policy and politics in nursing and healthcare chinn and kramer pdf

Policy and politics in nursing and healthcare chinn and kramer pdf

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Open Journal Systems

The Four Patterns of Nursing Knowledge

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Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care providers by their approach to patient care , training , and scope of practice.

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About the Author s. The Author s. This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The core of the nursing profession is caring for those in need. However, when the psychiatric nurse PN is overwhelmed by aggression from the person cared for, the ideal of rendering quality patient care is compromised.

There has to be a way to assist the PNs to manage aggression effectively in order to render quality patient care and improve PNs mental health. Objectives: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model that could be used as a framework of reference to facilitate the effective management of aggression as an integral part of the mental health of PNs.

Methods: A theory-generative, qualitative, exploratory, descriptive and contextual study design was used to develop the model. The process entailed the identification of the central concept, the definition of the central concept and other essential criteria and the classification of the central and related concepts.

The conceptual framework was then described and evaluated. Conclusion: The conceptual framework may be able to assist PNs in managing aggression effectively, taking control of workplace environment. Aggression in psychiatric institutions is a worldwide phenomenon Drach-Zahavy et al.

The research has also found that high rates of aggression impact on the quality of care provided to the patient Franz et al. In managing aggression, researchers have prioritised the identification of factors that increase the likelihood that a patient will act in an aggressive way Drach-Zahavy et al. A better management of workplace aggression must not view it as an individual problem but rather as a structural, strategic problem rooted in social, economic, organisational and cultural factors Van Wijk et al.

The first step would be to secure the environment and make PNs feel safe and have confidence to manage aggression; it should also be kept in mind that, as no single factor can stand alone as the cause of aggression Agency for Healthcare Research and Quality ; Daffern et al. In the context of South Africa, there is no comprehensive departmental guideline on how aggression is dealt with in psychiatric institutions. The lack of formal baseline data on the management of aggression Bock has resulted in PNs managing aggression in the best way they see fit.

Despite the negative experiences of PNs, very little has been done to put in place a mechanism that can assist PNs to deal with aggression effectively. The purpose of the research study was to develop, describe and evaluate a model that can be used as a framework of reference for the advanced Psychiatric Nurse Practitioner PNP to assist PNs in the effective management of aggression from the patients. The key concepts model, facilitation, effective, self-management and aggression were defined.

Chinn and Kramer define a model as a symbolic representation of an empirical experience in the form of words, pictorial or graphic diagrams, mathematical notations or physical material. In this research study, a model structure was developed as a framework of reference and illustrated what the advanced PN practitioner was to do in facilitating the effective self-management of aggression experienced by PNs.

The concept of facilitation is understood as a dynamic interactive process for the promotion of mental health through the creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacle in the promotion of mental health University of Johannesburg In this research study, facilitation was defined as a dynamic interactive process through which the advanced PNP guides and provides assistance to the PNs in making easier the effective self-management of aggression.

According to Wehmeier, McIntosh and Turnbull , effective means producing the result that is wanted or intended. In this research study, effective referred to the use of operative alternative means by PNs aimed at producing the intended result, which is their self-management of aggression.

The researcher was convinced that to manage other people, one should start with self or self-management. Franz et al. A psychiatric institution is defined as a mental healthcare facility where care, treatment and rehabilitation are provided in accordance with the rules and regulations of the Department of Health as stipulated in the Mental Health Care Amendment Act 12 of Government Gazette, no In this research study, a psychiatric institution referred to is a third-level referral hospital where adults and adolescents, male or female, general or forensic patients are referred for care, treatment and rehabilitation because of their being unmanageable in other healthcare facilities.

It is also important to note that in the concept of advanced PNP, a PN is referred to as a person with a post-basic qualification and having both theoretical and clinical competencies in the management of aggressive incidents. A postmodern constructivist philosophy of science was utilised throughout the study. Postmodernism is a theory and the basic concept is that knowledge claims must be set within the conditions of the world as it is today and in the multiple perspectives of class, race, gender and other group affiliations.

Social constructivism is an approach where individuals seek the meaning of the world in which they live and work. The meaning that individuals develop is subjective and derives from their experiences of certain objects or things. Central to social constructivism is the attempt to understand scientific activity and scientific knowledge in social terms, as arising from interactions between various participating agents in the social domain Quale The four steps of Chinn and Kramer — for theory development were used.

These four steps are concept analysis, relationship statements, description of the model and the evaluation of the model.

Concept analysis took place in two phases. In phase one, the central concept was identified, and in phase two, the identified concept were defined and classified. Concepts were defined using hard copies, online dictionaries and subject-specific literature.

The survey list of Dickoff, James and Wiedenbach — was utilised to classify the following concepts and comprised the agent, the recipient, the procedure, the dynamic, the context and the outcome as discussed below. The description of the model was based on the six components suggested by Chinn and Kramer — After providing a description of the model on structural and process aspects, the guidelines for the implementation of the model were provided. The evaluation of the model used the Chinn and Kramer — evaluation criteria of clarity, simplicity, generality, accessibility and importance of the model.

The model was evaluated throughout by three experts: two professors and one Ph. The model was also evaluated during the annual research forum organised by the University of Johannesburg. On all these occasions, the model was found to comply with the above criteria for model development.

The ethical principles that guided this research study are stipulated by the Medical Research Council of South Africa MRC :2—6 as published on their website www. These principles are autonomy or respect for persons, beneficence, non-maleficence and justice. The participants in the study were PNs who are able to make a sound and independent judgement about their actions. An invitational letter was sent to the participants setting out the research purpose, content and process and the participants freely signed an informed consent UNESCO after they had been given satisfactory information.

