Praxis Discussion - Paper Example

Practicing nurses must use the knowledge of ethics to practice and allure their knowledge from a comprehensive and broader pool of nursing proficiency. Exploiting one’s knowledge and ethics while combining them with clinical expertise avails a sturdy, unshakeable basis of ethical work that can be articulated through different theoretical models of nursing. The patients are properly served as well as the community at large by caring for and supporting them. Nurses can effectively implement the proposed policies for proper patient care and support in patients at risk. Nurses can also evaluate, plan, devise, and appraise the care plan through a personalized approach. Providing a patient with adequate and essential information, and creating a non-biases environment will allow them to execute an advanced directive for their end-of-life care. This paper will analyze the theoretical foundation for principled nursing practice and unite the theoretical argument to define the advanced directive.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

The Phenomenon of Interest: Advanced Directive

Advance directive or end of life care is a difficult choice for any patient to swallow. Patients who are dying should be able to find comfort as an indispensable component of healthcare at the end of life. The care helps soothe the person dying and the people he/she is leaving behind (Gilissen et al., 2019). While preventing and relieving the suffering of the ailing patient, advanced directive, or end-of-life care helps improve the patient's quality of life while respecting their wishes. Death comes suddenly in most cases than expected, and in some cases, a person might linger for some time but gradually fading (Tamura et al., 2017). The advanced directive gives close relatives or those providing medical care with a power of attorney to make various decisions regarding the dying or ailing patient.

The advance care plan was promoted among the seriously ill patients in the 21st century, although it had started earlier. In the 20th century, Luis Kutner, a lawyer, drafted and proposed the adoption of an advanced care plan, referred to as an advanced directive or a living will (Park & Kim, 2018). This allows a competent person to determine how he/she would live in their final stages of life. Advanced directives have proven to be an issue due to a lack of awareness/knowledge among the people, lack of confidence, and biases (Gilissen et al., 2019). In some cases, some nurses lack the knowledge about the advance directive, which has caused a negative implication to end of life patients. As such, lack of formal and advanced directive expertise becomes meaningless to the person and their family (Park & Kim, 2018). Currently, many chronic conditions threaten to take patients' lives, which has necessitated an advanced directive.

Nurses must undergo training and draw from their knowledge the expertise to care and support such patients. The perception of advanced directives is considered within the nursing function realm, which holds the concept of being obligatory in the healthcare setting (Miller, 2018). Therefore, nurses who have adequate recognized nursing training and clinical skills can manage a patient by availing the physical comfort, emotion, and spiritual well-being to these patients (Tamura et al., 2017). As nurses adhering to patients’ advanced directives will bring about patient satisfaction to the patients affected as well as their family members.

Nursing metaparadigm

The nursing metaparadigm encompasses a range of theories that offer structures on how the nursing discipline should work. The nursing metaparadigm consists of different concepts that evaluate the patient, their overall well-being, the patient's environment, and the nursing tasks (Nikfarid et al., 2018). Despite the full range of nursing theories, the basic concepts of nursing directly to a comprehensive view of care where the patient's well-being and healthiness are associated with four shared components (Bender, 2018). The nursing meta paradigms indicate their significant impact on current empirical studies that characterize scientific undertakings and nursing knowledge advancements. The nursing meta paradigms guide the nurses and healthcare providers for specialized education, morals, ethical principles, and philosophy.

Dr Jacqueline Fawcett first classifies the nursing meta paradigms into four categories: patient, setting, health, and nursing. An advance directive, in general, interconnects within these four categories. First, the patient model focuses on the receiver of care, where it does not include just the patient but also their families where they, too, are involved in influencing decisions regarding what can be done right by the patient. Patients who consent to advance care directive should come out as satisfied, which is determined by how patients interrelate with the physical and community contacts. The patient is sanctioned to maintain his health and well-being with dignity. The healthcare providers, including the nurses, must consider the patient's spiritual, societal, and healthcare needs during the end of life care. (Bender, 2018). Next, the environmental meta paradigm encompasses the person's surrounding that affects him (Nikfarid et al., 2018). When it comes to the environment, creating a non-judgmental and unbiased outlook from a provider as well as nurses is a vital key in patients’ decision towards the end of life care.

