THEORIES AND CLINICAL PROBLEM SOLVING PAPER 8
Theoriesand Clinical Problem Solving Paper
Theoriesand Clinical Problem Solving Paper
Thereare many theories developed to explain, control or predict phenomenarelated to medical or health conditions. More importantly, theoriesin nursing not only enable construction and interpretation of thenature of diseases but also provide guidance when planning fortreatment. As a result, prominent physicians, psychologists, andnurses have developed models based on these theories, useful inaddressing different medical and health complications. Two suchtheories that have been effective in the diagnosis, treatment, andcuring of some diseases are the Madeleine Leininger’s Transculturalnursing theory and the theory of goal attainment by Imogene M. King.Intheir development and application, these two theories enablecombinations of different skills and knowledge paramount in solvingmedical problems practically
TheOverview of the Theories
MadeleineLeininger (1925-2012) was a nurse with several nursing educationawards from St. Anthony`s Hospital School, Catholic University ofAmerica, Creighton University and Benedictine College (Mixer, 2011).She also worked with Cadet Nurse Corps in the provision of care tothe soldier of World War II (Easterby etal.,2012). In her nursing career, Leininger became aware of the need toenhance health care across the cultural boundaries. Consequently, sheintroduced the concepts of transcultural nursing theory first in 1978and later developed them to operate within the nursing context.
Inthis theory, the provision of care is about the patients’ culturalvalues and beliefs. Simply put, the theory seeks to identify thesimilarities or differences between the cultures, thereby enablingthe practitioners to enhance the care delivery (Mixer, 2011 Im &Ju Chang, 2012). The theory has greatly assisted nurses inunderstanding the cultural norms or behaviors that can affect thetreatment of illness (Easterby etal.,2012), leading its adoption in nursing education.
Theoryof Goal Attainment
ImogeneM. King (1923-2007) was a theory developer with several nursingeducation achievements. Professionally, she had a nursing diploma(1945), a degree in nursing, and masters in nursing (1957) (Caceres,2015). She worked with the Royal University and World HealthOrganization in different programs involving linking theoreticalprinciples into practice, careers that saw her introduce and developthe theory of attainment.
Thetheory recognizes the nursing as a process involving actions,reactions, and interactions between the patient and a nurse. In thisinteraction, there is a flow of information essential in shaping uptheir perception when addressing a medical condition (Caceres, 2015).Also, she introduced three interactive systems of a Theory of GoalAttainment that are the personal system, interpersonal system, andsocial systems.
Thepersonal system refers to the self-growth, body image, space and timewhile interpersonal system refers to the interaction, communication,stress, transaction, and roles (Im & Ju Chang, 2012). Finally,the social systems refer to the power or authority, status,organization, and the decision-making process within a nursingcontext.
Also,the theory also emphasized the importance of nursing processes thatare assessment, planning, implementation and evaluation as a completeseries of activities leading to attainment of the set medical goals(Im & Ju Chang, 2012). Since its introduction in 1960, thistheory has helped nursing community establish effective models forachieving different goals.
AnExample of Nursing Practice Problem
Oneevening, a young Muslim woman came to the hospital with a broken armand red spots on her face. These marks especially those of punches onher face indicated that the woman must have been involved in a fight.A male nurse approached her, and after a session of physicalexamination, he enquired about the injuries in a series of questions.Unfortunately, the victim remained silent and did not answer any ofthe nurse’s questions. Based on the physical examination, the nursedecided to do an X-ray scan on the victim`s hand to check any damageto the bone.
Althoughshe was refusing to give a hand for inspection at first, the test wasdone, and results came positive as the bone was fractured at a pointnear the wrist. Later, the nurse provided the patient with careaccording to the physical exam and the result from testing. After awhile, a Muslim female nurse reported for the evening shift. When themale nurse explained the situation to her, she revealed that Muslimwomen are culturally prohibited revealing upper parts of the arm ortalking with other men particularly on matters of family, health ormedical condition.
Thissituation is an example of a nursing practical problem since therewas no effective communication between the patient and the nurse thatcould have led to the acquisition of important information. Thus, itwas hard to develop the best treatment goals. Also, the nurseattending the patient had limited or no skills of culturalcompetency. Evidently, the nurse failed to understand the patient’slack of cooperation, which would have helped in diagnosis andtreatment.
TheApplication of Theories in the Nursing Problem
Intheir aim to provide holistic care to individual patients, a nurserequires to recognize the cultural differences and apply thenecessary skills as demonstrated in the above practice problem(Fatemeh & Aliakbari, 2015). Mixer (2011) explains that thenursing faculty is deeply rooted in the religious values, beliefs,and practices which in the most situation may determine how a patientinteract with a caregiver during the diagnosis and treatment (p.6).For example, female Muslims are not allowed to discuss some familyissues with other men. In this case, it would be hard for a Muslimwoman to explain what happened leading to a fractured hand especiallywhen it was a family dispute. However, and with proper culturalcompetency skills, a nurse can use other indirect means without usinggender or sensitive religious questions. More importantly, thesituation would have been better solved if the male nurse contacted aMuslim female nurse or doctor to handle the patient.
