Introduction
My track is related to Advanced Registered Nursing Practice, specifically Family Nursing Practice. This paper will provide a conceptual framework, a theoretical model of the Need Theory – grand nursing theory, and transition theory – a middle nursing theory that is essential for my practice.
The Need Theory defines the role of nursing and the approach to care emphasized by the practice. It was chosen due to my belief that nursing should help individuals at times when their independence in achieving basic needs is threatened. At the same time, transition theory helps define the time or situations in which nursing is necessary and acts as an intervention guideline for care.
The Need Theory – Conceptual Framework
The fundamental objective of Virginia Henderson’s Needs Theory, which was developed in 1966, was realizing that all individuals have 14 basic requirements. These needs are unique in terms of nursing care and treatment. This is the notion I find most appropriate to my own philosophy of patient care, which holds that individuals must be treated and cared for as individuals. Having realized that therapy should be tailored to the patient and his or her specific requirements has allowed me to create deeper and more lasting connections with my patients.
Like others in the nursing profession, I have accepted the attitude that one should treat people as one would like to be cared for and how one would treat an ill or passing family member. Basically, I want to treat my patients how I would like my sick relative to be treated. I am also able to accept and adapt to various lifestyles, religious beliefs, cultural variations, and ethical distinctions due to the variety of the numerous regions of the nation in which I have lived and the different faiths to which I have belonged.
The Need Theory was designed to define the patient-centered emphasis of nursing as a profession. It focuses on strengthening the independence of patients throughout the treatment process, particularly following hospital release. The approach emphasizes the significance of meeting human needs and the role that nurses should play in it.
Grand nursing theories provide a comprehensive framework for tackling complicated nursing thoughts and concepts. These categories of nursing theories provide abstract and broad notions regarding the various components of the nursing metaparadigm, such as health, environment, individual, and nursing.
According to Henderson, the definition of nursing is a “concept,” with nursing actions separated into fourteen elements that correspond to the requirements of their patients (Smith & Gullett, 2020). The concept of the Need Theory identified the roles of health practitioners as substitutive, complementary, and supplemental, all of which aim to assist patients in achieving maximum independence (Smith & Gullett, 2020).
Within the substitute position, nurses must carry out certain duties in place of their patients. In the complementary role, healthcare practitioners are required to establish successful strategies with their patients for addressing their healthcare risks and obstacles. In the supplemental role, nurses assist their patients in gaining independence and making well-informed choices to improve their health outcomes.
The Need Theory – Theoretical Model
Henderson saw the nursing process as dynamic and using a rational approach to problem-solving (Smith & Gullett, 2020). The theory is adaptable and may be used by nurses in a variety of care settings by customizing the model to the specific requirements of each patient. Patients must be taught how to achieve independence and care for themselves throughout the healing process (Smith & Gullett, 2020). Since all patients wish to be healthy, nurses serve as facilitators and helpers and focus their work on meeting patients’ needs. The nurse aids the patient, whether he or she is sick or not, in doing actions that promote health, recovery, or a peaceful death (Potter et al., 2021).
The aim of the nursing process is to achieve this as quickly as feasible, and independence is the desired outcome. This procedure is managed by the nurse independently of doctors.
As a profession, nursing may be judged based on the degree to which it allows the person to perform each of these duties independently.
The importance of Henderson’s model resides in the theorists’ advice to improve the quality of treatment for patients and to encourage their autonomy.
The nursing care is provided to achieve patient autonomy in relation to the following:
- breathing
- eating and drinking
- elimination
- movement and posture
- sleep and rest
- clothing
- maintenance of body temperature
- cleaning and grooming of the body and integument protection
- avoidance of environmental dangers and injury to others
- communication
- worship
- work
- play and participation in recreation
- learning and discovery.
The first nine components of good nursing care are physiological and include guidelines about breathing, nourishment and water, bodily waste, posture, rest and sleep, suitable clothing, body temperature, cleanliness and grooming, and safe locations (Smith & Gullett, 2020). The tenth and fourteenth components are connected to patients’ psychology, indicating that they should interact with people and express their feelings, as well as fulfill their sense of curiosity, which leads to good health and general growth (Smith & Gullett, 2020). The eleventh component relates to the need for patients to seek spiritual assistance via their religious activities (Smith & Gullett, 2020). The other components concentrate on the social and vocational habits of the patients (Smith & Gullett, 2020).
Transition Theory
Nurses have had a significant role in providing care for individuals during transitions, particularly for individuals, families, and communities undergoing changes that result in new responsibilities, network losses, and loss of support (Liehr & Smith, 2018). There are transitions from an intensive care unit to a long-term care facility, from a health center to the community, from one nation to another, and within a hospital as a result of administrator changes.
The Transitions Theory began with the premise that nursing phenomena may be described as a health or illness perspective amid major life transitions (Liehr & Smith, 2018). The idea has often been used to describe nursing phenomena in a variety of contexts, including those involving changes in health or illness, living circumstances, developmental stages, and institutions (Liehr & Smith, 2018).
Therefore, preventing illnesses, reducing health risks, enhancing health and well-being, and facilitating rehabilitation for individuals in transition are essential for nursing care (Liehr & Smith, 2018).
Transition Types
Typically, people experience these transitions concurrently.
Developmental transitions, health and sickness transitions, situational transitions, and organizational changes are included in the idea of transition types (Liehr & Smith, 2018).
