Problematic situations in nursing: analysis of Orlando''s theory based on Dewey''s theory of inquiry

Orlando's theory, proposed as a framework to use in problematic situations, was analysed using Dewey's theory of inquiry. This analysis revealed that Orlando's concepts are remarkably similar to those of Dewey. Each used an organizing principle that was derived from the meaning of experience and both view investigation as a serial process using facts and ideas to determine the problem and its solution. Several areas in Orlando's work could be enhanced and extended through the formulations of Dewey. The analysis supports the use of Orlando's theory in problematic situations.     

A nursing theory for nursing leadership

For many years nursing practice has found its foundations in nursing theory. A review of theorists such as D. E. Orem, C. Roy, B. Neumen, V. Henderson, M. E. Rogers and others reveals a focus on the management of patient care, not leadership. This has provided most nurses with a solid foundation in 'management', but little in terms of 'leadership.' In more recent years, theories such as the Deming Management Method, Managers as Developer Model, Shared Governance and Transactional Leadership have been introduced, none of which are nursing theories. This article discusses the conceptualized differences between management and leadership theory arguing that there is a difference between 'leadership and management'. A leadership theory is proposed utilizing Ida J. Orlando's model for nursing. This theory provides a nursing foundation for nursing leaders to utilize both in the management of patient care and in leadership.     

Nurse-Expressed Empathy, Patient Outcomes, and Development of a Middle-Range Theory

Purpose : To demonstrate how a middle-range theory was developed and tested through research that examined relationships between nurse-expressed empathy and two patient outcomes: patient-perceived empathy and patient distress.
Significance: Nurse-patient relationships are the basis for all nursing care and empathy is an important aspect of these relationships. Research is needed, however, to determine the patient outcomes that are related to the empathy of nurses.
Organizing Framework: Orlando's (I 96 1, 1972) nursing model. Scope: 140 subjects, 70 staff RNs and 70 patients from hospital medical-surgical acute care units. Each nurse-subject completed two measures of nurse-expressed empathy and each patient-subject completed a measure of perceived empathy and two measures of distress.
Findings: Negative relationships were found between nurse-expressed empathy and patient distress (r = -.71, p < .001), and between patient-perceived empathy and patient distress (r = -.71, p < .007). A moderate positive relationship was found between nurse-expressed empathy and patient-perceived empathy (r = .35 to .47, p < .05).
Conclusions: A model can be tested when propositions theoretically linked to the model are empirically tested. This study's findings demonstrated support for relationships proposed in Orlando's model.     

An analysis of senior nursing students'' immediate responses to distressed patients

The purpose of this study was to determine whether the effectiveness of senior nursing students' immediate responses to patients is influenced by type of distress presented by patients or by type of student degree programme. Forty-four ADN and 31 BSN seniors from four schools agreed to participate. Subjects viewed two videotaped simulations of 'patients' complaining of pain and two of 'patients' manifesting emotional distress. Content validity of simulations was established through nurse experts. After each tape, subjects answered four research questions based on Orlando's nursing process concept. The fourth question asked what subjects would say initially to 'the patient'. The data revealed eight response categories which were scored according to their congruence with Orlando's concepts. Independent categorization of responses yielded a 0.92 inter-related reliability; t-tests indicated that type of distress was related to response effectiveness (P less than 0.01) but type of degree was not (P greater than 0.01). The presumed emphasis on communication and psychosocial foundations in BSN curricula may not translate into more effective exploratory skills in these students. These skills are a key component of the complex assessment skills which enable nurses to 'diagnose human responses' to health problems. Orlando's model is recommended for teaching BSN students to conceptualize the interactional process and its goals.     

Analysing managerial responses in face-to-face contacts

Executive nurse managers, as well as other nurse managers, spend much time responding verbally to people. Whether or not their responses are effective in these situations remains an unexplored area in nursing administration. The author describes a research-based framework to analyse managerial actions. Five types of actions, three non-exploratory and two exploratory, were identified through previous research using Orlando's theory as the framework. Subsequent research suggests nurses prefer that their managers use exploratory action. The article contains discussion on how specific types of actions facilitate or thwart problem identification.     

