Question

1. Your nursing class is debating the issue of the usefulness of grand theories in current practice. Make a case for the applicability of grand theories in modern nursing and describe how nurses can use the original nursing theory—Nightingale's environmental theory—in the following settings:

a. Critical Care Unit

b. Emergency Department (ED)

c. Home Health

2. You are providing care to a patient with chronic obstructive pulmonary disease (COPD) who has been readmitted 3 times within the past month for difficulty breathing. Explain how you would apply Peplau's interpersonal theory to help this patient prevent complications and promote self-management of his disease.

3. For the same patient described previously, how would you apply Orem's self-care deficit theory to help the patient? Compare and contrast the use of Peplau's and Orem's theories for this patient.

Answer 1

1.Grand theory :

-derived from conceptual models

- most complex, widest scope

- attempt to explain broad issues within the nsg discipline

- abstract concepts (less abstract than conceptual models)

- may or may not be testable

- developed through thoughtful/insightful existing ideas

- may lead to production of middle range theories

- guide research (applied to education, practice, further research, administration) for EBP → enhance QOL/health/pt safety/ predictable pt outcomes= necessary for evaluating nursing interventions

-theory requires constant renewal and re-evaluation due to ever changing health care field

# Grand theory is useful now in the following ways :-

-advantage→ applied to multiple patients and problems

-abstract makes it more difficult to apply to all situations

Grand theories help us to reflect nursing practice and what nursing is about. But they aren’t designed for empirical testing and limited in directing, explaining and predicting nursing in specific situations.

2. Nightingales environmental theory :

Florence Nightingale is considered the first nursing theorist. She believed the environment had a strong influence on patient outcomes, and many elements of her Environmental Theory are used in the following areas critical care , emergency department ,and home health in the following ways :-

Patients should have clean air and a temperature-controlled environment

Patients should have access to direct sunlight and not be subjected to unnecessary noise, especially when sleeping

Rooms should be kept clean

Hospital facilities should be well-constructed

Bedding should be changed and aired frequently

Patients should be kept clean and nurses should wash hands frequently

Patients should be offered a variety of scenery, such as new books or flowers, to prevent boredom

Nurses should be positive but not offer false hope to patients or make light of their illness

Offer a variety of small meals instead of large ones, and do not do patient care while patient is eating as it is distracting

Consider not only the individual patient but the context of where he or she lives.

2.# Peplau's interpersonal theory in nursing is defined as an interpersonal, therapeutic process that takes place when professionals, specifically educated to be nurses, engage in therapeutic relationships with people who are in need of health services.

In this case nurse uses this theory to create a therapeutic relationship with the client and encourages the client to express his concerns about his readmission for COPD ,make careplan based on the needs of the patient and implement the plan for providing care to prevent complications and teach him about the preventive measure to be taken to avoid readmission .

3. Orem's general theory of self-care deficit nursing states that a self-care demand exists when the patient of family members are not able to provide care for him/herself and those self-care demands can be met by the nurse .

For this patient , peplau's theory is used for developing therapeutic interpersonal relationship while Orem's theory is used for providing care to those patients who are unable to take care of themselves .