An interpretation of family within Orem's general theory of nursing

This article offers an interpretation of family from the perspective of Orem's theory of nursing. The family is conceptualized within this theory from three perspectives: (a) as a factor that conditions an individual's requirements for care and ability to provide care for self; (b) as a dependent-care unit; and (c) as a unit of service. The meaning of these perspectives to the nurse is examined. The different assessment questions are identified. The family is seen as having functions related to the members' development of self-care agency and the establishment of appropriate dependent care systems in such a way as to promote the health of the entire family.     

Application of Orem's Self-Care Deficit Theory to the pediatric chronically ill population

The conditions under which children with long-term chronic health problems are cared for have changed dramatically in the past decade. These children are more often living longer and being cared for at home by their families and nursing supports. An effective tool allowing nurses to systematically assess, plan, implement, and evaluate the care needs of these children is a nursing theory. Orem's (1985) self- or dependent-care deficit theory is a useful basis from which the care of the chronically ill pediatric population can be planned. Attention is given to a caring relationship in which there is a dependent person in need of care and an individual who serves as that dependent person's agent of care. This article discusses several of the major concepts of the self- or dependent-care deficit theory and how it can be applied to guide clinical nursing practice aimed at meeting the care demands of the pediatric chronically ill population and their families.     

Capacities and limitations of information systems as data sources on quality of care at the end of life

Assessing quality of care at the end of life involves measurements in several domains-use of evidence-based guidelines, patient and family satisfaction, quality of life, and incidence of adverse events, among others. There are several different data sources from which to calculate quality measures. Each data source has a balance of strengths and weaknesses, and not all data sources are available in all possible settings of care. This paper describes how various data sources can be used to obtain the key data elements required for quality of care measures, as well as the challenges to linking data elements across sites and levels of care. There are some important quality domains (e.g., interpersonal and spiritual aspects of care) that are very difficult to assess using readily available data; primary data collection through interview and survey methods will be required to assess quality in these areas.     

Bourdieu's theory of practice and its potential in nursing research

AIMS: This paper seeks to consider the utility of Bourdieu's "Theory of Practice" in nursing, and considers specifically its use as a framework for research exploring nurses' conceptualizations of illness and the patients in their care. Bourdieu's work uses the concepts of field, capital and habitus to explain interactions within the social world. This paper describes these concepts and their relationship with nursing is discussed using dementia care as an example. BACKGROUND: The work of French scholar Pierre Bourdieu has contributed to debates throughout the social sciences, but has had relatively little attention in the nursing literature. Pierre Bourdieu's work developed against a backdrop of change in the academic world. The emergence of the social sciences and the debate around objective and subjective styles of research were influential in the development of his "Theory of Practice". DISCUSSION: The importance of the conceptualization process is discussed, and the considerable potential influence of conceptualization on patient care is highlighted. Reflexivity is a cornerstone of Bourdieu's work, and is an important feature of nursing research. Examples of health care research using his work as a framework are discussed, and some of the challenges of the approach are outlined. CONCLUSIONS: The use of Bourdieu's "Theory of Practice" as a research framework could allow nurse researchers to explore the interactions of nurses with the structures, agents and symbols of illness within the field of care. This work could enhance understanding of how nurses view and react to patients in their care, and promote the development of practice innovations and policy change. The theory may, therefore, have much to offer future nursing research.     

Toward a theory of patient satisfaction with physiotherapy: exploring the concept of satisfaction

Patient satisfaction is increasingly seen as an important area of research because it has been found that satisfied patients are more likely to benefit from their health care. However, there has been comparatively little work in this field within physiotherapy. Eliciting patients' expectations and needs of their care and addressing these during treatment could not only influence their subsequent health-related behaviour but could also contribute to a more favourable evaluation of the whole therapeutic experience. While various determinants of satisfaction have been identified and examined in the literature, there has been little work to develop a theory to underpin the concept of satisfaction. Such a theory is important in physiotherapy because it can inform current practice and its evaluation and have implications for future patient care. In this article satisfaction with physiotherapy is defined on the basis of a review of the satisfaction literature in health care. A theory of patient satisfaction with physiotherapy is then developed by exploring the concepts of need and expectations that are proposed as being important determinants of the construct in relation to the physiotherapeutic approach to care, drawing on need theory and relevant social science and marketing theories.     

