Concepts that comprise nursing theories are arguably the leading pillars in directing the work of nurses. Moreover, nurses are always expected to follow evidence-based interventions while caring for patients, which requires them to understand theoretical underpinnings properly. Additionally, the theories are guided by conceptual frameworks only applicable in nursing theories. According to Brandao et al. (2019), nursing conceptual frameworks are the base for practicing sound evidence-based practice. The concepts argued out in a nursing theory help in guiding, directing, and steering nursing roles in the event of pitfalls and obstructions capable of rendering the interventions ineffective. Roy (2019) separates the nursing theories into three groups – namely, practice-level, mid-range, or grand theories. The difference between the three lies in the level of abstraction in the concepts.
Grand theories tend to be the most abstract, followed by mid-range and practice-level theories. Practice-level theories tend to be easily understood, relay the information directly, and have a narrow scope. Finally, mid-range theories constitute the majority of nursing theories developed by nursing theorists such as Florence Nightingale, Dorothea Orem, Madeleine Leininger, and Jean Watson (Roy, 2019). This paper discusses the application of theoretical concepts to nursing practice with reference to a clinical problem of lack of sound sleep among patients in the telemetry unit. Special attention is also given to how the theory relates to Jean Watson’s Theory of Human Caring.
The Nursing Practice Outcome that Needs Improvement
Generally, the hospital environment can be described as one that is poorly conducive for sound sleep. Some of the factors that affect the quality of sleep include medication effects, pain, light, and environmental noise (Stewart & Arora, 2018). Sadly, patients who are acutely ill and hospitalized are at the greatest risk despite the fact that they need sleep to facilitate the recovery process. The nursing practice outcome discussed in this paper is the lack of sound sleep among patients in the telemetry unit. This outcome is measurable and emerges as a clinical need requiring quality improvement in the respective setting. Sound sleep is an essential component of the recovery process for all patients (Antonio, 2020). This is based on the foundation of patient-centered care, which is to provide utmost satisfaction to patients (Alharbi & Baker, 2020). However, the telemetry unit environment is typically noisy, which prevents patients from getting sound sleep. One of the adverse consequences of sleep deprivation for recovering patients is that their perception regarding the care experience can be adversely affected. In this regard, noise within the telemetry unit has been a long-standing problem experienced by hospitals.
Clinical Nursing Theory
Regarding the identified clinical problem of lacking sound sleep by patients in the telemetry unit, it is possible to create a clinical theory that follows the concept A-Proposition-concept B format. Given this design, the following components will be used to develop the theory:
All stakeholders in the clinical setting with telemetry monitoring are familiar with the constant beeping sound that represent patients’ heartbeats. This sound is meant to reassure the nurses of the patient’s safety and well-being. However, it can also become background noise in the telemetry unit with continued patient stay. According to Antonio (2020), one may define noise as an unwanted sound that tends to be an environmental pollutant, therefore, causing disruption and resulting in health implications. The most straightforward way to measure it in a study would be to assess the loudness of noise in decibels and the frequency of noise per unit of time. The subjective well-being of admitted patients can be affected by noise from various sources in the hospital setting in general and, specifically, from equipment. This is an indication of a relationship between psychological and physiological disturbances and hospital noise.
The lack of sound sleep in the telemetry unit is a subjective concept that portrays recovery as not going well. Sound sleep is one with low latency and waking time and high efficiency – falling asleep quickly, waking up rarely while sleeping, and spending no less than 85 percent of all time in bed sleeping. Subjective soundness of sleep may be assessed through surveys or interviews with the patients as well as sleep diaries. There are also objective ways to measure the quality of sleep, such as polysomnography and actigraphy. The study of sleep as a factor in recovery is justified because relaxation has proved to result in health-related benefits as it measures the quality of life when considered alongside socioeconomic indices (Antonio, 2020). From a biological perspective, noise triggers both the sympathetic nervous system and pituitary gland to produce sympathetic effects and endocrine, respectively. These components are commonly seen when responding to a stressful situation (Antonio, 2020). Furthermore, stress theories explain that such negative reactions are linked with negative health outcomes. In this regard, noise-induced stress deprives the patients of sound sleep.
From the analysis above, concepts A and B show a positive correlation. In this case, concept A is the reason behind the occurrence of concept B, with this relationship being one of direct causality. The response of a patient to noise in the telemetry unit is affected by both psychological and physiologic stress, which may cause a lack of sound sleep. In turn, the clinical nursing theory developed from the scenario is that noise in the telemetry unit is a risk factor for a patient’s lack of sound sleep.
Comparison with Watson’s Theory of Human Caring
Watson’s theory argues that taking care of the needy person amounts to developing mutual benefit through a therapeutic bond nurtured between the patient and nurse. Furthermore, nurses get an opportunity to showcase their innate capabilities. Alharbi and Baker (2020), therefore, identify four main concepts in Watson’s theory that directly relate to nurses. The first is offering selfless care for others in need of assistance to restore their well-being. The second is nurses fulfilling the role of patient advocacy and being change agents within a therapeutic healing environment. Apart from that, well-being and healing can be achieved by nurturing a therapeutic nurse-patient relationship. The last concept is that besides medical intervention, it is necessary to believe in spirituality, divine intervention, and miracles.
Watson’s theory proposes that the nursing profession treats caring as a necessity. It means that human beings bear the moral obligation of preserving and protecting human well-being, wholeness, and dignity (Alharbi & Baker, 2020). There is a clear correspondence between this proposition and the clinical nursing theory created in the previous section. In this case, the current theory advocates for the application of evidence-based interventions in addressing the lack of sound sleep. This advocacy is determined and implemented within a moral obligation perspective. Therefore, it is critical for the hospital to apply a patient-centered approach in identifying noises perceived as bothersome. As mentioned above, that would require surveys, which would then guide unit-based changes in practices followed by continued monitoring of the outcomes. The objective here would be to improve patients’ sleep patterns, preserve their well-being, and restore dignity. All these initiatives are in line with the concepts in the theory of Human Caring.
Amongst Watson’s ten Caritas factors, the one matching concept ‘A’ in the developed theory involves creating a healing environment that shows respect for the human body (Perkins, 2021). From the analysis of Concept ‘A,’ subjective well-being derived from sound sleep is prone to the influence of noise in general and, specifically, from the beeping of clinical sources in the telemetry unit. This makes patients in this unit vulnerable to adverse health outcomes. In this regard, it is important for the hospital to ensure that the healing environment respects the needs of the patients in the telemetry unit. Minimizing noise levels from clinical sources will result in a healing environment that respects the human body. This advances the congruence of mind, body, and spirit achieved through completeness and well-being.
Looking at the theory developed and Watson’s theory, there is a congruency between the two, showcasing how Watson’s theory falls under a mid-range nursing theory fully compatible with practice situations in the clinical context. A quiet environment has been identified as potentially conducive to improved sleep patterns for patients by reducing their stress levels. One discovery from the readings is how sleep quality may be a foremost component of life quality, along with socioeconomic indicators. Another one is the necessity to understand the healing process and its aspects holistically – for example, considering all factors impacting the sleep quality, from medications and pain to noises. Most importantly, this paper establishes the clinical nursing theory targeted at patients in the telemetry unit context also fits within mid-range theories and resonates well with Jean Watson’s theory of Human Caring. The main question requiring further research would be the most cost-effective way to measure the quality of sleep in a telemetry unit. All the discoveries and questions stress and enhance the obligation of preserving and protecting human well-being, wholeness, and dignity, which lies at the core of nursing.
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