The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

A concept analysis of empowerment

In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research.     

Transcultural nursing care of Arab Muslims

Nursing care of the Arab Muslim client can be extremely rewarding providing the nurse is knowledgeable about important features of the culture. Knowledge of the complex social structure, world view and cultural context features is critical in promoting a sense of care for these clients. The centrality of religion and the family are closely interrelated and reflect many aspects of health care. This article has presented an overview of some of these features. The importance of culturological assessment for each client and family cannot be over emphasized, since cultural background, education and degree of acculturation will lead to variation in these patterns. The use of Leininger's theory and modes of nursing interventions can be most helpful as a basis for decision-making processes related to care of the Arab Muslim client. Only through knowledge, respect and sensitivity can nurses be effective in meeting the goals of the theory which is culturally congruent care to all clients of diverse cultures.     

Hospital case management: the path to empowering nurses

Hospital nursing case management is a client-centered approach to patient care that emphasizes client outcomes and nurse accountability. While nursing case management uses the nursing process, it also promotes patient advocacy throughout the entire episode of illness. By incorporating this model of care, nurses can increase their authority, creativity, and satisfaction in the health care system.     

Negotiated care: a model for nursing work in the renal setting

AIM: This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. METHODS: Materials from several streams of literature are used to conceptualize the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualized by viewing the renal setting as a specialized social context constituted by a dominant professional discourse and a contrasting client discourse. DISCUSSION: While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. CONCLUSION: Within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanize contemporary medical technologies by responding to clients' experiences of illness and therapy.     

The client as educator: learning about mental illness through the eyes of the expert

Increasingly, educators are asking clients who have a mental illness to make a contribution to nursing students' learning as a way of informing their attitudes towards persons experiencing mental illness and thus enhancing care delivery. The nature of clients' involvement in the classroom and the quality of learning by students through this approach has rarely been questioned. This paper discusses a model of client/nurse educator collaboration in a mental health course with undergraduate nursing students. It draws on the nursing education experiences of the first author, and the personal views of the second author, a user of mental health services. Specifically, it addresses positive features of collaboration as perceived by students, client, and nurse educator and analyzes some of the challenges/issues for the nurse educator. In addition, it outlines helpful aspects of the collaborative process for both nurse educator and client, in particular, its impact on the client's personal well being. This kind of analysis is essential if we are to develop education models of such collaboration that are beneficial for all partners in the learning process.     

Attentively Embracing Story: a middle-range theory with practice and research implications

This paper describes the middle-range theory of attentively embracing story. Attentively embracing story is connecting with self-in-relation through intentional dialogue to create ease. The theory emerged in the context of the neomodernist and simultaneity paradigms as the authors shared situations in practice and research and linked these encounters to the story literature. Practice implications with a client who has hypertension and research implications with a pregnant adolescent are presented. The proposed middle-range theory is offered for critical examination by the nursing community as a guide for practice and research aimed at the promotion of human growth and change.     

Application of a model of social information processing to nursing theory: how nurses respond to patients

Title. Application of a model of social information processing to nursing theory: how nurses respond to patients. Aim. This paper is a report of a study to assess the applicability of a theoretical model of social information processing in expanding a nursing theory addressing how nurses respond to patients. Background. Nursing communication affects patient outcomes such as anxiety, adherence to treatments and satisfaction with care. Orlando’s theory of nursing process describes nurses’ reactions to patients’ behaviour as generating a perception, thought and feeling in the nurse and then action by the nurse. A model of social information processing describes the sequential steps in the cognitive processes used to respond to social cues and may be useful in describing the nursing process. Methods. Cognitive interviews were conducted in 2006 with a convenience sample of 5 nurses in the United States of America. The data were interpreted using the Crick and Dodge model of social information processing. Findings. Themes arising from cognitive interviews validated concepts of the nursing theory and the constructs of the model of social information processing. The interviews revealed that the support of peers was an additional construct involved in the development of communication skills, creation of a database and enhancement of self‐efficacy. Conclusion. Models of social information processing enhance understanding of the process of how nurses respond to patients and further develop nursing theories further. In combination, the theories are useful in developing research into nurse–patient communication. Future research based on the expansion of nursing theory may identify effective and culturally appropriate nurse response patterns to specific patient interactions with implications for nursing care and patient outcomes.     

A middle-range theory of self-care of chronic illness

Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.     

Differentiated practice: The evolution of professional nursing

Differentiated practice identifies and uses three distinct nursing roles to create a comprehensive nursing care delivery system that meets client needs across the health care continuum. Clearly defined associate degree in nursing, bachelor's of science in nursing, and master's science in nursing competencies present career opportunities for professional nurses at the bedside providing, integrating, or managing client care as well as options in management, education, and regulation. An evolutionary paradigm shift required of all nurses is the awareness that each nurse is not the whole of nursing, but rather each nurse contributes to the whole of nursing. A nursing community comprised of differentiated roles that are mutually valued and well integrated will position nursing as a powerful force in meeting the diversity and complexity of health care needs in contemporary society.     

Incorporating cultural diversity in nursing care: an action plan.

This article examines the context of culture from the perspective of the increase in immigration and concomitant growth of diversity within the United States. It proposes that nurses who deliver culturally competent care are brokers of three cultures: their own; the health care system; and the client. The mechanism for creating approaches to care that utilize this concept is the nursing process. A culture-specific assessment can be achieved using the explanatory model of illness. The inadequacies of some frequently used strategies such as nursing diagnosis are also discussed with suggested changes.     

