FNP-Family Nursing Practitioner
MMRC-Medical Management Routine Care
QOL-Quality of Life
Ailments,particularly long-lasting ailments, can be a substantial problem onthe life of a patient and their family. Transitional by nature,periods of illnesses are often described by unexpected alterationsthat ultimately become a cause of instability and disturbance tonormal life which can be overwhelming (Laffey, 2016). Whether long(chronic illness) or short (acute illness), the author notes thatperiods of transitions can represent a time when there are severalsources of distress, multiple newly-established needs, and numerousillness-related tasks to be undertaken. Effectively managed by acompetent NP, transition-related taskscan guarantee the realization of the best possible outcomes in termsof a patient’s general health and wellness (Thompson, 2014). It isglobally recognized that nursing theories can be applied to solvesuch problems in nursing practice. In this respect, this paper is anapplication of Meleis’ theory of transition to resolve the problemof high readmission rates occurring within FNP Practice in bothclinical and primary care settings.
Developedby Afaf Ibrahim Meleis, Chang and Im (2015) note that the transitiontheory is based on the principle that all individuals go throughchanges in life hence the designation “transition.”The term transition is plagiaristic of the Latin word transire,which literally means to goacross (Chang& Im, 2015). Basically, transition implies a movement from onestable status to yet another stable condition indoctrinating theelements of perception, time span, and process. During transitions,Costa dos Reis and Mendes Costa (2014) argue that nurses have theopportunity to facilitate these transformations in regards to healthand wellness by providing health promotion. Ms. Meleis coined thetransition theory when nursing science was developing, which sawnursing change to a professional-based vocation from anemployment-based vocation. Meleis noted that by identifying theseperiods of transitions, nurses could create appropriate interventionsfor their patients which would in turn assist them realize positivehealth outcomes (Al-Yateem & Docherty, 2015). By developing thetransition theory, the authors argue that Meleis was encouragingnurses to use their critical thinking skills to identify the momentswhen their patients were transitioning, thus selecting the bestinterventional protocols that would make the entire transitioningprocess a success.
Accordingto Meleis’ theory of transition, the progression of a patient fromone stage to another entails three phases each with uniquecharacteristics. The first stage consists of individual separation ordisengagement from the present-day circumstances (Kutzleb, 2015).Here, the author observes that a patient is retreating from thecurrent roles and begins taking on a completely new role.Nonetheless, the past roles are still dominant in the backdrop of thechanges, although the new reality has not yet transpired. A patient’scapability to make significant progress in the transition process,according to Laffey (2016), is dependent on their capacity to passthe first stage of the process of transition. The second stage, alsoknown as the “neutral phase,” transpires when a patient has leftthe first stable state but has not yet successfully entered the nextstable state (Kutzleb, 2015). This stage is often marred bydisorientation and discovery of new things in preparation for takingon new roles. At this point, Kutzleb (2015) perceptively states thatthe indispensible personal and environmental changes take place,enabling a patient to enter into the last phase of the process oftransition (self-generation stage).
Inthe third and final stage of the process, Thompson (2014) observesthat a patient attaches meaning to the newly found reality, engagingthe possibility of new future prospects. Once this is achieved, apatient experiencing the transition has now entered a new stage orplace in their life after which they will successfully return to astate of equilibrium. Per se, a transitioning patient willincorporate all the newly established realities into new identities,enabling them to engage in behavioral patterns of dealing withthemselves and others. As initially conceptualized, nursing theoriesare known to be applied in solving such issues in the practice ofnursing as a profession. The subsequent section of this paper shedslight on the problem that can be resolved by Meleis’ theory oftransformation in practice as elucidated later in this paper.
