Nursing models: extant or extinct?

Nursing care and models of care in relation to older people in long-term care contexts: a scoping review protocol

INTRODUCTION

What nurses do and how they do it can influence older people's experiences of the quality of long-term care. In addition, a clear role definition for nurses supports them in giving patients appropriate basic care. Despite this, there is a lack of a clear role definition regarding policy, work descriptions and expectations. Therefore, the objective of this scoping review is to map the literature on nurses' role, function and care activities and/or nursing interventions, as well as to identify nursing interventions (as models of nursing care, patient care pathways and/or clinical practice guidelines) in relation to older people in long-term care. Hence, to explore how nurse's role, function and care activities in relation to older people's basic care needs are described and understood by key stakeholders (older people, their next of kin, nurses) in long-term care.

METHODS AND ANALYSIS

Arksey and O'Malley's methodologic framework for scoping studies will be used for this upcoming scoping review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist will be followed. Search strategies will be developed in collaboration with the research team and an experienced librarian. Search strategies will be adjusted for each of the databases: PubMed, PsycINFO, CINAHL and Scopus. Data will be charted using a pilot extraction sheet. Quantitative data will be described numerically, and qualitative data will be analysed using thematic analysis. The key stakeholders will be consulted for validation.

ETHICS AND DISSEMINATION

The upcoming study will follow All European Academies' principles for good research. The findings will be used to inform the design of future studies aiming to develop a nursing intervention targeting older peoples' basic care needs.

Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts

AIMS AND OBJECTIVES

To elucidate the synergies between fundamental care and seminal nursing theories.

BACKGROUND

Nursing theories are often criticised for their limited clinical relevance, with the existence of a theory-to-practice gap widely acknowledged. Pervasive examples of poor-quality care, particularly for people's most fundamental needs, raise questions as to whether nursing theories sufficiently prioritise fundamental care. The Fundamentals of Care Framework (hereinafter "the Framework") represents a valid, comprehensive and evidence-based description of fundamental care. The Framework captures the complexity and multidimensionality of fundamental care delivery, predicated on the nurse-patient relationship; integration of physical, psychosocial and relational needs; and a supportive context. Despite strong face validity, the Framework's alignment with seminal nursing theories remains unexplored.

DESIGN

Narrative review.

METHOD

Twenty-nine seminal nursing theories were included. Categories for analysis were developed inductively and deductively, focusing on the themes of relationship, integration of care, context and the theories' ease of use. Results are reported in accordance with PRISMA-ScR guidelines.

RESULTS

Though relationship, integration of care and context and were features shared across a number of nursing theories, no single theory depicts these collectively to the same extent as the Framework. In particular, integration of physical, psychosocial and relational aspects of care was found to be poorly described in the theories.

CONCLUSION

Failure to account for integration of care means that nursing theories continue to conceptualise fundamental care as a series of discrete tasks. To ensure relevance at the point of care, future nursing theories must accurately reflect the complexities of fundamental care delivery, specifically the need to integrate multiple care needs simultaneously, alongside being straightforward to apply in practice.

RELEVANCE TO CLINICAL PRACTICE

Bridging the theory-to-practice gap requires a nursing discourse that is relevant at the point of care. We provide suggestions for how future nursing theories can bridge this gap.

Advancing nursing practice for improved health outcomes using the principles of perceptual control theory

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses' actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them.

Gifts of wise women: A reflection on enduring ideas in nursing that transcend time

In this essay, I propose there are enduring ideas in the works of nurse theorists from the 1960s and 1970s that were valuable not only in the past, but in nursing today as well as in possibly shaping the future of nursing knowledge development. I identify these as gift ideas and draw on the work of Wiedenbach for the gift of dignity in nursing philosophy, and the gifts of dialogue from Orlando, behavioral systems from Johnson, context from Roy, self-care from Orem, and finally the gift of nursing science as emergent in understanding life processes from Rogers. Although the core of nursing knowledge may be elusive, the gift ideas mentioned in this essay provide some guideposts in articulating and developing that core in the present as well as in the future.

