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Old 02-13-2008, 10:39 AM
spencer.jj
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Default Nursing Theories

So!

What is your favourite nursing theory, and why? Teach everyone a little bit about the theory/theorist (history, metaparadigms, advantages, disadvantages, etc).



And/Or, tell us about the nursing theory you've developed after being a nurse/student for x years.
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Old 02-13-2008, 12:44 PM
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One of my own personal favorites is Patricia Benner's novice to expert theory.

I have always been interested in how nurses learn through their practice and how while you can learn a certain amount in the classroom you actually need to go through a learning process 'at the bedside' before you can be the all round knowledgable and experienced nurse.

Well done for taking up the challenge on this Jacob!
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Old 02-13-2008, 07:40 PM
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Hmmm... my favorite nursing theory. I'm not sure this is an official nursing theory but the realization that no matter how much you do for a patient, they may still not like you.

The second part of that is, no matter how much you do for a patient, you may not like them.

Either way, you have to handle it not giving a clue that the fact they don't like you, or the fact that you don't like them does not affect the type of patient care you provide.

Did that rambling make any sense at all?
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Old 02-13-2008, 11:43 PM
spencer.jj
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Julie, about how long do you think it takes for a nurse to become an expert? In real life, not according to Benner's theory.

And MyOwnWoman (that sounds weird...for me to be saying "My Own Woman"). Anyways. How do you maintain your professionalism (do you think that's a good word to describe your previously mentioned theory?)? Do you have any good stories about a time when you really disliked a patient, but still provided excellent care? I think that would be a good thing for some of us almost new nurses to hear.

I don't know if this is a theory, but I think something that distinguishes nurse caring for normal caring is our intentionality. We don't just wipe bottoms - we know why we are doing that (to prevent skin breakdown, etc). Granted, that's a simple example - but I think it holds true for any actions we could perform. Do you agree?

These are great guys, keep 'em coming.
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Old 02-14-2008, 01:41 AM
LesleyJoy
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The nursing theory that most closely mirrors my own is Madeleine Leininger's Transcultural Nursing: "Transcultural Nursing is how professional nursing interacts with the concept of culture. Based in Anthropology and Nursing, it is supported by theory, research, and practice" ( http://www.madeleine-leininger.com/en/faq-1.shtml ). The importance of cultural competence is nicely discussed at the following: http://www.culturediversity.org/cultcomp.htm . Plainly stated, it is my opinion that clincial competency without cultural competency results in suboptimal nursing.
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Old 02-14-2008, 03:23 AM
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Julie, about how long do you think it takes for a nurse to become an expert? In real life, not according to Benner's theory
Well as they say how long is a piece of string!

It all depends on how interested you are in the work you do and to the learning situation that the working environment becomes. It depends on the people around you and how keen they are to help you to become that expert nurse. Of course you can be an expert in one thing and a novice in others (as after 28 years I still am!), thought as time goes on there is more chance that your skills are transferable. Also once you have been an expert even if you don't do something for a while you never quite revert to novice.
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Old 02-14-2008, 03:27 AM
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it is my opinion that clincial competency without cultural competency results in suboptimal nursing.
I completely agree Joy and it is an area that those involved in worldwide recruitment fail to pick up on. I shall certainly have a look at that particular theory.
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Old 02-14-2008, 07:17 PM
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Quote:
Originally Posted by LesleyJoy View Post
Plainly stated, it is my opinion that clincial competency without cultural competency results in suboptimal nursing.
Leininger's theory sounds interesting - the prof who will be lecturing on it in a few weeks is one of my favorites. I'm curious to learn about it.

LesleyJoy, do you think Leininger's theory is applicable only to those from traditionally different cultures (Chinese, Mexican, etc)? Or do you think it could work with the (I say this as delicately as possible) lower socioeconomic status patients? Do you think that the poor are a different enough culture to warrant Leininger?

Goodness, that sounds elitist, but I'm not trying to be like that. I'm genuinely curious, because it seems that the patients I've taken care of during clinicals, more often than not, are from poor backgrounds, and I'm interested in taking good care of them without looking down my nose at them (which I am prone to do).