Descriptionof the Problem
Theissue for this paper is high readmission rates occurring within FNPPractice in both clinical and primary care settings. According toRamsay et al. (2013), research studies conducted around the US in2012 showed that an estimated 25-30% of patients that were dischargedfrom hospital had greater chances of being readmitted back tohospital within 30 days of which 80% of the readmissions werepreventable. Additionally, Kutzleb (2015) conducted aquasi-experiment in which the purpose of the study was to compare thehealth outcomes between a NP-Led TCI and a MMRC in the management ofHF. The specific objective of the experiment was to determine ifpatient sensitization and follow-up improve health care outcomes,measured by the QOL. The results of the study exemplified the factthat the HF patients under the NP-Led TCI achieved better outcomes inthree domains of the measurement of QOL: health, social, and economicfunctions (Laffey, 2016). In other words, Kutzleb’s (2015) workproves that in a clinical or primary care setting, a NP-Led TCIsignificantly improves the quality of patient care, and can thereforebe instrumental in reducing high hospital readmission rates withinFNP Practice. What’s more, it helps in condensing the costs ofhealth care (Laffey, 2016).
Nursingas a profession should care about the worrying trend of high hospitalreadmission rates simply because NPs are increasingly playing apivotal role in caring for patients. Nursing practitioners areincreasingly becoming important in patient and family education, andshaping policies that sway the general delivery of quality patientcare (Chang & Im, 2015). Additionally, nurses should care aboutthis issue because they play a crucial role in helping hospitalsdevelop systems that improve on the level of care given to patients.Therefore, nurses should care about this issue because it is theirefforts that can turn these appalling statistics around. Nurses canachieve this by applying nursing concepts and principles that improvethe overall outcome of patient care consequently reducing hospitalreadmission rates (Laffey, 2016).
Inother words, reducing readmissions is a win-win for both quality andcost devoid of the possibility of a rationing. And it is not onlynurses that should be concerned about this issue. We should all beworried about high hospital readmission rates because they are aclear indication of a decrease in the quality of patient careprovided. Bearing in mind that high hospital readmission rates havean economic implication, the costs of health care will significantlyincrease (Kutzleb, 2015). In other words, high hospital readmissionrates imply a decrease in the quality of health care delivery whileincreasing the costs. From the patients’ perspective, highreadmission rates signify reduced QOL health wise, economically, andsocially. The spillover of such a scenario is that the generalpopulation will experience an increasing number of illness-infestedindividuals, which will in the long run turn out to be detrimentalto the overall health of the United States. Therefore, we should allbe concerned about this issue because it either directly orindirectly affects us in one way or the other. As the majorstakeholders affected by this issue, patients, their families, andhealth care providers should be concerned with being part of theinitiatives intended to condense the high rates of hospitalreadmissions.
Applicationof Theory to Issue
Developedby Afaf Ibrahim Meleis, the transition theory is based on theprinciple that all individuals go through alterations at some pointin their lives. Meleis noted that during transitions, nurses have theopportunity to facilitate these life transformations in regards towellness and health by providing health promotion (Thompson, 2014).In accordance to Meleis’ theory of transition, a patient goesthrough three phases of transition. For the successful process oftransition, a patient has to successfully pass through the trio ofstages.
Inthis regard, a high hospital readmission rates occurring within FNPPractice in both clinical and primary care settings can be attributedto unsuccessful patient transitional processes. After discharge,patients easily find their way back to hospital beds when they havenot successfully completed all the three stages of the transitionprocess. To this effect, Meleis’ theory of transition can be usedto solve the problem of high hospital readmission rates by providinga template through which nurses, acting in their professionalcapacity, can step in and assist patients successfully complete allthe three phases of the process of transition.
Accordingto Meleis’ theory of transition, a patient has to go pass all thephases of the process of transition. A high hospital readmission rateindicates patients’ unsuccessful completion of any of Meleis’three phases of transition. Because of patients’ inability toachieve a new steady state, he/she is likely to be readmitted becauseof the lack of attaining some form of new equilibrium in the newlyfound reality (Costa dos Reis & Mendes Costa, 2014). Therefore,one strategy that can be useful in solving the problem of highhospital readmission rates can be improving patients’self-awareness on the medical conditions triggering the transitionprocess (Al-Yateem & Doherty, 2015). Through these protocols ofhealth promotion (patient sensitization), NPs can assist patientspass all the three stages as designated by Meleis’ theory oftransition. For instance, if a patient is likely to be readmittedbecause of a failure in the second stage of the transition process, aNP, using a NP-Led TCI, can assist patients to take on new roles bysuccessfully taking them through the second stage thereby helpingthem to achieve a new equilibrium in the third phase of transition.
