Defining Your Phenomenon of Interest within a Theoretical and Scientific Framework

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nSummary of Phenomenon of interest

nDiabetes mellitus is one of the non-communicable diseases that affect most people across the world. The number of patients diagnosed with diabetes mellitus (DM) has increased over the last decades due to inadequate diet and sedentary lifestyle (Tieder et al, 2013). According to national center of disease control (CDC) approximately 9.3 percent or 29.1 million people in the U.S has been diagnosed with diabetes mellitus. However, due to DKA difficulty, most of the patients are hospitalized. DKA is caused by deficiency in production of insulin in patients suffering from DM. The complication is also caused by build-up of ketone bodies in the body due to triglycerides lipolysis. DKA is responsible of high rate of readmissions of patients in the ICU (Misra and Oliver, 2014). Reports indicate that 20.3 per cent of DKA patients are readmitted in ICU. One of the major causes of readmissions is that most patients do not abide by diet and treatment prescriptions, which lead to decrease in quality of life. The majority of these patients also do not have medical insurance. Therefore, in order to reduce these cases, training packages should be implemented. Research suggests that hospital readmissions can be prevented for the DKA patients through patient education during the hospital stay (Elliott et al, 2014). Teaching strategies such as the Dose Adjustment for Normal Eating (DAFNE) can be utilized in this program. The DAFNE has a significant role in healthcare because it reduces the number of hospital readmissions by 61 percent.

nFawcetts Nursing Meta-paradigm

nFawcetts meta-paradigm theory suggests four elements that form the foundations for planning nursing beliefs and knowledge concerning nursings content and context. They include nursing, health, environment and person (Fawcett, 1999). A person is the one under the nursing care or getting cure. On the other hand, environment refers to the circumstances or immediate environment where care is being offered. Moreover, health means the process of human beings to live and die. Finally, nursing refers to the search of facts of illness and health processes. These four meta-paradigms components are relevant in the phenomenon of interest (POI). They are also interrelated hence; they collaborate to establish the ‘person. In this case, a patient suffering from DKA should remain at the foundation of nursing care (Fawcett, 1999). All the four meta-paradigm have the same level of importance hence none is essential than the other.

nPerson

nThis is the first paradigm of the theory and it describes the sick persons as patients rather than subjects. It also includes family members and friends who care for the patient. In case of Diabetic ketoacidosis (DKA) patients, they should be treated as autonomous and unique individuals (Sochan, 2015). Therefore, a nurse should develop a relationship with the person founded on dialogue. In addition, a nurse should be under the guidance of mutual awareness (Fawcett, 1999). Furthermore, when providing care to the patients, it is crucial to view them as associates. When implementing the DAFNE, the nurse should have a good relationship with the patient in order to facilitate the learning process. As an educator and as a nurse, it is crucial to participate in expressive encounters. Similarly, nurses should try to develop authentic linkages with families and patients.

nResearch by Traav, Gabrielsson & Cronqvist, (2014) posits that when patient-nurse relationship is good, they will be able to facilitate a learning process. Consequently, programs such as DAFNE will succeed to reduce the number of ICU readmissions for DKA patients. In this regard, the researcher suggested that nurses should develop a shared negotiation and transparency when implementing the DKA educational programs in order to strengthen this relationship (Traav, Gabrielsson & Cronqvist, 2014). As an educator, a nurse should attempt to understand the patient, respect his/her spirit and assist in their development.

nHealth

nAs a nurse implementing DAFNE to help patients with DKA, it is important to understand their health determinants. In addition, as an educator, nurses should utilize all-inclusive perspective to DKA patients. Furthermore, they should use a wide range of strategies in teaching to help DKA patients participate in their own perspectives (Sochan, 2015). Most importantly, nurse educators should encourage the DKA patients to understand the important determinants of health such as diet.

