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Application of Theory in Nursing Process

This page was last updated on October 28, 2011

Introduction

Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature.

Theories are composed of concepts, definitions, models, propositions & are based on assumptions. They are derived through two principal methods; deductive reasoning and inductive reasoning.

Objectives

to assess the patient condition by the various methods explained by the nursing theory to identify the needs of the patient to demonstrate an effective communication and interaction with the patient. to select a theory for the application according to the need of the patient to apply the theory to solve the identified problems of the patient to evaluate the extent to which the process was fruitful.

Definition

Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. "A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing."

C h a r a c t e r i s t i c s o f a U s e f u l T h e o r y [Robert T. Croyle (2005)] A useful theory makes assumptions about a behavior, health problem, target population, or environment that are:

Logical

Consistent with everyday observations Similar to those used in previous successful programs and Supported by past research in the same area or related ideas.

Importance of nursing theories

Nursing theory aims to describe, predict and explain the phenomenon of nursing It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future. Theory is important because it helps us to decide what we know and what we need to know

It helps to distinguish what should form the basis of practice by explicitly describing nursing. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education

The main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge

This can be seen as an attempt by the nursing profession to maintain its professional boundaries

Evolution of Nursing Theories & Application

The history of professional nursing begins with Florence nightingale. Later in last century nursing began with a strong emphasis on practice. Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing.

As more and more nurses began to pursue higher degrees in nursing, there emerged the research era. Later graduate education and masters education was given much importance. The development of the theory era was a natural outgrowth of the research era. With an increased number of researches it became obvious that the research without theory produced isolated information; however

research and theory produced the nursing sciences.

Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

Characteristics of theories Theories are

Interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. Logical in nature. Generalizable. Bases for hypotheses that can be tested. Increasing the general body of knowledge within the discipline through the research implemented to validate them. Used by the practitioners to guide and improve their practice. Consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

Purposes of theory in practice

Assist nurses to describe, explain, and predict everyday experiences. Serve to guide assessment, intervention, and evaluation of nursing care. Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.

Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined.

Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions.

PURPOSES OF NURSING THEORIES In Practice:

Assist nurses to describe, explain, and predict everyday experiences. Serve to guide assessment, interventions, and evaluation of nursing care.

Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.

Help to describe criteria to measure the quality of nursing care. Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words are defined. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions.

In Education:

Provide a general focus for curriculum design Guide curricular decision making.

In Research:


Practice

Offer a framework for generating knowledge and new ideas. Assist in discovering knowledge gaps in the specific field of study. Offer a systematic approach to identify questions for study; select variables, interpret findings, and validate nursing interventions. Approaches to developing nursing theory Borrowing conceptual frameworks from other disciplines. Inductively looking at nursing practice to discover theories/concepts to explain phenomena. Deductively looking for the compatibility of a general nursing theory with nursing practice. Questions from practicing Nurse about using Nursing theory

Does this theory reflect nursing practice as I know it? Will it support what I believe to be excellent nursing practice? Can this theory be considered in relation to a wide range of nursing situation? Personal Interests, Abilities and Experiences What will it be like to think about nursing theory in nursing practice? Will my work with nursing theory be worth the effort?

Conclusion

If theory is expected to benefit practice, it must be developed cooperatively with people who practice nursing. People who do research and develop theories think differently about theory when they perceive the reality of practice. Theories do not provide the same type of procedural guidelines for practice as do situation- specific principles and procedures or rules. Procedural rules or principles help to standardize nursing practice and can also be useful in achieving minimum goals of quality of care.

Theory is ought to improve the nursing practice. One of the most common ways theory has been organized in practice is in the nursing process of analyzing assessment data.

Introduction to Psychiatric Nursing This page was last updated on March 1, 2011

Introduction

"A specialty nursing practice focusing on the identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders." The American Psychiatric Nurses Association

The scope of psychiatric nurses may be in general psychiatry care and specialised areas like child-adolescent mental health nursing, geriatricpsychiatric nursing, forensics, or substance-abuse.

History of Psychiatric Nursing

In the 1840s, Florence Nightingale made an attempt to meet the needs of psychiatric patients with proper hygiene, better food, light and ventilation and the use of drugs to chemically restrain violent and aggressive patients. ( (Reddemma K & Nagarajaiah, 2004))

Linda Richards, the first psychiatric nurse graduated in the United States in 1882 from Boston City College.

In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum.