Toward a theory of patient satisfaction with physiotherapy: Exploring the concept of satisfaction

Patient satisfaction is increasingly seen as an important area of research because it has been found that satisfied patients are more likely to benefit from their health care. However, there has been comparatively little work in this field within physiotherapy. Eliciting patients' expectations and needs of their care and addressing these during treatment could not only influence their subsequent health-related behaviour but could also contribute to a more favourable evaluation of the whole therapeutic experience. While various determinants of satisfaction have been identified and examined in the literature, there has been little work to develop a theory to underpin the concept of satisfaction. Such a theory is important in physiotherapy because it can inform current practice and its evaluation and have implications for future patient care. In this article satisfaction with physiotherapy is defined on the basis of a review of the satisfaction literature in health care. A theory of patient satisfaction with physiotherapy is then developed by exploring the concepts of need and expectations that are proposed as being important determinants of the construct in relation to the physiotherapeutic approach to care, drawing on need theory and relevant social science and marketing theories.     

Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care

spence laschinger h.k., gilbert s., smith l.m. & leslie k. (2010) Journal of Nursing Management 18, 4–13
Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care
Aim  The purpose of this theoretical paper is to propose an integrated model of nurse/patient empowerment that could be used as a guide for creating high-quality nursing practice work environments that ensure positive outcomes for both nurses and their patients.
Background  There are few integrated theoretical approaches to nurse and patient empowerment in the literature, although nurse empowerment is assumed to positively affect patient outcomes.
Evaluation  The constructs described in Kanter's (1993) work empowerment theory are conceptually consistent with the nursing care process and can be logically extended to nurses' interactions with their patients and the outcomes of nursing care.
Key issues  We propose a model of nurse/patient empowerment derived from Kanter's theory that suggests that empowering working conditions increase feelings of psychological empowerment in nurses, resulting in greater use of patient empowerment strategies by nurses, and, ultimately, greater patient empowerment and better health outcomes.
Conclusions  Empirical testing of the model is recommended prior to use of the model in clinical practice.
Implications for Nursing Management  We argue that empowered nurses are more likely to empower their patients, which results in better patient and system outcomes. Strategies for managers to empower nurses and for nurses to empower patients are suggested.     

Patient perceptions of nursing care: an emerging theory of interpersonal competence

Nurse-patient interactions were examined to identify elements of interpersonal competence among nurses from the perspective of patients Forty patients and 12 nurses participated in this qualitative study at a private acute care hospital Two-hundred and forty-five observations were completed. Open-ended questions were utilized in 85 audio-taped semi-structured interviews Data collection and analysis occurred simultaneously using the constant comparative method Four major processes emerged from the data to provide the framework for the themes 'translating', 'getting to know you', 'establishing trust', and 'going the extra mile' In the 'translating' theme, patients expressed satisfaction with the nurse-patient interaction when nurses informed, explained and instructed on specific aspects of treatment, and taught general principles of care The nurses' personal sharing, kidding and clicking appeared as important processes in 'getting to know you' Patients reported confidence and trust when nurses took charge and appeared to enjoy their work The theme of 'going the extra mile' included friendship and providing care beyond that expected The processes provide a framework for an emerging theory of interpersonal competence     

Challenging the philosophy of partnership with parents: a grounded theory study

BACKGROUND: Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term 'partnership with parents' has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom. OBJECTIVES: To explore children's, parents', and nurses' views on participation in care in the healthcare setting. DESIGN: Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England. RESULTS: Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than 'doers'. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital. CONCLUSIONS: The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents' and nurses' experiences in hospital.     

Methodological considerations for grounded theory research in critical care settings

BACKGROUND: The context of critical care and human phenomena involved in critical illness offer rich opportunity for nursing research. Naturalistic investigation with grounded theory methods can uncover previously unexamined elements and interactions in the critical care setting. This article presents methodological considerations for conducting grounded theory research in fast-paced physiologically and technologically complex critical care settings. APPROACH: Critique and recommendations are based in review and analysis of grounded theory research in adult critical care settings and on the literature describing grounded theory methods. The authors' experiences in medical and surgical intensive care units provide added practical context for this article. RESULTS: Barriers to achieving grounded theory in critical care settings, such as communication impairments, participant attrition, and observational difficulties, are explored. Methodological strategies and data sources particular to critical care settings are also discussed. Critical care settings offer a variety of data sources that should be rigorously pursued in grounded theory research. DISCUSSION: Given current trends in healthcare treatments and demographics, future research must examine physiological and technological data as integral components of basic social psychological or social structural processes in critical care interactions and should include technology as a component of nurse-patient interaction.     