Birth, adolescence, menopause, aging, and death are examples of developmental transitions. Transitions in health and sickness include the healing process, hospital release, and the identification of a chronic condition. (Liehr & Smith, 2018) Situational transitions are those caused by changes in living circumstances, such as enrolling in an educational program, traveling to a new country, or transferring from one’s house to a nursing home (Liehr & Smith, 2018). Organizational transitions include shifting environmental circumstances that have an impact on the lives of patients and workers (Liehr & Smith, 2018).
Characteristics of Transition
According to the Transitions Theory, the characteristics of transition experiences include:
- Awareness
- Engagement
- Change and difference
- Time span
- Critical points and events
Transitions are determined by lived experience and personal factors, situations, and resources, which may result in the consideration of a subjective concept. (Martins & Caldeira, 2021). Spirituality, as a subjective component intimately connected to the experience of life, is one example of these resources and personal qualities, which become increasingly significant at times of crisis and disease (Martins & Caldeira, 2021).
Perception, knowledge, and acknowledgment of a transitional event comprise awareness. Engagement is one of the properties of transitions. Engagement is the extent to which an individual exhibits engagement in the transition process. Among the characteristics of transition are also changes and differences. Changes in a person’s identities, positions, connections, talents, and behaviors provide internal and external processes a feeling of movement or direction. Differences are understood as a transitional quality. Another characteristic of transitions is their duration. The degree of congruence between what is known about processes and reactions and what defines an anticipated set of responses and perceptions of others facing comparable transitions may indicate the level of awareness (Liehr & Smith, 2018).
According to Meleis, the amount of awareness determines the level of participation, and without awareness, there would be no engagement (Liehr & Smith, 2018). Difficult differences may result from unmet or abnormal expectations, feeling different, being seen as dissimilar, or interpreting the world and people in dissimilar ways (Liehr & Smith, 2018).
In order to offer sufficient and appropriate care for patients through transitions, Transitions Theory proposes that nurses must take into account a client’s degree of comfort and mastery in coping with changes and differences. In reality, transition refers to a period of time having a distinct beginning, beginning with the earliest signals of expectation, perception, or manifestation of change and continuing through a period of instability, confusion, and discomfort to a new beginning or period of stability. However, Meleis also cautioned that defining the duration of some transitional experiences might be difficult or impossible (Liehr & Smith, 2018). According to Transitions Theory, all transitions may be defined as fluid and dynamic across time.
Transition Conditions
In Transitions Theory, it was accepted that some transitions may not have distinct marker events despite the fact that the vast majority of transitions have crucial marker points and dates. Frequently, the important periods and times are connected with an awareness of change or a difficult involvement in transition processes. A feeling of familiarity with new schedules, skills, habits, and self-care routines indicates the last key aspect. The transition conditions depend on personal, communal, and social aspects that might promote or impede the transition processes and results.
Examples of community and social circumstances are community resources and the position of marginalized immigrants in the host nation, respectively.
Birth, death, the stopping of menstruation, and the identification of disease are all examples of critical points and events. Transition conditions are variables that impact how a person navigates a transition and either help or impede progress toward attaining a healthy transition. Personal circumstances include meanings, cultural beliefs and attitudes, socioeconomic standing, readiness, and information. Community and social circumstances may either promote or impede effective transitions.
Transitional Theory Application
Transitional care was first offered to newborns with very low birth weights, women having cesarean sections, patients with gestational diabetes, and hysterectomy patients, and was subsequently extended to surgical and heart disease patients (Zhan et al., 2022).
Under the guidance of transition theory, Korukcu O et al. studied the factors influencing the transition to motherhood for women with congenital malformation (Zhan et al., 2022).
Joly E.’s literature analysis explores the transition to adult care for adolescents with complicated disorders and evaluates the complexity of disease progression (Zhan et al., 2022).
Graphical Representation
The application of these theories for my practice could be represented in the cycle of families experiencing transition that interferes with basic needs. Therefore, nursing care is provided that targets transitional experiences to cope with the transition and help the individual or family regain autonomy in these needs.
Conclusion
Henderson’s Need Theory stresses the significance of enhancing the patient’s independence so that development is not slowed following hospitalization. Her emphasis on fundamental human needs as the core focus of nursing practice has resulted in the expansion of nursing theory addressing patient requirements and how nurses might aid in satisfying those needs.
The theory suggests that fundamental requirements are essential components of health. Patients may need aid to gain health and independence, as well as assistance to die peacefully. Mind and body are linked and interdependent for the person who examines their biological, psychological, social, and spiritual aspects.
Transition theory recognizes that patients, families, and health systems experience and confront many changes, necessitating procedures and techniques to adapt to these changes and their consequences. The objective of intervention in this case is to promote both a healthy transition process and healthy outcome reactions. Interventions may include giving expertise, highlighting milestones, illustrating the roles of others, allocating assistance and practice opportunities, and offering debriefing.
References
Liehr, P. R., & Smith, M. J. (2018). Middle range theory for nursing. Springer Publishing Company, LLC.
Martins, H., & Caldeira, S. (2021). Disclosing and discussing the role of spirituality in the transition theory of Afaf Meleis. Nursing Philosophy, 22(2), e12348.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2021). Fundamentals of Nursing. Elsevier.
Smith, M. C., & Gullett, D. L. (2020). Nursing theories and nursing practice. F.A. Davis.
Zhan, L. J., He, Y. C., Liu, Q. J., Pei, M. Y., Yu, L. X., & Liu, X. Y. (2022). Progress in the application of Meleis transition theory in the nursing field. Nurs Commun, 6, e2022016.