Abstract
The nursing theory of vigilance is grounded on the philosophical underpinning that care is the essence of nursing practice and vigilance is the essence of caring. Nurses cannot provide quality patient care without being vigilant. The theory was developed by Jeanine Carr. Professional vigilance can be defined as a state of great alertness that is characterized by optimal physiological and psychological readiness to detect, identify, and address risks and threats to patient health and safety. In that regard, nurses are required to be attentive in observing patients for the various clinical cues. Also, they should possess the knowledge to calculate the risks associated with various clinical situations and practices, and they should be ready to act swiftly to eliminate threats and dangers in nursing environments.
The theory is founded on Leininger’s caring framework that suggests that it is important for nurses to comprehend the cultural needs of patients to provide quality nursing care. The nursing theory of vigilance is grounded on the quality-caring model that comprises five main components namely environment, communication, allocation of resources, nursing roles and responsibilities, and caring practices. The theory has heuristic value because it can be used to develop new ways of improving the efficacy of nursing practices and creating environments that enhance the quality of nursing care. It can be used as the backdrop of research studies to find out the role of vigilance in the development and implementation of caring practices in nursing. For example, ways of reducing the number of medical errors can be developed and applied in nursing practice.
Introduction
In the nursing profession, caring is one of the fundamental requirements that all professions are required to provide. Professional vigilance is the most important aspect of nursing care. The nursing theory of vigilance is conceptualized within Leininger’s caring framework and it is best described as the most important aspect of nursing care. It is applied in providing care to patients as well as their loved ones. The theory was developed by Jeanine Carr who described vigilance as the protective involvement of individuals in caring for their loved ones. Vigilance is an expression of caring and it is best expressed in the application of a family-centered model of care delivery. Also, it is evident in open visitation policies that allow the families and relatives of patients to watch over them.
Philosophical underpinnings
Vigilance is the most important aspect of quality nursing care. In the nursing profession, nurses are required to provide care that improves the safety and the overall wellbeing of patients. Caring is a multidimensional concept that encompasses several aspects that include vigilance, communication, environment, nursing practices, and knowledge (Kooken & Haase, 2014). Vigilance is defined as the state watchful attention and the psychological and physiological readiness to identify and address any event or occurrence that endangers the life of a patient (Carr, 2014). In that regard, nurses should pay attention to clinically significant cues, determine the risk associated with various nursing situations, and be ready to act to minimize risks and threats to patients’ health and lives.
Vigilance is founded on a profound knowledge of nursing practice and it is an important factor in effective nursing practice. All nursing activities should be conducted with great attention that caters to the needs of patients (Kooken & Haase, 2014). Many tasks in nursing require great levels of vigilance to ensure the safety of patients (Carr, 2014). However, nurses sometimes exhibit low levels of vigilance because of factors such as stress, distractions, and burnout. The families and relatives of patients have a role to play in creating vigilant partnerships with nurses (Plakas, Taket, Cant, Fouka, & Vardaki, 2013). Examples of these measures include identifying threats to patient safety, comprehending the extent of human limitations, finding ways to clear fatigue, creating balance about the attention given to various tasks, and understanding the major doctrines of vigilance (Kooken & Haase, 2014).
Main concepts of the theory
Vigilance requires nurses to attach meaning to what is, anticipate what could happen, calculate risk, stay ready to act, and monitor results of interventions (Kooken & Haase, 2014). First, the theory recognizes that caring is the essence of nursing, and vigilance is the essence of caring (Carr, 2014). It is impossible to care for a patient without paying close attention to them. Second, nurses should be able to observe, identify, and place meaning to various nursing cues that are important to the provision of quality care (Geyer, 2015). Also, they should be able to anticipate what might occur and calculate the risks of various practices or decisions. Third, vigilance encompasses the readiness to act under any situation or circumstance and the attentive monitoring of patients to determine the efficacy or effectiveness of different interventions (Carr, 2014). A nurse should always find the meaning of any event or outcome. For example, upon examining a patient, a nurse should be able to determine what is going on with the patient, what it means, and how significant it is to their health (Schreiber & MacDonald, 2010). This is done through extensive assessments that require great attention.