The first psychiatric nursing textbook,Nursing Mental Diseases was authored 1920. by Harriet Bailey, in

The registration of psychiatric nurses was done by 1920 in the UK and degree courses in psychiatric nursing began in the USA.

Psychiatric nursing was included in the basic nursing curriculum by the International Council of Nurses in 1961.

In 1963, President John F. Kennedy in United States passed the Community Mental Health Act which proposed the deinstitutionalization of mentally ill persons.

History of Psychiatric Nursing

In fourth century AD, during the period of Emperor Ashoka, hospitals with 15 beds for mentally ill with two male and two female nurses. In1964-65 Psychiatric nursing was included in curriculum. (Reddemma K & Nagarajaiah, 2004)

For the first time in India, 11 British nurses along with one matron were brought from the UK to work in the mental hospital at Ranchi in the 1930s.

Short training courses of three to six months were conducted in Ranchi in 1921, which were recognized by the Royal Medical Psychological Association.

During 1948-50 four nurses were sent to the U.K.by Govt. of India for mental health nursing diploma.

From 1943, the Chennai Government organised a three months psychiatric nursing course (subsequently stopped in 1964), for male nursing students at the Mental Hospital, Chennai (in lieu of midwifery).

During 1954 Manzil Medical Health centre, Lucknow gave psychiatric nursing orientation course of 4 6weeks duration.

Govt. of India decided to start training psychiatric nurses during 1953-54 and started the first organized course at All India Institute of Mental Health (presently NIMHANS).

In 19641965, the Indian Nursing Council (INC) made it a requirement to integrate psychiatric nursing in the nursing diploma and degree courses.

In 1967, a separate Psychiatric Nursing Committee was formed in the Trained Nurses Association of India.

Diploma in Psychiatric Nursing is conducted in three institutions in India.

Master of Psychiatric Nursing (MPN) programme is conducted in many institutions.

Visit Psychiatric Nursing Profession in India

Doctoral programme in psychiatric nursing (Ph.D.) at NIMHANS, Bangalore.

Principles of Psychiatric Nursing

Allow client opportunity to set own pace in working with problems. Nursing interventions should center on the client as a person, not on control of the symptoms. Symptoms are

important, but not as important as the person having them.

Recognize your own feelings toward clients and deal with them. Go to the client who needs help the most. Do not allow a situation to develop or continue in which a client becomes the focus of attention in a negative manner.

If client behavior is bizarre, base your decision to intervene on whether the client is endangering self or others.

Ask for helpdo not try to be a hero when dealing with a client who is out of control!

Avoid highly competitive activities, that is, having one winner and a room full of losers.

Make frequent contact with clientsit lets them know they are worth your time and effort.

Remember to assess the physical needs of your client. Have patience! Move at the clients pace and ability. Suggesting, requesting, or asking works better than commanding. Therapeutic thinking is not thinking about or for, but with the client. Be honest so the client can rely on you. Make reality interesting enough that the client prefers it to his or her fantasy.

Compliment, reassure, and model appropriate behavior.

Theories Applied in Psychiatric Nursing

Psychiatric nursing uses theories of human behavior as its scientific framework and requires the use of the self as its art or expression in nursing

practice.

Some of the theories applied in psychiatric nursing are

o o o o o o o

Hildegard Peplau - Theory of interpersoanal relations Psychoanalytic theory Behaviorism Jean Piaget: Theory of Cognitive Stages of Development Humanistic Theories - Abraham Maslow, Carl Rogers Existential Theories Tidal model by Dr Phil Barker and Poppy BuchananBarker

Role of a Psychiatric Nurse

Providing a safe therapeutic milieu Working with patients or clients on the real day-to-day problems they face Identifying and caring for the physical aspects of the patient's problems Assuming the role of social agent or parent for the patient in various recreational, occupational, and social situations

Conducting psychotherapy Providing leadership and clinical assistance for other nurses and health care workers.

History of Psychiatric Nursing


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By an eHow Contributor

The ancient Roman philosopher Cicero devised the first interview questionnaire for mentally ill patients to prescribe a course of treatment. Cicero and 19th-century English and American reformers

such as Dr. William Ellis, Florence Nightingale, Dorothea Dix and Linda Richards played significant roles in founding modern psychiatric nursing, despite differences in time and gender. Related Searches:

Mental Illness Nursing Home Nurses

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o

In 1836, British Dr. William Ellis published "Treatise on Insanity," arguing that trained nurses calmed depressed patients and offered hope to the hopeless. His ideas established psychiatry as a profession and formalized the field of psychiatric nursing, but popular attitudes toward the mentally ill changed slowly.