‘I Think the Carer-Partner Dichotomy is Always Interesting’: Tensions in Health Professionals’ Engagement with Spousal Care givers of People with Parkinson's

Background:The spousal care givers of people with Parkinson's (PwP) have unique, first-hand information that is invaluable in the effective management of Parkinson's disease (PD). However, there is a dearth of research that specifically focuses on health professionals’ experiences of engagement with the spousal care givers of PwP.

Methods:Interpretative phenomenological analysis (IPA) was used to describe and identify the meaning that health professionals working with PD (HPPs) gave to their engagement experiences with spousal care givers of PwP. Semi-structured interviews with a purposive sample of 12 HPPs were digitally recorded, transcribed verbatim and analysed for emerging themes.

Results:Two major themes emerged from the interviews with HPPs: (i) the Philosophy of Care (PoC) is an Intrinsic Element in the Engagement Experience; and (ii) HPPs Expressed a Deep Appreciation of Partners’ Support of the PwP. HPPs experienced significant tensions and challenges in their engagements with the partners of PwP, as a result of the interaction between their lived reality and their PoC. They also appreciated greatly the caregiving provided by the partners. The insights gained have the potential to ease or resolve problematic tensions within the engagement process.

Aplikacija adaptacijskega modela Calliste Roy pri pacientu z rakom in s kronično bolečino

Uvod: Prilagajanje je ključni dejavnik za uspešno soočenje posameznika s spremembami v svojem notranjem in zunanjem okolju. Z aktivnostmi zdravstvene nege medicinske sestre pomagajo zagotoviti potrebne vire za uspešnejši proces prilagajanja. Avtorji v prispevku razpravljajo, ali bi teoretični model prilagoditve Calliste Roy ustrezal pri obravnavi in zdravstveni negi v enoti za zdravljenje bolečine.Metode: Uporabljena je triangulacija metod pregleda literature in kvalitativne metode z raziskovalno tehniko kritičnega dogodka. Pregled literature je bil narejen v vzajemni bibliografsko-kataložni bazi COBIB.SI in Cumulative Index to Nursing and Allied Health Literature (CINAHL). Pridobljenih je bilo 165 zadetkov in uporabljenih 34 znanstvenih člankov ter 7 monografij. Kriteriji izbora so bili primarni viri Calliste Roy, dostopnost, relevantnost, kritična ponazoritev teoretičnega modela. Tehnika kritičnega dogodka v treh fazah opiše incident, ga analizira ter poda možne izide. Rezultati: Adaptacijski model Calliste Roy je aplikativen, uporaben in v sedanji situaciji se dobro dopolnjuje s štirinajstimi temeljnimi življenjskimi aktivnostmi po Virginie Henderson. Model daje možnost ocene tako fizičnega kot psihosocialnega stanja. Najpomembnejše prepoznane intervencije medicinske sestre, ki pripomorejo k prilagoditvenemu procesu pacienta, so psihosocialna podpora, učenje in svetovanje. Diskusija in zaključek: Prednost obravnave pacienta z rakom in bolečino po izbranem modelu zdravstvene nege je v možnosti ocene stanja po vseh štirih ravneh prilagajanja in v prikazu načrta zdravstvene nege. Pokazalo se je kot pozitivno, da medicinska sestra lahko s psihosocialno podporo in informiranjem vpliva na kakovost življenja pacienta. Pacient in družina se soočata s kronično boleznijo, načinom življenja in pomenom poznavanja ter nadzorovanja bolečine. 

Care planning in the emergency department

There are many demands placed on staff working in emergency departments such as the currently witnessed overcrowding, bed shortages and long waiting times for patients. Despite these demands nursing care needs to be carefully assessed, planned and documented. This study aimed to examine attitudes of staff towards the use of a nursing care plan in the emergency department. The sample comprised the total population (n=38) of all nursing staff working in an emergency department at one regional general hospital in the Republic of Ireland. The method adopted was a survey approach which employed the use of standardised questionnaires comprising both open and closed questioning styles. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were manually analysed for themes. The data obtained in this study identified that care plans were valued by respondents, stating that they contribute to holism, increased nurse/patient contact time and better communication. The findings also identified that there is a need for continuing education, further research and a need to address issues in relation to specific patient groups, including paediatrics, minor injuries, mental health and the elderly attending the emergency department.

