug administration. As a nurse, this writer would create a positive impact by enrolling the patient in a counseling program and a brief intervention despite his aggressive behavior. The patient would be registered to an outpatient program or inpatient stay program depending on his current condition. A consideration must be made as to whether the patient will have appropriate moral support back home since he has constantly faced rejection and ridicule form family members due to his alcoholism.
Application of Ethical Theories and Middle Range Theories to Case Scenario or Problem
Since our practices are based on nursing concepts and prepositions, it is essential that I comply with the stipulated code of ethics and ethical theories in solving the problem. Georges condition needs hospitalization mainly because he could be a safety threat to family members and friends. Additionally, someone must follow up on him closely since he has battled addiction and intoxication for an extended period. After I consulted with the hospital psychiatrist, he also recommended that he be hospitalized until his alcohol use disorder stabilizes (Willenbring, 2013). One of the hospital core values is to promote healthy living to all patients so that they can contribute towards the growth of the nation’s economy. Being an alcohol or substance abuse addict renders one a dependent which drains family income and in turn hurting the economy. Therefore, as we have done previously, George must be assisted regardless of the gravity of the matter.
Ethically, it is the hospital’s routine to make patients understand their condition and the impacts it has on them health-wise, financially and socially. Despite his aggression and resistance to change, George’s wife insisted that he needed to be helped lead a normal life. This family acknowledgement and approval is important so that it does not seem to the patient like we are coercing him to change his livelihood. First, there is need to involve learning skills and devising a treatment plan according to his needs (Willenbring, 2013). Giving him self-help manuals and counseling regarding his condition is important. Allowing him to give his views and opinions is healthy and assists him in recovering from alcoholism. Ethically, virtue ethics and deontology apply such that the patient has their voice as well as exercising justice and prudence.
Psychological counseling and follow up care will help him understand his problem. This can be done in a group so that the patients get a chance to express themselves to others freely. Family support is also essential such that they encourage them not to give up no matter how long the recovery journey may take. Ethically consequentialism applies in this case such that a positive outcome is based on the counselor approach to the condition (Monteverde, 2013). There must be tolerance and appreciation of each patient’s contribution. The counselor and the nurse must be guided by ethical and nursing principles in all their actions such that whenever a dilemma arises, the best course of action is followed for efficiency in the field. Nevertheless, moral conduct of the patients must be controlled such that they are supported towards the right direction of withdrawal of alcoholism regardless of what the practitioners go through to achieve that goal.
Intervention, Implementation and Evaluation of Health Care Problem
Medical treatment of alcohol use disorder could involve administration of certain drugs orally and by injection. Detoxification is a medically managed program that takes two to seven days. Sedations could be used when detoxifying the patient to prevent withdrawal symptoms and relapse. This is usually the initial step before counseling sessions whereby the nurse should monitor the patient closely. Friends can be tempted to bring in some alcohol to the patient which slows down recovery process. Disulfiram is usually administered to prevent a person form drinking even though it does not cure the condition or prevent the urge of drinking (Jorgensen, Pedersen, & Tonnesen, 2011). This is whereby the nurse can ethically engage the patient so that he does not contemplate drinking. The nurse could undergo verbal abuse form some patients but they must persevere to the end. The nurses can nevertheless know that the patient drunk alcohol after taking that drug if they vomit and experience headaches.
Other drugs a nurse can administer to such patients are Acamprosate which help combat alcohol cravings and reduce the urge to drink. On the other hand, injections can be used once a month to patients, for example, vivitrol which is essential for such people due to consistency (Jorgensen, Pedersen, & Tonnesen, 2011). Ethical and moral support is essential to patients since most of them could relapse during the program. Nurses ought to understand that alcohol use disorder could be accompanied by mental and other health disorders. Patients may depict signs of stress, anxiety and depression. Since the nurses are also under pressure, it is good to control emotions even when the patients are agitated. Psychotherapy sessions and medications could be applied in such cases. Other patients could be having other health conditions like inflammation of liver which needs special attention and follow-up by appropriate practitioners.
Middle range theories are applicable in this case such that the nurse must observe caution since alcohol abuse disorder patients are sensitive. The patients are prone to emotional imbalance and get agitated easily. The Benner model of skill acquisition is one that has five stages a nurse must undergo in the field (Warren, 2016). Different health conditions of patients require specific types of nurses depending on complexity of the condition. Alcohol use disorder could require a competent, proficient or even an expert nurse. This is because there is need to have prior experience of a similar condition to maximize efficiency. George’s condition needs to be handled in line with prepositions of middle range theory such that all operations are in line with the nursing practice. Problem solving and analytical skills are essential since the patient could be having many interrelated medical conditions which require a practitioner’s informed decision. Since nursing is sociological field, giving hope to patients is essential to their recovery journey.
Synthesized Literature Findings
Both ethical theories and middle range theories are interdependent since a nursing practitioner cannot ignore the applicability of either in their operations. Moral and ethical virtues must be in line with the stipulated nursing guidelines and policies (Monteverde, 2013). George, the patient was found to respond positively to the medical attention and the psychological counseling sessions. Within six days, he had begun to recover from the alcohol use disorder. He had stopped being aggressive and bitter about his life which made him vow to completely quit alcohol and be a productive citizen. Since he is well learned, he will be able to secure a stable job and be a family pillar due to the transformation. Essentially, ethical theories are usually applicable to many fields and are interrelated. This is because being ethical is all about relating well with fellow humans and offering moral support.