Reformers Rally for the Mentally Ill


o

American reformer Dorothea Dix noted that mentally ill patients were treated like animals in 19thcentury America, and she opened 32 state asylums to care for them. English reformer and nursing pioneer Florence Nightingale fought for quality care for the mentally ill. She collaborated with her American colleague, Linda Richards and inspired Richards to open Boston City College in 1882.

Boston City College


o

Boston City College was the first school opened specifically to train nurses in psychiatric care, with a curriculum that focused mainly on nutrition, hygiene and activity. Linda Richards is considered the founder of American psychiatric nursing.

Patients Outnumber Nurses


o

The first psychiatric nurses worked in difficult conditions and received little professional recognition. They faced overcrowding, few colleagues, scarce resources and an exploding patient population in asylums and hospitals by the end of the 19th century. Their primary job was cleaning the premises, keeping patients in order and following doctors' orders.

Psychiatric Nursing Turns Professional


o

By the 1920s, psychiatric nursing became an official and separate curriculum at most colleges and universities, and by 1950, the National League for Nursing required nursing schools to include psychiatric nursing in their clinical practice for national accreditation. The role of the psychiatric nurse expanded when the Community Mental Health Act of 1963 encouraged deinstitutionalization and psychiatric drugs that allowed patients to live on their own became more common.

Carrying on Cicero's Tradition


o

By the 1990s, psychiatric nurses were providing outpatient services such as counseling, prescribing medications and helping to diagnose and treat mental illnesses. Today, psychiatric nurses face challenges such as post traumatic stress disorder, domestic violence and the stigma of mental illness, but their focus remains the same as Cicero's--helping people cope with mental illness.

History of Psychiatry; Psychiatric Nursing 81

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By jagged81

History of psychiatric mental health


The history of psychiatric mental health has come a long way or it would be better said that the study of psychiatric mental health has come a long way. Skulls recovered and dated back to 5000 BC have large holes drilled into the sides of their head to release the demon spirits that possessed them.
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Psychiatric mental health history


Hippocrates later would try to rationalize the existence of mental health, he refused to believe that they were possessed by the demons or that God was responsible. Hippocratic medicine as it was coined by his peers revolved around the theory of humours, no not humors as in funny. Humours as in basic juices or fluids health or illness was a result of these juices included blood, choler (yellow bile), phlegm, and melancholy. Before the asylum, from the beginning of time to as early the 1800s another treatment was to lock up the mentally ill and to treat them basically like animals. They were chained up in basements to keep them safe from themselves and others. Most of the time the family members had done this because there family member hadnt always been like this and they still love them deeply.

Hippocrates in the Flesh

See all 12 photos


Yes! This is a real photo of Hippocrates.

First Asylum in U.S.

Public Hospital for Persons of Insane and Disordered Minds in Colonial Williamsburg, VA

Dorothea Dix

Rather Stunning.....uh maybe we just need a color photo?

The First "Asylum" for the Insane!


The first asylum was introduced in the 1730 in the U.S. but it was hardly close to the civilized facilities that we run today. This asylum as it was called was the typical dungeon looking castle on the hill the one you find in the horror movies, perhaps the one the created the stigma behind the psychiatric mental health. Unfortunately, the stigma is part of the history and the history is part of the stigma that we as nurses and other healthcare professionals are trying to escape. The first hospital for the mentally ill was established in Williamsburg, VA, and brought us one step closer to the ever evolving area of psychiatric mental health. Another key area were the crusades of the famous Dorothea Dix where she was responsible for the organization of 32 mental hospitals, and transfer of those with mental illness from asylums and jails.

Clifford Beers

Clifford Beers.

Adolf Meyer

Adolf Hitler sure did mess over all the great people with his first name.

The work of Clifford Beers and Adolf Meyer.

Clifford Beers (18761943) was hospitalized in several mental hospitals after a nervous breakdown and he describes his accounts of this in his autobiography A Mind That Found Itself (1913). Basically he founded the principles of mental hygiene movement which included emphasizing early intervention, prevention, and the promotion of mental health. These ideas were later crafted into the basic ideas of mental hygiene which were founded by the psychoanalysis of Adolf Meyer (1866 1950). He believed that the treatment of early forms of maladjustment could prevent more serious problems later on. His ideas also contained suggestions for preventive measures.

President Truman signed the National Mental Health Act

Great President!