nEnvironment

nNurses have a unique responsibility of keeping patients under the appropriate environmental conditions. In order to facilitate learning of DKA patient in the DAFNE program, a nurse should pay close attention to the external and internal elements of environment (Fawcett, 1999). Environmental conditions are crucial in the recovery of health. Similarly, they help in enabling better learning for the DKA patients. On the other hand, as a nurse educator, the issue of environment widens to involve the constructed and normal environments. The two concepts are very beneficial in population and personal health. According to McCormack & McCance, (2011), nurses must promote learning in families and social groups by enhancing awareness and change (McCormack & McCance, 2011).

nNursing

nNursing refers to the study of process of illnesses and health in human beings. The nursing care is assisting, supporting and facilitating societies, communities, families and individuals to recover, safeguard and enhance health. In addition, nursing practice encompasses the amelioration and reduction of effects of disease or illness (Jones, 2010). The educational program and training of DKA patients should focus on improving the quality of life for these patients. In this case, a nurse educator should concentrate on sharing important concepts in the process of teaching DKA patients (Sochan, 2015). However, in order to succeed in education DKA patients, nurses should have appropriate and adequate skills, competence and knowledge proficiency.

nFurthermore, they should have positive relationships, attitudes and actions in order to promote good nursing care in the DKA patients. Similarly, nurses should be guided by a moral practice aiming to restore good health to these patients rather than personal benefits or gain (Traav, Gabrielsson & Cronqvist, 2014). DKA patients who are readmitted in the ICU should have a caring behavior and relationship, which involves affective and cognitive virtues.

nGrand Nursing Theories

nGrand nursing theories refer to a wide range of theories that explain general propositions and concepts. These theories are anticipated to be relevant to all circumstances of nursing (McCormack & McCance, 2011). They also include theoretical structures defining wide perceptions for nursing practice at a particular phenomenon.

nLife Perspective Rhythm Model

nLife Perspective rhythm by Joyce Fitzpatrick is one of the grand nursing theory. Fitzpatrick nursing proposes four elements of meta-paradigm, wellness-illness, health and person. In addition, the theory suggests that human development process involves rhythms that take place within the basis of incessant environment-person relations (Fitzpatrick & Kazer, 2012). Furthermore, the role of nursing is to promote the progress towards better health. Concepts labeling and identification enables communication and appreciation between nurses and patients (Jones, 2010). Similarly, languages enable the sharing of important concepts and information. The theory also fit in the POI because it attempts to explain how health of DKA patients can be improved through proper nursing practice.

nPerson

nIt refers to the humans and comprises both self and other people. In these cases, a person refers to the patients suffering from DKA. Moreover, a patient is viewed as a system; hence, a nurse should identify his/her special attitudes that are likely to influence well-being and health (Fitzpatrick & Kazer, 2012). Therefore, in the process of implementation of DAFNE program, a nurse educator should identify the special social stimuli, self-evaluation and self-standards that are likely to reduce the rate of ICU readmissions of these patients.

nHealth

nAccording to Fitzpatrick, health refers to a vibrant state of existences that is affected by interaction of a person with her or his environmental conditions. The status of existence of a human being can be dysfunctional, diseased, ill or well. Therefore, in case of DKA patients, a nurse should seek to understand the state of patients health in order to initiate appropriate training and educational programs (Fitzpatrick & Kazer, 2012). Additionally, the theory proposes that continuous health awareness on DKA patients helps to improve their health status. Most importantly, health can be achieved through good associations between nurses and patients. It can also be accomplished via guiding the behavior of patients.

nWellness-illness

nThe theory suggests that nurses can enhance wellness of DKA patients by treating them attentively. More significantly, they should offer restorative nursing care to rehabilitating or convalescing patients. By interacting in education and training of DKA patients through DAFNE program, nurses should enhance, re-establish and preserve the environment hence make patients healthier (Sochan, 2015). In other words, nursing care should embrace promotional care in this program.