The 12-step program used by Alcoholics Anonymous is a well-known treatment method that’s used for many types of addiction, not just alcohol. The 12-Step Program is a uniquely, well-rounded phase of treatment that includes maintaining a close relationship with a sponsor who is experienced with self-discipline and long-term abstinence of alcohol (Majer, Jason, Aase, Droege, & Ferrari, 2013). The meetings also incorporate skills such as helping others, taking responsibility for recovery, sharing personal experiences, and accepting the existence of a higher power. The 12-Step program addresses the factors or causes that are responsible for, or related to, substance abuse by helping individuals to understand the concept of change. “Processes of change are the covert and overt activities that people engage in to alter affect, thinking, behavior, or relationships related to particular problems or patterns of living” (Majer, Jason, Aase, Droege, & Ferrari, 2013). The 12-Step Program helps by addressing a patient’s motivation and ability to change while building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, increasing social alternatives and behaviors that elicit old behaviors, as well as, improving problem-solving skills, and incorporating sponsorship to help build, or rebuild, healthy interpersonal relationships. It has also been proven that participation in group therapy, during and following treatment, can help maintain abstinence.
Proposed Solutions to Theoretical Approach Gaps
Further studies need to be conducted regarding middle range theories and ethical theories. This is because there has emerged some criticism empirically on the effectiveness of the same. The increasing number of middle range theories leads to disintegration of nursing field knowledge. However, experts in the field have attempted to link some of the theories with nursing concepts and principles to ensure that there is inclusivity and integration of propositions. For example, therapeutic intention theory under middle range theory has been consolidated with Levine’s conservation principles. A gap exists in the manner that nurses continue to use other concepts and theories form other disciplines other than nursing (Snowden, Donnell, & Duffy, 2014). There is therefore the encouragement from stakeholders that researchers come up with more concrete practice theories in the field for the sake of growth and independence.
There is usually confusion as to what really constitutes middle range while some of the theories lack basis of empirical testing. Due to limitation of scope, the theories have been criticized as lacking intellectual ambition in today’s dynamic world. Ethical theories on the other hand have not received much criticism since they are based on societal expectation of human nature. However, some of the nurses in modern day world are driven by desire of material gain without prioritizing patients’ wellbeing. They are supposed to always act in good faith and be guided by a code of ethics but many have lost their licenses to being unethical (Snowden, Donnell, & Duffy, 2014). Due to moral decay in the society, some nurses could not be competent in their work leading to untimely deaths followed by legal suits and litigation to the health care facility.
Rationale for Empirical Evidence and Description of Tenets
Through experimentation and observation, nursing practitioners can acquire and prove the tenets of nursing theories. When a patient responds positively to treatment and counseling sessions due to ethical conduct and stipulated guidelines, empirical research realization is attained. This enables stakeholders and researchers to understand the scope of the theories and concepts in the nursing sector. Both qualitative and quantitative methods are used to collect data appropriately from patients to aid their recovery (Snowden, Donnell, & Duffy, 2014). Alcohol use disorder experiments used to manage the condition can be recreated and tested on different patients to avoid bias. The problem also has methods, instruments and controls used to an individual or group of persons.
All theories including nursing ones should be interactive to avoid obsolescence. They should also be put in practice to maintain and promote relevance in the field. As a matter of fact, each time a scholar or a nursing practitioner conducts a research to come up with a nursing model, they should consider past contributions, their strengths and weaknesses as well. The weaknesses could be stepping stones to emerge with stronger milestones on a better researched model or theory (Monteverde, 2013). This way, the field of research maintains interaction and relevance in the foreseeable future without forgetting past contributions. It is important to note that nursing is currently on its own and no longer depends on theories or models from other disciplines like medicine, psychology or sociology for practice.
Conclusion
Nursing just like any other field of study usually has a knowledge base. Ethical theories and middle range theories are interdependent since a nursing practitioner cannot ignore the applicability of either in their operations. Moral and ethical virtues must be in line with the stipulated nursing guidelines and policies. Alcohol use disorder as presented in the case study is a sensitive issue has an emotional and psychological influence on the patient. However, an integration of the concepts of the two sets of theories enables a nurse to manage the condition. Middle range theory faces criticism on basis of empirical testing, using other discipline’s concepts and lacking intellectual ambition hence integration of nursing knowledge. Moral decay rampant in modern world limits efficiency of ethical theories.
References
Jorgensen, C., Pedersen, B., &Tonnesen, H. (2011). The Efficacy of Disulfiram for the Treatment of Alcohol Use Disorder. Alcoholism: Clinical and Experimental Research, 35(10), p. 1749-1758. http://dx.doi.org/10.1111/j.1530-0277.2011.01523x
Majer, J., Jason, L., Aase, D., Droege, J., & Ferrari, J. (2013). Categorical 12-step involvement and continuous abstinence at 2 years. Journal of Substance Abuse Treatment, 44(1), p. 46-62.
Monteverde, S. (2013). Undergraduate health care ethics education, moral resilience, and the role of ethical theories. Nursing Ethics, 21(4), p. 385-401. http://dx.doi.org/10.1177/0969733013505308
Snowden, A., Donnell, A., & Duffy, T. (2014). Pioneering theories in nursing (1sted.). London: Andrews UK.
Warren, H. (2016). Middle-Range Theories. Plastic Surgical Nursing, 36(1), p. 9-11. http://dx.doi.org/10.1097/psn.0000000000000
Willenbring, M. (2013). Relapse in Alcohol Use Disorder. JAMA Psychiatry, 70(11), p. 1248-1266. http://dx.doi.org/10.1001/jamapsychiatry.20