On July 3, President Truman signed the National Mental Health Act, which for the first time in history funding for psychiatric education and research was available. This lead to the establishment of the National Institute of Mental Health (NIMH) in 1949, also in 1949 lithium was discovered and greatly reduced the symptoms of bipolar disorder although the FDA wouldnt approve the drug until 1970.

Lithium

So call "Happy Pills"

Chlorpromazine (Thorazine)

John F. Kennedy

Three years after the discovery of lithium in 1949, the first psychotropic drug was discovered. Chlorpromazine (Thorazine) alleviated symptoms of hallucinations, delusions, and agitation and thought disorders. This discovery greatly improved the condition of consumers with psychosis and delusion paving the way for the beginning of psychotropic drug discovery. Congress back the funding of twelve million dollars for research in the clinical and basic aspects of drugs that would help to treat individuals with a mental illness and so the Psychopharmacology Service Center was birthed. The number of mentally ill in mental hospitals declined due to the response of the disease processes to the newly discovered psychotropic drugs. With a growing need to continue to help those discharge from the institutions and to maintain that they continue to respond well to the new treatments the Health Amendments Act authorized the support of community services for the mentally ill, such as halfway houses, daycare, and aftercare. In 1961the Action for Mental Healthwas proposed to Congress. This proposal assessed mental health conditions and resources throughout the United States to arrive at a national program that would approach mental illness and treat each person with a mental illness as a unique individual. This opened the door in 1963 when President Kennedy proposed and signed legislation that started the community mental health center movement. These facilities today are the backbone of psychiatric nursing care because this is the system used when deinstitutionalizing somebody and integrating them back into the community. This legislation was also used to substitute comprehensive community care for institutional care. The Community Mental Health Center Act Amendments of 1965 were passed and included changes that would allow funds to be granted to facilities that served clients with alcohol and substance abuse construction and staffing grants to centers were extended and facilities that served those with alcohol and substance abuse disorders. Grants were also handed out to support and provide facilities that reached out to poverty areas to establish mental health services in those areas. Further grants were used to facilitate further establishment of psychiatric mental health children services.

Electroconvulsive Therapy

Patient needs to sign an informed consent for any ECT that is to be given. The same as you would do for a surgery.

Over that flew over the cuckoo's nest

Wow, Jack looks younger!

President Jimmy Carter

Electroconvulsive therapy (ECT) which has place in mental health today was struck with a fiery dart from Hollywood in the movie One that Flew Over the Cuckoos nest in 1975. In the movie it depicted ECT as a form of punishment rather than a means to reach a therapeutic outcome in the mental wellness of patients. The account of ECT had nothing to do with what actually occur during ECT, but it did not matter, during that generation people believed ECT must be stopped. This would be overcome however and in 1987 the APA published a report that stated ECT was not just for desperate cases anymore but as an effective treatment for bipolar disorder. ECT has widespread use and apart from the stigma that still covers it, it still has a therapeutic outcome. Today informed consent must be signed before an ECT can be done to a patient and the post-ECT recovery is much like what would occur during general anesthesia recovery.

During the President Jimmy Carters term in 1980 he proposed the Mental Health Systems Act which updated the federal community mental health center program by strengthening the bonds between the federal, state, and local governments to ensure that they were all on the same page. This Act was the final result of many recommendations made by Jimmy Carters Mental Health Commission. Grant programs were authorized for the CMHCs to assist in expanding services to meet an array of populations that were needed to be reached with mental health needs such as lower income households. These grants also included expanded development of services for the severely mentally ill as well as severely emotionally disturbed, and grants that was intended for expanding education on mental wellness and to get patient input and participation of mentally ill patients. The role of the nurse in psychiatric nursing is to establish a client-nurse relationship that is both therapeutic and goal oriented. Nurses have the task to assess clients to see if they are progressing as they should with their current treatments. Cultural influences as far as the history of Psychiatric mental health is due to early dealings with the mental health patients. Many stigmas about how the mentally ill are treated and what they are capable of have been erroneously molded by society and consequently has become a part of the history of psychiatric mental health that we are trying to escape. As the history of psychiatric mental health has told us, the world has come a long way in treating the mental illness once they have been identified. Now the goal of mental health is to catch somebody before they begin to exhibit symptoms of a mental illness through screenings. Psychiatric mental health is something used throughout our nursing careers whether or not we are working with a mentally ill patient or not. It is in our everyday lives as a nurse that we use psychiatric mental health that has evolved so well throughout history.