A critical review of appropriate conceptual models for use by coronary care nurses

BACKGROUND

There is little evidence of the extent of conceptual model use within cardiovascular nursing. Concern exists within nursing that nursing theory and conceptual model use within practice is less than optimal. It is further suggested that there is little evidence of nursing theory occupying its true position as the central tenet of nursing practice and cardiovascular nurses have been challenged to reconsider this aspect of practice.

AIM

The aim of this review is to explore the effectiveness of conceptual models used within cardiovascular nursing to further explore their potential benefit.

METHODS

Using key terms, a search was conducted using electronic databases CINAHL and PUBMED; yielding seven papers that fulfilled selection criteria.

FINDINGS

Few papers related to research studies in the area. However, of those identified significant examination and testing of concepts emerged within the studies. Rather than merely using concepts as an organizing framework or a component of the study, theories alluded to were scrutinized and consistently applied. Although studies identified mostly referred to specific testing and examination of aspects of conceptual models, the notion of self-care and support for clients emerges as a strong theme within the review. The relationship between nurse and client seemed to be pivotal in any noted improvements.

CONCLUSIONS

The findings have limited application to practice. In the absence of large-scale longitudinal studies, only selected aspects of conceptual models or theory were scrutinized. Further research is required in this area to identify conceptual models of nursing that are most appropriate for cardiovascular nursing care.

Best practice interventions to improve the management of older people in acute care settings: a literature review

AIM

This paper is a report of a literature review of experimental evidence describing interventions to manage the older adult in the acute care hospital setting.

BACKGROUND

Older people are increasingly being cared for in a system largely geared towards acute care. This approach is often inadequate to meet the needs of older patients with chronic and complex conditions. In response to these challenges, evidence-based interventions are required to improve health outcomes.

METHOD

The MEDLINE and CINAHL databases and the Internet were searched using the keywords elderly, older, geriatric and aged care. Studies published between 1985 and 2006 were included if they reported, in English, a controlled trial of an intervention designed to improve the management of older adults in the acute care setting. The findings were synthesized using the method of a modified integrative literature review.

FINDINGS

Only 26 controlled trials met the inclusion criteria. The following elements of interventions appear critical in providing optimal health outcomes for older people admitted to acute care: (1) a team approach to care delivery either directly in a designated unit for older patients or indirectly using gerontological expertise in a consultancy model; (2) targeted assessment techniques to prevent complications; (3) an increased emphasis on discharge planning and (4) enhanced communication between care providers across the care continuum.

CONCLUSION

A multidisciplinary team approach, using gerontological expertise, in acute care settings is recommended to improve the care of older patients. Care delivery should occur in a specially designed unit, with communication strategies that emphasize discharge planning.

An analysis of psychosocial theories of ageing and their relevance to practical gerontological nursing in Sweden

BACKGROUND

Theories exist to challenge current practice, create new approaches to practice and remodel the structure of rules and principles. One question is whether nurses could find in psychosocial theories of ageing a theoretical foundation on which to base support of older people in their ageing process.

AIM

The aim of the present paper was to analyse five psychosocial theories of ageing and to discover what they could mean for gerontological nursing in Sweden.

METHOD

A literature search was conducted to find original works. Research questions inspired by Fawcett's framework guided the analysis.

FINDINGS

Psychosocial theories of ageing cover different aspects of the ageing process, but do not address crucial issues regarding the attitudes and structure of good nursing care. These theories provide no clear guidance on how to care for older people and how to support them in their ageing process. However, the analysis did show that the theories contain underlying values that influence society and staff as regards their views on the ageing process and how care of older people should be carried out. Nursing interventions to support ageing will be quite different depending on the theoretical perspective taken by nurses.

CONCLUSIONS

There is a need to translate the ageing theories into guidelines, so that staff in gerontological care will have tools to use in practice irrespective of which theoretical perspective they choose to use in care. This could also promote care that is tailored to each individual older person.

Discursive practices in the documentation of patient assessments

AIM

This paper reports a study analysing the various functions of nurses' documentation of patient assessments.