The theory’s framework’s model
The nursing theory of vigilance framework is based on the quality-caring model. The quality-caring model is founded on five major concepts namely nursing roles and responsibilities, environment, caring practices, communication, and resource allocation. Resource allocation includes conservative scheduling and continuity of assignments. Communication includes electronic documentation and effective interactions between patients and nurses. Based on this model, vigilance is enhanced by creating an environment that eliminates distractions and promotes attentive practice (Kooken & Haase, 2014). For example, there should be therapeutic lighting, noise control procedures, focused reminders, and open visitation. Caring practices include centering, assigned breaks, purposeful interaction, and opportunities for reflection. The environment should promote safety, healing, and caring (Schreiber & MacDonald, 2010). This model facilitates interactions among the concept of vigilance and its various aspects such as environment, nursing practices, and communication. Resource allocation involves the possession of the necessary tools, technology, people, and materials need to provide quality nursing care to patients (Kooken & Haase, 2014). Professional nursing characteristics that enhance vigilance include authority, accountability, autonomy, professional development, evidence-based decision-making, competence, and empowerment.
The heuristic value of the theory
The nursing theory of vigilance can be used to develop and improve nursing practices that help to care for patients as well as their loved ones. Professional vigilance is an important aspect of nursing practices such as diagnosis, monitoring, and assessment. The theory can lead to new ways of thinking about patient safety and quality care from the backdrop of vigilance. Also, it can be used to develop new ways of enhancing interactions between nurses and patients to improve the quality of health outcomes. The theory has several implications for advanced nursing and research. Patient safety is one of the major issues discussed in the medical profession. Nurses can use concepts of the theory to improve safety by reducing the number of medical errors that occur during diagnosis and assessment. Also, it can be sued as a backdrop for studies on how to improve nursing practices to improve patient safety.
Analysis
Vigilance is the essence of quality nursing care (Geyer, 2015). It is characterized by three main concepts that include calculation of risk, great attention, and readiness to act. Nurses should give great attention to their patients and identify clinical cues or signs that are important indications of a patient’s state of health before and after treatment (Plakas et al., 2013). They should able to calculate the risk involved in conducting certain nursing practices. They should also be ready to act under different situations and circumstances to minimize the risk and threats that could affect the health and overall wellbeing of the patient. Other important concepts of professional vigilance include monitoring the results of interventions and attaching meaning to events and occurrences (Schreiber & MacDonald, 2010).
Conclusion
Caring is perhaps the most important aspect of nursing that encompasses concepts such as vigilance, communication, and knowledge. Jeanine Carr developed the nursing theory of vigilance to espouse the importance of vigilance in the provision of nursing care. According to the theory, nurses should use vigilance to prevent harm to patients by calculating risks, being ready to act under different circumstances, and actively identify clinical signals that have health implications. Nurses also expect the patient’s relatives and families to be vigilant to improve the health outcomes of patients. Professional vigilance in nursing is a critical aspect because it is the foundation of quality care.
References
Carr, J. M. (2014). A Middle Range Theory of Family Vigilance. Medsurg Nursing 23(4), 251-255.
Geyer, N. (2015). Vigilance is the Essence of Nursing. Professional Nursing Today 19(2), 36-27.
Kooken, W. C., & Haase, J. E. (2014). A Big Word for Something We DO All the Time:Oncology Nurses Lived Experiences of Vigilance. Cancer Nursing 37(6), 15-24.
Plakas, S., Taket, A., Cant, B., Fouka, G., & Vardaki, Z. (2013). The Meaning and Importance of Vigilant Attendance for the Relatives of intensive Care Unit Patients. Nursing in Critical Care 19(5), 243-254.
Schreiber, R., & MacDonald, M. (2010). Keeping Vigil over the Patient: A Grounded Theory of Nurse Anesthesia Practice. Journal of Advanced Nursing 66(3), 552-561.