Please forgive me if I've offended anyone - I'm not very articulate...or tactful (just ask the girls in my clinical group

I just found this article about cultural differences contributing to health care disparities. It's more geared towards medicine, but it fits for nurses too. (I found this through the ANA SmartBrief - if you don't subscribe, you should)
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Old 02-14-2008, 10:44 PM
MyOwnWoman
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Well Spencer, let me tell you a little ditty that happened to me just last week. I got to work at PM. We were holding 15 patients in the ER, some for greater than 24 hours. One of the patients we were holding had to have peritoneal dialysis. I haven't done peritoneal dialysis in over 17 years and didn't have a clue how to give it. I asked the family if they knew how to do it and the wife and son said, "Of course we know, we do it every day." (That should have been my first clue.) So, I asked the ER doctor if the family could give the dialysis because if they didn't, then I'd have to call the nephrologist to get an order for the specific dialysate and then find someone in the hospital who was willing, able, and had the time to help me do the dialysis. Keep in mind I had 9 other patients along with one other nurse. The decision, after a few phone calls, was decided that the family could do his peritoneal dialysis and get their own equipment from home. This seemed to satisfy them. Immediately after the dialysis, she wanted to feed her husband because "he is a diabetic you know." (Clue number two; the comments of "you are so stupid nurse.") Dinner trays had just arrived for our 15 patients and I immediately brought him his. At 5:30 I went to lunch and then my assignment was changed to Triage.

Each and every time I brought a patient back to a room this wife would stop me and tell me how long she had been waiting. I told her that the hospital was full and that the room that was assigned to him had a patient in it and when that when that patient left, the room would have to be terminally cleaned due to an infection that the patient had. I told her up front that it would probably be hours before her husband go up to a room.

Then it happened. A woman was sent to her room and the wife told me about it. I tried to explain to her that the room that was ready was a female room. She didn't care; all she knew is that I didn't get her husband up. Once again I tried to explain to her that I was no longer his nurse; but she didn't care. She zeroed in on me and it didn't matter what I did, I got her wrath.

The last straw was when she came behind the nurses station while I was writing the name up on the grease board and started waving her finger in my face telling me that I gave her husband's room away to.........no less, a black man. She told me I had a poor attitude and didn't give a damn about her husband because I sent the black man up first. I was stunned. I wasn't her husband's nurse, but I was apparently the only one who was willing to go out of my way to get him things; yet she still hated me.

In the middle of the nurses station, she yelled, and screamed and was in my face. I stood there and took every word she threw my way because explaining to her was useless. She had a mindset already in place.

What did I do? I called the nursing supervisor, make him aware of the situation and then walked into the room with him and said to the woman, "this is the nursing supervisor, it appears you have a problem with me and perhaps you need to express your displeasure with me to him so he can tell the appropriate authorities.

The supervisor asked if I had gotten his dialysis taken care of, she said yes and she was grateful for that. He asked if I had fed him when asked, she said yes and she was grateful for that. He asked if I did his blood sugar prior to his meal, and she said yes and she was grateful for that also. "Then what is your problem with her?" Her answer, "She's rude and she gave my husband's room away to a black man." The supervisor asked, "how do you know that?" She raised her eyebrows in the "all knowing look" and said..."I just know, you can't deny it. I know it and that's that."

I left the room, he stayed briefly. Nothing more was said. Did he get good care despite his wife? He sure did. What was her beef? 1. She was tired and wanted to go home but felt she would seem uncaring if she did so. 2. She was just plain crazy!
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  #10  
Old 02-15-2008, 02:58 AM
LesleyJoy
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Quote:
Originally Posted by spencer.jj View Post

LesleyJoy, do you think Leininger's theory is applicable only to those from traditionally different cultures (Chinese, Mexican, etc)? Or do you think it could work with the (I say this as delicately as possible) lower socioeconomic status patients? Do you think that the poor are a different enough culture to warrant Leininger?

Goodness, that sounds elitist, but I'm not trying to be like that. I'm genuinely curious, because it seems that the patients I've taken care of during clinicals, more often than not, are from poor backgrounds, and I'm interested in taking good care of them without looking down my nose at them (which I am prone to do).

Please forgive me if I've offended anyone - I'm not very articulate...or tactful (just ask the girls in my clinical group


Well, now... You have opened a can of worms and tipped the can over. Worms are crawling all over the table. Some have fallen to the floor. And some are crawling back up the table legs.

Of course there are cultures within cultures. Within the cultures of nationality or ethnicity are people who may be viewed as rich or poor, beautiful or ugly, powerful or powerless, acceptable or unacceptable. These people naturally gravitate toward and band together with others of similar circumstances. We both need and seek out others who understand our situation, language, food, and stressors.

It is good that you have recognised your propensity to think more highly of the rich than you do the poor. Perhaps one day soon you will begin to believe that a person's worth does not depend upon his wealth, his use of standard grammar, or his occupation. Perhaps soon after that you will be able to see that each person is of magnificient and inestimable value. When this occurs, you will have become an extraordinary nurse.

As a side benefit, this maturity will also protect you from the cynicism that so easily besets healthcare providers because it will allow you to view the person as separate from from his/her behavior.

In short, truly culturally competent nursing is loving our neighbors as we love ourselves.

Stepping off of my soap box and hoping no one throws tomatos,

Joy

Last edited by LesleyJoy; 02-15-2008 at 03:56 AM. Reason: The syntax fairy was laughing at me
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