BACKGROUND

Modes of documentation have received much attention in the nursing press since the integration of the nursing process and nursing models. Previous research has shown that current documentation practices do not consistently promote effective communication and evaluation of patient care. A recent systematic review found no evidence that any particular system of documentation improved this situation. However, nurses' documentation serves not only to communicate information to others, but also has a political function as a presentation of what is important and ethically 'right' to report.

METHOD

A Foucauldian approach to discourse analysis was used to analyse 45 patient records.

FINDINGS

The findings indicate that nurses employ three discernible discursive practices in the documentation of patient assessments: medical, nursing and informal. Each practice has an effect on the presentation of nursing in the documentation. Because of the complex interplay between these practices, nurses present themselves as aligned with the medical profession, as distinct and professional, and as informal in their descriptions of non-biological information. The use of these practices appears to be motivated by the type of information being reporting.

CONCLUSION

Existing literature highlights the functional aspects of nursing documentation. In contrast, this paper explores the way in which nurses, through their documentation, constitute themselves and the nursing profession. In this way, nursing documentation is viewed as a social practice and a conduit through which particular power effects are produced and reproduced, rather than simply a matter of, for example, knowledge, individual choice or good practice.

Towards a Chinese definition of nursing

BACKGROUND

A theory of nursing derived from nurses' experience can reflect indigenous practice values, which in turn can act as a fertile source of ideas and inventiveness in developing a relevant knowledge base to inform practice. However, systematic study of how Chinese nurses articulate nursing in their everyday practice is lacking.

AIM

The aim of this paper is to describe how Chinese nurses conceptualize the practice of nursing; and to arrive at a definition of nursing based on this common understanding.

METHOD

A systematic inquiry using a modified version of Van Kaam's controlled explication was designed. In the prescientific phase, 254 written accounts of nurses' views on nursing as lived in their everyday practice were collected in eight Chinese cities. In the scientific phase, concept analysis based on Aristotle's notion of four causes was adopted to capture the richness of the phrases that explain the multi-dimensionality of Chinese nurses' concepts of nursing. This was followed by a survey of 1782 nurses to verify the findings. The most commonly held views were summarized and a Chinese definition of nursing was drafted.

FINDINGS

Nursing in the Chinese sense means to understand the dynamic health status of a person, to verify health concerns dialectically, and to consider interventions with the goal of assisting the person to master the appropriate health knowledge and skills for the attainment of optimal well-being. The survey findings show that nursing has developed into a professional caring practice in China today. The definition has some similarities with those of Western nurses, but the underpinning epistemic concerns are grounded in the philosophy of traditional Chinese medicine and Eastern ideologies.

CONCLUSION

The findings provide Chinese nurses with a definition of nursing articulated in their own language. The identification of qing, li, zhi, and xin as its epistemic concerns, and the articulation of the process of nursing as 'dialectical verification', provides a perspective for understanding nursing based on Eastern philosophies. The findings can enhance nurses' engagement in a cross-cultural dialogue to promote better understanding of nursing as it is practised in different parts of the world.

Using the Roper-Logan-Tierney model in neonatal transport

In recent years approaches to nursing practice have changed. Nursing theorists have advocated the need for nursing practice to be carried out using a systematic rather than an intuitive approach. A process of nursing has been developed as a method of organizing and delivering nursing care. This change in nursing practice has resulted in the need to establish a knowledge base that relates specifically to nursing. Conceptual models of nursing, advocated by nursing theorists, have come into use in Ireland, the UK and the USA. These models aim to promote greater understanding of people and their nursing needs. They advocate a certain approach to nursing and attempt to define nursing as a role independent from other health care roles. The need to develop a knowledge base specific to nursing remains a central tenet of the profession (Aggleton and Chalmers, 2000). Nursing models serve to provide this knowledge base through the description of the nature of people, health, environment and nursing. The aim of this article is to explore the use of the Roper-Logan-Tierney (RLT) nursing model in a neonatal transport setting. The first section provides an overview of the model. The second section describes the background information on a selected patient, followed by a detailed assessment of this patient using the activities of living. The final section evaluates the use of the model in this clinical situation with reference to literature on the topic.

Nursing theory views on how to support the process of ageing

BACKGROUND

An important purpose of theories is to challenge practice, create new approaches to practice and remodel the structures of rules and principles. Therefore, it is of interest to study whether it is possible to make use of nursing theories in care of older people, when the aim is to support them in the process of ageing.