nMeta-paradigm

nAccording to Fitzpatricks theory, nurses should help DKA patients in their transitions in life. The transitions involve phases of progress and growth. The basic meta-paradigm elements include nursing, health, environment and persons. Therefore, nurses have a special responsibility in reducing the number of ICU readmissions for DKA patients (Fitzpatrick & Kazer, 2012). The Life Perspective Rhythm Model by Fitzpatrick guide in the assessment of the POI because it offers a strategy of labeling and identifying the nursing concepts (Jones, 2010). In addition, this theory is important in the case of my POI because it advocate for communication between nurses and patients. It also offers a compact anchorage for knowledge in nursing.

nMiddle-range Theories

nThe Health Promotion Model Theory

nThe Health Promotion Model theory by Nola J Pender is aimed at improving the well-being of the patient. It describes the multidimensional feature of people as they relate to their environment, which ultimately affect their health. The theory is based on five major concepts of person, environment, nursing, well-being and disease (Pender, Murdaugh & Parsons, 2014). In addition, health promotion model address crucial aspects, which include behavioural results, behavior effects and cognitions, and individual experiences and features.

nMost importantly, the theory can be utilized to explain how the health of DKA patients can be improved through implementation of DAFNE program. In this case, it suggests that every individual has a special personal trait and experiences that influence future actions (Raingruber, 2014). Patients are provided with information, which can lead to behavior change. Penders theory noted that health-promoting behavior is necessary to DKA patients since they it marks the beginning of behavioural change (Pender, Murdaugh & Parsons, 2014). Therefore, implementation DAFNE training is important because it promotes proper behaviors such as proper diets that lead to better health, higher quality of life and improved functional ability for DKA patients (Raingruber, 2014). The ultimate behavioural need is affected by the emergent competing preferences and demands that can affect the expected actions for promoting health.

nAccording to the HPM theory, a DKA patient is a biopsychosocial being who is partly influenced by the environment. However, they can build an environment where acquired traits can be completely developed (Raingruber, 2014). There is a shared relationship between environment and a person. Personal features also affect the health behaviors of these patients. The environment is physical, cultural and social context that unfolds life courses (Pender, Murdaugh & Parsons, 2014). The environment can be influenced by person to establish a positive indicator for behaviors that enhance health.

nThe HPM theory suggests that the success of nurses in implementation of DAFNE program requires a partnership with communities, families and individuals who build the most favorable factors for optimal health and well-being. Pender suggest that in reference to an individual, there is a realization of intrinsic and acquired potential of human beings via goal-based traits and fulfilling others relationships. Therefore, changes in human beings are made as required to satisfy the harmony and integrity with a suitable environment. Health is a dynamic knowledge in life (Raingruber, 2014). Illnesses are distinct events in the lifetime of either long-term (chronic) or short-term (acute) period that can prevent or enable a person from progressing with good health.

nTherefore, Health Promotion Model Theory addresses the concepts of meta-paradigm such as person, environment, and health. It also proposes that a person is actively involved in health-seeking behaviors (Pender, Murdaugh & Parsons, 2014). As a person interacts with the environment, he/she continually change it and the environment transforms the patients character over a given period. Health Promotion Model theory is also related to grand theory (the Life Perspective Rhythm Model) because it proposes that nurses is part of interpersonal environment that controls individual throughout their lives (Raingruber, 2014). Therefore, nurses can use the HPM to develop proper relationships with DKA patients in order to ensure success of DAFNE program.

nComplexity Science

nComplexity science in nursing suggests that relationship is the key factor for success in healthcare. It involves utilization of complex ideas and interconnects that helps nurses to deal holistically with different experiences. For patients suffering from diabetic ketoacidosis requires a unique nursing care (Mitchell, Jonas-Simpson & Cross, 2013). Unpredictability and indeterminacy are important concepts of complexity science, which enables nurses to be innovative and creative in their nursing care. The POI in this case is utilization of DAFNE program to educate patients on how to deal with complex diabetic ketoacidosis.