A contingency measure was in place in case any participant would need it though no harm had been foreseen. Beneficence represents the opposite of harm and refers to any favourable outcome of the research to the society or to the individual MRC :2—6.

The criteria of credibility, transferability, dependability and confirmability were followed. De Vos et al. The researcher ensured credibility by using various methods in data collection triangulation including interviews, field notes, naive sketch writing and observation as well as maintaining a reflexive journal in which all his experiences and observations during the model process were noted. The model structure was presented in a doctoral seminar and recommended adjustments were made.

Confirmability entailed being objective De Vos et al. An independent coder, with known academic expertise, was used. The researcher remained faithful to the academic and ethical requirements of conducting a research study. The process consisted of analysing the results and, with the available literature, finding the concept that represents the challenge that the PNs are faced with in dealing with aggression.

PNs are facilitated to utilise operative means and take responsibility aiming at producing the intended result, that is, the self-management of aggression. Through the process, the PNs are able to regulate their emotions and to take control of the workplace environment in effectively self-managing aggression from patients.

The agent is the person that makes the process of the facilitation of effective self-management of aggression to happen. In this research study, the agent is the advanced PNP who assists the PNs to find an effective way of dealing with aggression. The management also plays a role in the facilitation of effective self-management of aggression by allowing the researcher to use the facility and by providing the necessary resources, human and material, for the implementation of the model to take place.

In this study, the recipient is the PN who works in this specific psychiatric institution and participates in the search for a constructive way of managing aggression. The context is the situation or environment in which the facilitation for effective self-management of aggression takes place. In the study, the context is a public psychiatric hospital. This psychiatric hospital is a provincial and academic hospital where psychiatric nursing students and medical students further their training in psychiatry.

The main criterion for patients to be admitted is for them to be unmanageable in the referring hospitals and clinics. The dynamics in this model consist of PNs experiencing aggression by patients.

This aggression is expressed verbally, physically and emotionally and has negative personal and professional impact on them. The process for the facilitation by the researcher of effective self-management of aggression by PNs consisted of three phases: the relationship phase, the working phase and the termination phase.

The process moves the PNs from the feeling of inadequacy and powerlessness to the feeling of self-confidence and taking control of the workplace challenges. A PN who is experiencing aggression by patients and is unable to manage it effectively needs assistance and guidance in order to move from the position of victimhood to the position of taking control of the workplace aggression through a dynamic interactive process.

This makes it easier for them to take actions for change in their workplace environment. PNs need to trust the facilitator and to believe in the process by taking responsibility for their actions or inactions in the workplace aggression. The PN will succeed in dealing with aggressive incidents effectively by unleashing the power within and being able to regulate their emotions so that they can use their skills and knowledge in a sound manner.

In embracing and implementing the alternative means, the PN would be empowered and grow both personally and professionally. They are able to take control not only of their lives and the workplace environment but also of every decision they make and how they interact with fellow professionals. The structure of the model is discussed following the sub-headings: purpose of the model, assumptions of the model, relationship statements and the process description.

The theoretical definitions of the central concept and the relationship statements have been described previously. The purpose of the model was to provide a frame of reference for the advanced PN practitioner for the facilitation of effective self-management of aggression experienced by PNs working in a psychiatric institution.

The assumptions of this model are embedded in the Theory for Health Promotion in Nursing University of Johannesburg :4— Assumptions were also inspired by another source: the Cognitive Behaviour theory Blenkiron :1— These assumptions are set out below. PNs and the advanced PNP are seen wholistically; embody dimensions of body, mind and spirit; and function in an integrated manner with the environment University of Johannesburg The environment includes an internal and external environment. The internal environment consists of dimensions of body, mind and spirit.

The external environment consists of physical, social and spiritual dimensions University of Johannesburg Psychiatric nursing is an interactive process for the facilitation and the promotion of mental health University of Johannesburg This process is not a linear one. It requires patience, commitment, material and spiritual resources, and a clear vision in a safer workplace environment.

PNs mobilise resources by identifying and bridging the obstacles in the promotion of health University of Johannesburg The identification of obstacles entails assessing the environment both internal and external for what it really is and strategising on how to solve the identified problems in it with the available resources.

The bridging of obstacles comprises self-assessment for the strengths and weaknesses, the resources human and materiel required for an effective and lasting solution University of Johannesburg

The Four Patterns of Nursing Knowledge

Professionals define themselves in terms of what knowledge they possess and seek to acquire. Barbara Carper identified four fundamental patterns of knowing that form the conceptual and syntactical structure of nursing knowledge. These four patterns include: personal, empirical, ethical, and aesthetic knowing. This type of knowledge comes to us through the process of observation, reflection, and self-actualization. When you began to study nursing, what knowledge did you possess?

About the Author s. The Author s. This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The core of the nursing profession is caring for those in need. However, when the psychiatric nurse PN is overwhelmed by aggression from the person cared for, the ideal of rendering quality patient care is compromised.

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Rainier C. Background: Health disparity can be observed using the lens of emancipation through nursing. These attributes were preceded by the following antecedents: marginalization, hegemony, the oppressed and the emancipator, centering, and liberation. The resulting features of enlightenment, enervation, empowerment, and evolvement served as constructs that collectively structured the theory of Emancipation through Nursing in the Context of Health Disparities.

Nursing's fundamental patterns of knowing --The history of knowledge development in nursing --Emancipatory knowledge development --Ethical knowledge development --Personal knowledge development --Aesthetic knowledge development --Empiric knowledge development : conceptualizing and structuring --Description and critical reflection of empiric theory --Confirmation … 4th ed. Korean translation published in Apply the five patterns of knowing to improve patient care!

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