Thestrengths of transcultural nursing.In the development and application, the transcultural theory has twomajor strengths. One, the theory focuses on increasing culturalsensitivity among the caregivers. In this case, it enables nurses tobe culturally conscious that is important in responding to medical orhealth needs of a patient with different religious or cultural values(Im & Ju Chang, 2012). Second, the theory recognizes the careprovision as the core of nursing career.
Theweaknesses of the transcultural theory. However, this theory has been reported to be a source of somemedical errors in decision modeling due to misperception of thepatient’s values. In this case, instances of inaccuracy leading tomedication or treatment ineffectiveness may arise (Im, & JuChang, 2012). Also, in the case of nursing fail to capture thelogical cultural aspects, patient’s satisfaction will beundermined.
Otherareas of application.As a nursing theory, cultural care theory is applicable in theprovision of care among the patients of a particular group withdistinguished sets of principles (Jeffs etal.,2013). For example, treating military patients may involve somebehaviors restricted by their code of ethics or marshal lawsespecially when sensitive security information or protocols may berevealed in the diagnosis process. However, as highlighted in in thediscussion on the weakness of the theory, it is not possible to applythe principles of cultural theory in treating a group of patientswith the similar disease or showing common symptoms.
Theoryof Goal Attainment
Asmentioned earlier, Kings Theory recognizes the importance of threeaspects of the theoretical framework that are the individual, groupand society levels important in planning for quality care provision.According to Caceres (2015), these three levels enhance therelationship between the patient and nurses thereby promoting thedevelopment of information and knowledge necessary to achieve the settreatment goals. Notably, factors enhancing the interaction between apatient and a nurse such as communication, perception, stress andtime are given much emphasis in this theory for effectivedecision-making and problem-solving relationship. In the abovepractice problem, these factors were undermined since the patientcould not interact freely with the male nurse. Consequently, thediagnosis and treatment were not easily attained. Additionally, thefollowing procedures of scanning and other technological protocolsused to identify the broken bone were costly, something that thepatient would have evaded through proper communication andcollaboration in setting the goals.
Thestrengths of King’s theory.Unlike many theories in the field of nursing, this theory by Kingrecognizes the importance of testing, diagnosis, planning andimplementation of different strategies in patient’s recovery.Additionally, it recommends continuous evaluation of these strategiesthroughout the care period to identify the need for improvements (Im,& Ju Chang, 2012). Also, the theory has easy to understand andapply concepts, while the logical sequence of care events ismaintained.
Theweaknesses of the theory. Although it has been effective in different areas in nursing andbusiness, this theory is criticized for its limited application inareas of nursing where the patients and nurses cannot interact (Im, &Ju Chang, 2012). Moreover, the theory lacks development and properapplication due to inconsistencies. For instance, King recognizespatients and nurses as strangers, but she insists on working togethertowards common goals.
Otherareas of theory application.Kings theory is applicable in different areas requiring thecollaboration of two parties towards common objectives (Jeffs etal.,2013). Such collaboration can involve to a law firm and its clientsor a research organization such as World Health Organization and acommunity facing infection of Ebola. However, the theory cannot workin circumstances where the patient is in a coma or unable to expressher views on the treatment.
Inbrief, theory development and application have greatly affected theways nursing team perceive a medical problem, develop a plan andachieve quality care and patient’s experience. Evidently, thetranscultural theory has enabled nurses to solve issues of culturaldiversity while the theory of goal attainment enhances therelationship between care stakeholders.
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Easterby,L. M., Siebert, B., Woodfield, C. J., Holloway, K., Gilbert, P.,Zoucha, R., & Turk, M. W. (2012). A Transcultural ImmersionExperience: Implications for Nursing Education. ABNFJournal,23(4), 81-84.
Fatemeh,F. & Aliakbari, H. (2015).Learning theories application in nursing education. JournalOf Education And Health Promotion,4. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355834/
Im,E., & Ju Chang, S. (2012). Current Trends in Nursing Theories.Journal Of Nursing Scholarship,44(2), 156-164. doi:10.1111/j.1547-5069.2012.01440.x
Jeffs,L., Sidani, S., Rose, D., Espin, S., Smith, O., Martin, K., & …Ferris, E. (2013). Using theory and evidence to drive measurement ofpatient, nurse and organizational outcomes of professional nursingpractice. InternationalJournal Of Nursing Practice,19(2), 141-148. doi:10.1111/ijn.12048
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