Specialism in nursing: the case of nursing care for elderly people

Is elderly care nursing a speciality? This paper reports results from an interview-based study which aims to uncover the distinctive elements of nursing work with elderly people Within the context of sociological literature on specialism it is concluded that a case for seeing elderly care nursing as a speciality area can be made However, that case has implications for the continued marginalization of elderly people in society     

Pastoral care for the dying and bereaved

There has been renewed interest in both pastoral care and spiritual care in North America and in Europe. It is important to realize that spiritual care is broader than religious care. Spiritual care so jar has received little more than lip service because of this confusion. Spiritual care consists of those elements by which the patient comes to terms with his/her meaning as a person.     

The home as a setting for care. Clarifying the boundaries of practice

This article has outlined the need for clarification of home care nursing practice to retain the elements essential to professional practice. Home care that is nursing focused, based on concepts of community health nursing, and client/family centered forms the core of professional home care nursing. Technical services that are provided in the home should be clearly delineated so that consumers, payors, and practitioners can determine the roles and functions of the various providers. Professional home care, practiced not just by nursing but by all licensed providers, is practice driven. The boundaries of practice are determined by professional standards with a basis in scientific theory and research. The foundation for this type of practice is strong and should continue to be practiced in the future. Technical house call services, on the other hand, are product driven, often with a zeal for the bottom line profits that does not take into account what is the best product for a specific patient situation or how well that product has been tested. There is definitely a need for both services in delivering health care to people in their homes. It is also hoped that both areas of service can work together to facilitate the management of patient and family needs. It is important, though, to fully define the type and substance of care that is provided in the home setting. Without this ongoing clarification, home care will continue to be fragmented and interpreted differently by everyone involved.     

Relatedness theory as a framework for the treatment of fatigued women

Fatigue is a phenomenon that advanced practice psychiatric nurses may see in both psychiatric and nonpsychiatric clients. Qualitative study findings support the need for health care professionals to intervene with the relational effects of fatigue. This article details the use of relatedness theory as a framework for nursing interventions. Relatedness states of disconnectedness and parallelism, and changes in relatedness elements of synchrony, sense of belonging, reciprocity, and mutuality are addressed. Therapeutic approaches to the negative relatedness influences of fatigue include evaluating the lack of presence, decreasing expectations, addressing effects on the family, and influencing the states and elements of relatedness.     

A theory of holistic comfort for nursing

Although the construct of comfort has been analysed, diagrammed in a two-dimensional content map, and operationalized as a holistic outcome, it has not been conceptualized within the context of a broader theory for the discipline of nursing. The theoretical work presented here utilizes an intra-actional perspective to develop a theory of comfort as a positive outcome of nursing case. A model of human press is the framework within which comfort is related to (a) interventions that enhance the state of comfort and (b) desirable subsequent outcomes of nursing care. The paper concludes with a discussion about the theory of comfort as a significant one for the discipline of nursing.     

Comprehensive health care: indications from the training of nurses

This study has the objective of understanding the training of nurses for comprehensive health care. It used data from interviews with teachers, students and service nurses submitted to discourse analysis. There is an understanding of comprehensive care in the training of nurses from the perspective of establishing a healthcare model in which care is directed to the patient. There are reflections regarding the technologies and the form of organization of the work, expressed in a permanent tension: Clinical versus Collective Health as a challenge for comprehensive care. It was identified that building completeness in the formation implies assuming acting in health as an educative principle in a new form of learning-teaching in health, which breaks up with pre-formed, out-of-context knowledge. The conclusion is that comprehensive health care is taken as an object of reflection in the movement for change in the pedagogical practices, and that it is reflected in health attention.     

Living with an adult family member using advanced medical technology at home

Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.