nComplexity of DAFNE program invites nurses to pay close attention to the inter-relational and pandimensional features of nursing care for DKA patients. Nursing care should also be guided by technological innovation. Therefore, they should consider embracing new technological ideas in the DAFNE program (Hast, DiGioia III, Thompson & Wolf, 2013). Complexity science also helps nurses to adapt to various program changes due to economic or social factors. Due to complexity of DAFNE program nurses requires support from other health care practitioners. In this regard, nurses are provided with supportive nursing interventions. Complexity theory also helps nurses to implement minor changes in the DAFNE program, which lead to great benefits to the DKA patient (Mitchell, Jonas-Simpson & Cross, 2013). The patient educational program may not produce immediate benefits but it has the potential to helpful effects in the future.

nConclusion

nDM causes many deaths across the globe. In addition, complications such as diabetic ketoacidosis (DKA) are responsible of large number of patients readmissions in the ICU. Therefore, nurses need to implement patients educational programs such as DAFNE for DKA patients (Misra and Oliver, 2014). Theoretical perspectives such as meta-paradigm theory help to explain how nurses should provide patient-centered interventions. Grand nursing theories such as Life Perspective Rhythm theory also suggest that a patient should benefit from proper environmental conditions that promote and safeguard their health (Jones, 2010). The Health Promotion Model theory also advocate for behavior change in order to enable better patients care.

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nReferences

nElliott, J., Jacques, R. M., Kruger, J., Campbell, M. J., Amiel, S. A., Mansell, P., & Heller, S. R. (2014). Substantial reductions in the number of diabetic ketoacidosis and severe hypoglycemia episodes requiring emergency treatment lead to reduced costs after structured education in adults with Type 1 diabetes. Diabetic Medicine, 31(7), 847-853.doi:10.1111/dme.12441

nFawcett, J. (1999). The relationship of theory and research. Philadelphia, Pa.: F.A. Davis.

nFitzpatrick, J., & Kazer, M. (2012). Encyclopedia of nursing research. New York, NY: Springer Pub.

nHast, A. S., DiGioia III, A. M., Thompson, D., & Wolf, G. (2013). Utilizing complexity science to drive practice change through Patient-and Family-Centered Care. Journal of Nursing Administration, 43(1), 44-49.

nJones, T. L. (2010). A holistic framework for nursing time: implications for theory, practice, and research. In Nursing forum (Vol. 45, No. 3, pp. 185-196). Blackwell Publishing Inc.

nMcCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons.

nMisra, S., & Oliver, N. S. (2015). Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. Diabetic Medicine, 32(1), 14-23 10p. doi:10.1111/dme.12604

nMitchell, G. J., Jonas-Simpson, C. M., & Cross, N. (2013). Innovating nursing education: interrelating narrative, conceptual learning, reflection, and complexity science. Journal of Nursing Education and Practice, 3(4), 30.

nPender, N., Murdaugh, C., & Parsons, M. (2014). Health promotion in nursing (7th ed.). New York: Pearson Education.

nRaingruber, B. (2014). Contemporary health promotion in nursing practice. Burlington, Mass.: Jones & Bartlett Learning.

nSochan, A. M. (2015). The Meta-Paradigm of Nursing within a Global Nursing Context. In 43rd Biennial Convention (07 November-11 November 2015). STTI.

nTieder, J. S., McLeod, L., Keren, R., Luan, X., Localio, R., Mahant, S., & Srivastava, R. (2013). Variation in resource use and readmission for diabetic ketoacidosis in children’s hospitals. Pediatrics, 132(2), 229-236. doi:10.1542/peds.2013-0359

nTraav, M. K., Gabrielsson, H., & Cronqvist, A. (2014). Conceptions of an implemented nursing philosophy: A phenomenographic study. Clinical Nursing Studies, 2(3), p86.