NURS 502 Week 8 Discussion Board Forum 3 on Theory, Worldview and the Advanced Practice Role Example

Discussion Board Forum 3: Theory and Worldview in the Advanced Practice Role

NURS 502 Nursing Theory and Advanced Practice, Discussion Board Forum 3

Thread by [Student Name]

The classmates replied to are composites written for a model discussion.

Eight weeks ago I would have said that nursing theory belonged in textbooks and that real practice ran on protocols and experience. Three assignments changed my mind. Writing my personal philosophy forced me to name the beliefs I already brought to the bedside. Analyzing Modeling and Role-Modeling taught me how to judge a theory by its clarity, generality and research support rather than by whether I liked it. Writing the exemplar showed me a theory doing real work: understanding a long-haul driver's view of heart failure explained missed visits that education alone never fixed.

I now think of theory in advanced practice in two ways. The first is as a lens. In the textbook's account, a theory organizes how a discipline looks at what it studies (McEwen & Wills, 2014), and a grand or broad theory such as Modeling and Role-Modeling changes what I notice about every patient. Because of it, I will ask new patients what they believe caused their illness before I explain it to them. A lens costs no extra time; it changes what I see in the time I already have. The second is as a toolbox. For specific problems, middle-range theories offer concepts I can measure and interventions I can test. As a future nurse practitioner in cardiology, I expect to use a theory of self-care in chronic illness to design teaching and to evaluate whether it works.

My worldview gives this work its purpose. The worldview text treats nursing as a vocation that answers God's own care for people rather than as employment alone (Shelly & Miller, 2006), and I now think of advanced practice in the same terms. Paul wrote, "Whatever you do, work heartily, as for the Lord and not for men" (English Standard Version Bible, 2001/2016, Colossians 3:23). Working heartily as an advanced practice nurse means more than working hard. It means taking the time to understand patients, keeping my knowledge current, and using the authority of the role to serve people who are often unheard, such as patients whose work, poverty or fear keeps them from following a plan designed without them.

I also leave the course aware of a tension. Busy clinics reward speed, and both theory and faith ask for attention that takes time. I plan to protect time in first visits for understanding the patient's world, because my exemplar showed that forty minutes early can prevent hours of crisis later. Theory and faith together give me reasons to defend that time when the schedule pushes back.

Reply to Hannah

Hannah, I enjoyed your account of using Kolcaba's comfort theory with patients after cardiac surgery, and I agree it is a strong fit for acute care. If you go on to work in a heart failure clinic, as you mentioned, you might pair it with a theory built for long-term illness. Riegel et al. (2012) built their self-care theory for long-term illness around three processes: maintenance, which keeps the illness stable; monitoring, which watches for change; and management, which responds to symptoms. Comfort theory would help you relieve distress during an exacerbation, while self-care theory would help you plan what the patient does at home between visits. The two together cover both the hospital and the kitchen table. Your point that comfort includes the spiritual dimension also fits the readings this week; a patient can be physically stable and still be troubled, and the theory gives a nurse language to notice that. Have you seen any heart failure programs that measure comfort as an outcome alongside readmissions? It would be an interesting measure to add to a clinic's quality reports.

Reply to Brandon

Brandon, your honest doubt that theory survives a clinic schedule of twenty-five patients a day deserves a serious answer rather than reassurance. I think you are right that a nurse practitioner will not consult a theory during each visit. But the theory can be built into the structure of the visit so it does not depend on remembering it. McEwen and Wills (2014) describe theory as guiding practice through the way assessments and interventions are organized, and a clinic can do exactly that, for example by adding two questions about the patient's beliefs and goals to the intake form, or by building teach-back into the medication review. Once the structure carries the theory, it takes no extra time. Proverbs 24:3 says that "by wisdom a house is built, and by understanding it is established" (English Standard Version Bible, 2001/2016), and a clinic's routines are part of its house. Would your current practice allow a small change to the intake form? A pilot on one provider's schedule for a month would show whether the questions change anything you can measure.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Wolters Kluwer Health.

Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204. https://doi.org/10.1097/ANS.0b013e318261b1ba

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). IVP Academic.