Barriers to effective screening for domestic violence by registered nurses in the emergency department

Triage nurses in the emergency department are in a unique position to screen for domestic violence. This study, using Orlando's theory with a focus on two of her five major concepts, identifies barriers that prevent effective screening for domestic violence. A quantitative survey was distributed to 101 registered nurses employed in a large emergency department. Results identified three major barriers and a relationship between age and inservice attendance on domestic violence. Education on abuse and resources should be essential in nursing school curricula. Policy development and review should be part of an annual, mandatory inservice for all emergency nurses.     

Action process of nurse administrators to problematic situations based on Orlando's theory

This study used Orlando's theory to investigate the action process of nurse administrators to realistic hypothetical situations presented to them by their staff. Ninety subjects recorded their thoughts, feelings and actions in response to six problematic situations. Findings indicated the administrators' first thought was seldom about their staffs reaction to the situation. Most experienced negative feelings about the staff member or about other people associated with the situation which were not expressed. The majority of administrators would handle the situation alone or tell the nurse what to do; less than half would ask their staff a question. The conclusion was that subjects did not consider situations as problematic.     

Productive work groups in complex hospital units. Proposed contributions of the nurse executive

The Fiedler and Garcia cognitive resources contingency model of leadership offers a new approach for nurse executives to influence the productivity of work groups led by nurse managers. The author offers recommendations toward achieving the relatively stress-free environment for nurse managers specified by the model using Schmeiding's application of Orlando's communication theory to nursing administration. Suggestions for incorporating these insights into graduate education for nursing administration follow.     

Nursing informatics,outcomes, and quality improvement

Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.     

A magnet nursing service approach to nursing's role in quality improvement

The heightened focus on quality and the rise of health care consumerism are manifestations of numerous interrelated dynamics, especially including the aging of the "baby boomers" and greater prevalence of chronic conditions, the explosion of biomedical scientific knowledge and technology, changes in prevailing methods of health care financing, a recent prolonged period of economic prosperity, widespread concerns about patient safety, return of disproportionate health care cost, and the democratization of medical knowledge consequent to widespread use of the Internet. Quality improvement in nursing was first introduced by Florence Nightingale during the Crimean War. Today, nursing quality continues to look at process, but has evolved to an emphasis on patient care outcomes. This article discusses nursing quality structure, processes, and outcomes at a large, teaching, tertiary medical center in Los Angeles, California. The medical center is one of two designated magnet nursing services in California. Nursing's role in achieving clinical and service quality for patients, communities, and staff are essential characteristics of magnet-designated nursing service organizations.     

Re-establishing psychodynamic theory as foundational knowledge for psychiatric/mental health nursing

Psychiatric nursing care is based on an interpersonal process that relies on the therapeutic use of self in the service of patient care. Despite acknowledgment of the importance of the relationship, there has been little attention paid to the knowledge embedded in psychodynamic theory that can provide a basis for understanding the nurse-patient relationship. This paper argues that nurses need to understand and apply such theory if they are to pursue the assertion that the relationship with the patient is the foundation of their practice. The authors discuss the essential components of psychodynamic theory and their application to nursing as well as the possible reasons for the loss of interest in such theory.     

Re-Establishing Psychodynamic Theory as Foundational Knowledge for Psychiatric/Mental Health Nursing

Psychiatric nursing care is based on an interpersonal process that relies on the therapeutic use of self in the service of patient care. Despite acknowledgment of the importance of the relationship, there has been little attention paid to the knowledge embedded in psychodynamic theory that can provide a basis for understanding the nurse-patient relationship. This paper argues that nurses need to understand and apply such theory if they are to pursue the assertion that the relationship with the patient is the foundation of their practice. The authors discuss the essential components of psychodynamic theory and their application to nursing as well as the possible reasons for the loss of interest in such theory.     

BedSAFE. A bed safety project for frail older adults

In response to heightened awareness of patient safety, restraint reduction, and the potential for life-threatening entrapment caused by bed rails, a quality improvement program entitled BedSAFE was conducted to systematically and safely decrease the use of bed rails in three nursing home care units. This article describes an interdisciplinary process of individualized patient assessment, selection of appropriate alternatives for residents, compliance monitoring, training, and monitoring of patient outcomes including falls and injuries related to falls from bed.     

Using continuous process improvement methodology to standardize nursing handoff communication

The purpose of this article was to describe the use of continuous performance improvement (CPI) methodology to standardize nurse shift-to-shift handoff communication. The goals of the process were to standardize the content and process of shift handoff, improve patient safety, increase patient and family involvement in the handoff process, and decrease end-of-shift overtime. This article will describe process changes made over a 4-year period as result of application of the plan-do-check-act procedure, which is an integral part of the CPI methodology, and discuss further work needed to continue to refine this critical nursing care process.     