Thestrategy of improving patient self-awareness on the causes oftransition (ailments) can be implemented by NPs right from the momenta patient is admitted. When a patient is being admitted, nurses cancollect pertinent information relating to the patient includingsocial, family, and economic aspects. Having collected all thisinformation, a nursing practitioner can inculcate any pertinentdetails that can help the client in realizing success in all thephases of the process of transition (Kutzleb, 2015). Beforedischarge, NPs can improve patient awareness (health promotion) onthe expected needs or role changes through every phase of thetransition process. Health promotion can be in terms of sensitizingthe patient on concerns like symptom exacerbation, making them knowtheir critical roles in the treatment process, and making them awareof the fact that the new equilibrium is the best stable state forthem.
Evenafter discharging their patients, nursing practitioners can makeperiodical follow-ups on the clients to determine whether they arestuck at any phase of the transition process (Thompson, 2014). Thismight entail calling the patients on specified periods of time forthe first thirty days following discharge, for instance thrice everyweek for the first 30 days and then twice every week for the next 60days. Through follow-ups, a nursing practitioner can guarantee thesuccessful completion of transition related tasks for the realizationof improved health care outcomes (Kutzleb, 2015). With the aid of acompetent NP, a patient who gets stuck at the second phase of thetransition process can successfully complete the entire processbecause a nurse can facilitate the effective movement from one stageof life to the next through health promotion.
Whethershort (acute illness) or long (chronic illness), periods oftransition can be a troublesome affair on a patient and their family.Effectively managed by a competent NP, transition-related taskscan guarantee the realization of the best possible outcomes in termsof a patient’s general health and wellness (Thompson, 2014).During transitions, Costa dos Reis and Mendes Costa (2014) argue thatnurses have the opportunity to facilitate these transformations inregards to health and wellness by providing health promotion. UsingNP-Led TCIs, nurses can support patients through the entire processof transition to avert a “reset” back to the past conditions.
Thispaper has discussed how Meleis’ theory of transformation can beused to resolve the problem of high hospital readmission rates in aFNP Practice through health promotion, patient sensitization, andpatient follow-up. To condense the societal problem, Meleis theorycan be used to improve patient care outcome by providing a frameworkthrough which patients can pass across from one life stage toanother. I can positively affirm that the research undertaken towrite this paper has increased my knowledge base on the applicationof a nursing theory to a professional concern. Therefore, I am now amore competent nurse because of my newly acquired knowledge which Ican use in practice to improve patient care outcomes.
Al-Yateem,N., & Docherty, C. (2015). Transition: A concept of significanceto nursing and health care professionals. Journalof Nursing Education and Practice,5(5).doi:10.5430/jnep.v5n5p35
Chang,S. J., & Im, E. (2015). Testing a Theoretical Model ofImmigration Transition and Physical Activity. Researchand Theory for Nursing Practice,29(3),177-188. doi:10.1891/1541-6522.214.171.124
Costados Reis, A. S., & Mendes Costa, A. M. (2014). Caring forImmigrants: From interacting in practice to building nurses’cultural competencies. RevistaDe Enfermagem Referência,61-68. doi:10.12707/RIII13118
Kutzleb,J. (2015). Nurse Practitioner Care Model: Meeting the Health CareChallenges With a Collaborative Team. NursingEconomics,297-306. Retrieved October 6, 2016.
Laffey,J. (2016). Reducing Readmissions Using a Nurse Practitioner-LedTransitional Care Intervention. NursingResearch.Retrieved October 6, 2016.
Ramsay,P., Huby, G., Thompson, A., & Walsh, T. (2013). Intensive caresurvivors` experiences of ward-based care: Meleis` theory of nursingtransitions and role development among critical care outreachservices. Journalof Clinical Nursing,23(5-6),605-615. doi:10.1111/jocn.12452
Thompson,A. C. (2013). Department expands to help all inpatients attransitions in care. AmericanJournal Of Health-System Pharmacy,386-387. doi:10.2146/news130018