Toward a mid-range theory of nursing presence

BACKGROUND. Presence is widely accepted as a core relational skill within the nursing profession. Nurse educators are challenged to ensure that the humanistic aspects of client care are included in the Bachelor of Science in Nursing (BSN) curriculum. Introducing and teaching presence skills early in the BSN curriculum will ensure the essential value of relational engagement with clients. Nursing literature, however, notes presence is a challenging concept for BSN students. Articulating a mid‐range theory of nursing presence will facilitate students' conceptual understanding of presence and guide nurse educators to teach presence skills. AIMS. To propose a mid‐range theory of nursing presence. Within the theoretical model, identify development opportunities to improve student nurse use of presence as a relational skill. METHODS. An extensive literature review was conducted. Materials were synthesized and the mid‐range theory was developed. DISCUSSION. Kim's nurse‐client domain provided the perspective that guided the parameters of the theory. Professional nursing presence is dependent upon the combination of five variables: individual nurse characteristics, individual client characteristics, shared characteristics within the nurse‐client dyad, an environment conducive to relational work, and the nurse's intentional decisions within the practice domain. The variables are described and the relationships among variables depicted in the model. Specific nurse‐sensitive points during a nurse‐client interaction determine or influence the nurse presence intervention and dose. Areas designed to teach or improve relational skills are identified for the BSN educator. CONCLUSION. A mid‐range theory of presence contributes to our understanding of the relational aspects of nursing practice within the contemporary healthcare environment. Identifying strategies to teach BSN students presence skills will facilitate the incorporation of the humanistic aspects of client care in the undergraduate curriculum.     

Development and testing of the theory of collaborative decision-making in nursing practice for triads

BACKGROUND: Although nurses depend heavily on informal family caregivers to provide care to clients and to be involved in care planning and decision-making, no nursing theories that include the client, the caregiver, and the nurse were available to guide collaborative care planning and decision-making. AIM: The purpose of this paper is to describe the construction and initial testing of the theory of collaborative decision-making in nursing practice for a triad. The theory represents an extension of Kim's theory of collaborative decision-making in nursing practice. Kim's theory was developed to describe and explain collaborative decision-making in a dyad (client and nurse). The inclusion of a third person (family caregiver) in the theory required the addition of concepts about the caregiver, coalition formation, and nurse and caregiver outcomes. The expansion of Kim's dyadic theory to a triadic theory was achieved by means of a modified version of the theory derivation process described by Walker and Avant. CONCLUSIONS: The theory of collaborative decision-making in nursing practice for a triad can be used to guide further research and clinical practice. The theory provides a framework for researchers who are interested in studying the effects of collaboration regarding decision-making among nurses, family caregivers, and clients. The initial testing of the new theory in home health care nursing revealed variety in the nature of the client-caregiver-nurse relationships, the many processes used by the nurses in proceeding with the home visits, a multitude of decisions considered and different collaborative, noncollaborative, and coalition-forming interactions. The limited evidence of the empirical adequacy of the theory precludes development of definitive guidelines for clinical practice at this time. More studies are required before clinical practice guidelines can be developed.     

Where does practice nursing fit in primary health care?

Practice nursing is an integral and growing part of primary health care internationally and increasingly within the Australian health care system. The potential for practice nursing being considered as a specialty of community nursing, boundary issues in community nursing, and defining characteristics of practice nursing as a model of community-based nursing are discussed in this paper. As the author has worked as a practice nurse, personal reflections on the evolving practice nurse role are provided. Practice nursing is a dynamic entity and will continue to evolve in the primary health care setting. In order for practice nursing to meet the primary health care agenda, there is a need to incorporate a social model of health with the medical model of health and to promote research and scholarship to support this goal.     

Health maintenance alteration: a nursing diagnosis of the elderly

The continually growing numbers of elderly persons in our society and the corresponding increase in health care needs for those over age 65 are providing significant challenges to the health care delivery system. Diminishing health care resources and a desire to avoid institutionalization of the elderly client are creating nursing roles for helping the elderly maintain healthful living within the community. Accurate assessment provides the nurse with access to client perceptions of health status as well as a picture of the health management practices of the older adult. A nursing diagnosis of health maintenance alteration is the basis for an individualized plan of care of nursing intervention which is directed toward reducing risk factors and assisting the elderly client to achieve optimum levels of function and independence within the limits of defined health maintenance alterations.     

Holistic symptom management: modelling the interaction phase

AIM: This article details an interaction model that links the way a nurse participates in a client's effort to describe the symptom experience and the eventual symptom management outcome. RATIONALE: Symptoms represent more than clues to an underlying disease process. Within a nursing perspective, managing symptoms requires an understanding of the person's experience and the meaning associated with each symptom. All nurses engage in symptom work with clients, but the extent of their accountability varies within their scope of practice. In the United States of America (USA) model of advanced practice nursing, the scope expands to include all aspects of symptom management such as eliciting an accurate understanding, using a symptom cluster to determine underlying causes, and involving the client in management decisions. A holistic nursing approach to symptom management is particularly well suited to the increasing numbers of people with chronic illness. METHOD: The discussion herein details the interaction phase of the evolving model of Negotiated Symptom Management in chronic illness. Analysis of the participants, process, and context governing this encounter reveal the complexities of the interaction. FINDINGS: It is argued that variables within the interaction have the potential to compromise desired nurse and client outcomes. Although symptom acknowledgement and relief is a primary goal, the emphasis for the nurse clinician remains on the person, not the symptom. Effective symptom management is dependent on hearing and attending to the lifeworld of the client. CONCLUSION: Attending to key areas of influence in the interaction process facilitates the achievement of desired outcomes in symptom management--accurate diagnosis, symptom relief, and agreement on a course of action. The dominance of chronic illness in health care, and the centrality of the symptom experience underscores the value of sensitizing nurses to these issues.