Quality assurance programme for nursing*

This article describes a conceptual and methodological framework for evaluating nursing care quality. The conceptual framework is based on Orem's theory of self-care which emphasizes the importance of decisions in the selection of nursing process based on patient status and problems. The primary outcome criteria is self-care. The methodological framework is based on Greenfield's criteria maps methodology for linking patient status (problems or diagnoses) to decisions about nursing interventions and linking these specific nursing intervention criteria to desired outcomes for self-care. The article further describes a multiagency quality assurance programme for nursing. The programme includes: a definition of criteria and standards across agencies; nursing care management protocols that define standards of care; continuing education courses for nursing based on management protocols; the maps method of auditing actual and recorded nursing process and patient outcomes as defined in the management protocol.     

Coaching patients to self-care: a primary responsibility of nursing

Aim.  To explore the process nurses use to guide and support patients to actively re-establish self-care.
Background.  The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care.
Method.  This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory.
Findings.  To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance.
Conclusion.  Coaching patients to self-care is a primary activity and technology of rehabilitation nursing.
Relevance to clinical practice.  Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse–patient interactions.     

Evaluation of the case method in nursing education

The case based learning (CBL) is a problem-based learning which engaging students and presenting them with learning-related and cognitive challenges. The purpose of the study was to elucidate nursing students experiences of the CBL as an educational tool in order to find out if it supports their learning. Qualitative content analysis was used and performed on the statements from nursing students' course evaluations. Students perceived the CBL as an approach combining theory with practice which provides an overview of upcoming profession. Students gain adequate knowledge about patient care in reality and thereby enabling them to obtain a holistic understanding of patients health problems. Reflections related to case seminars widen students perspectives, improve their capacity for cooperation and help them to achieve long-lasting knowledge. This learning method offers nursing students an opportunity to enhance their judgement and critical thinking skills by applying theory in practice. Students gain adequate knowledge about patient care which may benefit patient care due to students acting professionally in their future role.     

How to recognise a 'quality' grounded theory research study.

BACKGROUND: The quality of a research study is a key issue for clinical practitioners committed to the delivery of 'best-practice' patient care. With the increasing use of grounded theory in nursing research, attention is now focusing on the quality of studies using this research methodology. Indeed, within the growing body of grounded theory in nursing some methodological problems are emerging that raise questions about the quality of the research. AIM: This paper recognises that clinical practitioners need to be critical readers of grounded theory research, so that they recognise 'quality' research studies and can develop their clinical practice based on sound research findings. CONCLUSION: Grounded theory should be viewed as a package of research methods that includes the use of concurrent data collection and constant comparative analysis, theoretical sampling and memoing, all of which can create an awareness and an appreciation of the scientific merit required of grounded theory research and promote quality standards relating to research practices in grounded theory methodology.     

An experience in applying Watson's theory in caring for an enterovirus-infected child and his primary caregiver

Enterovirus is commonly seen in children. Its morbidity and mortality rate is about 18% (Department of Health, the Executive Yuan, 2003). This paper documents the use of Watson's theory in the care of a child aged two years and seven months and his primary caregiver. During the nursing process, the application of care and concern for the child and primary caregiver provided confidence, comfort, and relief of fear and anxiety caused by hospitalization, enabling the patient, during his time in hospital, to make physical and psychological progress. The caregiver was also able to gain an understanding of how to care for a child with enterovirus, which diminished some of the pressure caused by his admission to hospital and placed him and his family at the center of the nursing care.     

Physical assessment skills: a developing dimension of clinical nursing practice.

This paper proposes that the current use of physical assessment skills within critical care nursing practice is part of a on-going nursing role development process. A review of the critical care nursing role highlights how nurses in this setting have always been responsive to patient management needs. In exploring one recent nursing role development, the critical care outreach nurse, it is suggested that enhanced assessment skills enable these practitioners to safely and competently assess critically ill patients out of the intensive care environment. The use of patient case studies in this paper, demonstrate how the theory of a more intensive physical assessment knowledge base can be applied in the everyday practice of an critical care outreach nurse. Through such systematic patient review, patient management plans can be agreed and ward based practitioners can be supported in the on-going treatment of sick ward patients. The use of the cases presented also highlights the complexity of the outreach nurse's practice in addressing clinical management and team management issues.