AIM

To review 17 well-known nursing theories/models in order to delineate the views on ageing presented and discover whether there are descriptions of how nursing care of older people could be organized.

METHODS

Seventeen nursing theories/models originating over a 30-year period from the early 1960s to the early 1990s were chosen. A search of CINAHL was done and lists of reference from books were used to find original sources. For the review, a list of research questions were formulated and addressed to each theory.

RESULTS

Results showed that most nursing theorists see human ageing from a developmental perspective, but do not discuss what ageing implies. In only a few theories are some important aspects of nursing care of older people discussed, but no concrete instructions are given on how to apply these to nursing care.

CONCLUSION

There is a need to develop a nursing care model that - more than other contemporary theories - takes into consideration human ageing.

The meaning of models of nursing to practising nurses

BACKGROUND

It is contended that models of nursing have lost the momentum and challenge that they promised the profession. Their use, value and purpose have been seriously questioned and new perspectives on their use and implementation in practice, education and research are required. In addition, limited evidence exists on the implementation of models into clinical areas.

AIM

To explore the meaning of models of nursing to practising nurses.

METHODS

Serial interviews with qualified nurses who were undertaking an educational programme or module that explored and examined models of nursing.

FINDINGS

The outcome reveals that the use of the terms, models of nursing or nursing model, are limited and confusing as the terms can encompass a range of meanings. It is suggested that a three-model typology exists that clarifies more fully the present position of nursing models. The three models are Theoretical Model, Mental Model and Surrogate Model.

LIMITATIONS

The focus on data collection through serial interviews with qualified practitioners could have been broadened to include a range of data sources such as teachers and clinical areas, which could have enriched the phenomenon of models of nursing.

CONCLUSIONS

There is a greater need to understand nursing models within the framework of the three-model typology and to reconsider their introduction and use in this context.

A critical analysis of the philosophy, knowledge and theory underpinning mouth care practice for the intensive care unit patient

In the provision of high quality mouth care practice for the intensive care unit (ICU) patient, the nurse draws on philosophy, knowledge and theory. The complexity of mouth care for the ICU patient is compounded by their medical or surgical condition and the psychological effects of mouth care problems. Effective mouth care practice includes proactive prediction and prevention of complications, and prompt and skilled intervention in the problems arising. Therefore, critical analysis of the philosophy, knowledge and theory relevant to mouth care practice is important. The philosophical approach to mouth care requires the nurse to view the practice from different perspectives. Nursing knowledge has inextricable links with nursing practice that challenges the nurse in her/his everyday work. This application of knowledge to practice is conceptualised as ways of thinking, which is also based on what the nurse might know. Therefore, the judicious use of theory and the necessary skills are essential to provide high quality and effective mouth care practice. The purpose of this paper is to illustrate the ways in which philosophy, knowledge and theory all have an impact on the practice of mouth care for the ICU patient.

Being-with, doing-with: a model of the nurse-client relationship in mental health nursing

The authors describe a model of the nurse-client relationship within mental health nursing. This is preceded by a consideration of the literature in reference to the efficacy of nursing models in terms of their use within mental health nursing. A statement of philosophical beliefs is the starting point from which the model is described. The terms 'Doing-With' and 'Being-With' form the nucleus of the nurse-client relationship model that is founded upon the philosophy of Martin Buber. Buber explicated a philosophy of human relationships founded on his concepts of the 'I-Thou' and 'I-It' relationships. Two examples of the model illustrate its principles in clinical practice. The authors draw upon the work of Fawcett to argue the limitations and potential for the future development of the model described.

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.

Development of a meaningful learning environment in theatres

During the 1990s, geographical distancing of clinical areas and nurse education establishments led to breakdowns in communication. This article focuses on how Good Hope Hospital NHS Trust and the University of Central England in Birmingham created a meaningful learning environment for student nurses in the operating theatre using a revised version of Crofts and Taylor's (1996) perioperative placement model. The student evaluation has demonstrated that the quality of placement, teaching and supervision were of a high standard and students felt that their nursing skills had been enriched as a direct result of the placement. This article will also examine the background to student placements in the operating theatre.