Furthermore, the health meta paradigm determines the degree to which a person has admittance to health wellness. Patients self-awareness, as well as proper knowledge and seriousness of their health, will provide patients with an insight about their future goal towards their health and how they would like their end-of-life care to be carried out; This is where advanced directives help cover the patient's lifespan and health and wellness by carrying out their healthcare decisions on their behalf when they are not in the capacity to make them by themselves. Finally, the nursing metaparadigm entails the provision of ideal health results for the patient as per the advanced directives via a shared affiliation in an innocuous and compassionate environment. Hence, with every aspect of the nursing metaparadigm, such as the patient, setting, health and nursing, healthcare providers and nurses influence a patient’s decision on advance care directive.

Grand Nursing theory

The grand theories are considered universal since their concepts and suggestions are less abstract and broad compared to the concepts of a conceptual model. The theory provides an overall framework for structuring ideas and concepts (Zaragoza & Bailey, 2017). The first application of the universal grand theory is the relationship model between individuals explaining the relational facets and patterns pertinent to advanced directives. Patient satisfaction and contentment of the nursing purpose is critical and must be recognized as per the subtleties of ever-changing values in the nursing milieu. For nurses to understand their patients, they must work based on different already established theories of which they must understand them before translating them into practice (Sitzman, 2017). A relationship between the nurse and patient must be allowed to unfold naturally for the theory to be applicable. Its pertinence in nursing has generated suitable levels of realization, and vital factors rebounded in good nursing practices.

Newman's theory of health as expanding consciousness brings forth the model of universality in which there is a field of pattern manifested by human existence and universal energy. Newman appreciates the patient-care relationship fostered, which allows a scientist/researcher of a caregiver to study his patient in a unitary process (Sitzman, 2017). When a healthy individual becomes sick, the overall human existence structure becomes disrupted hence a new path in created of expanding consciousness. The person undergoes self-organization towards a higher level of organization (Zaragoza & Bailey, 2017). Consciousness became one of Newman's concepts under his theory besides the foundational concepts; movement, time, and space. Consciousness was identified to compensate for the imposed alterations of natural movement.

Newman noted consciousness to translate as a dynamic pattern that necessitated the emphasis of nursing to be the patient with the evolving patterns. The other concepts, time, and movement also play a more significant role in human existence and universal energy (Zaragoza & Bailey, 2017). For instance, when a patient is bedridden or in restrain due to alerted mental status, restriction of movement affects the sense of time and well-being in general. Therefore, the universe must be aware of and sensitive to these differences, striving to synchronize with the person exhibiting the patterns and requiring the individual to make a choice (Sitzman, 2017). As a result, recognition of consciousness can further deliver a better patient outcome.

In the case of an advanced directive for end of life care, death can be expected or unexpected, which leaves on in anguish and apprehension most of the time. It is for this reason that people are encouraged to make advanced directives for their end of life care (Sitzman, 2017). Hence, making or planning end of life care will prevent future chaos between family and friends and anguish of having to make confident decisions on one's behalf, especially when incapacitated to make such decisions for themselves.

Middle Range Theory

The nursing middle range theory of self-transcendence is created from the human environment, a unitary transformative paradigm of health. The philosophy is based on how a person transcends adversity and his relationship among psychological development, mental health, and well-being (Meyfroidt et al., 2018). The primary assumption is that people are a fundamental part of their surrounding environment; they coexist with their surroundings and are adept at spreading awareness outside of their physical and temporal scopes. The main concepts of self-transcendence theory include vulnerability, well-being, and self-transcendence itself. An individual is regarded as a unitary developing in a shared and synchronized process; change, therefore, becomes artistic and impulsive (Heinze & Jappe, 2020). On a practical level, it entails a fundamental spiritual overhaul, sustenance of inner means, and extension of interpersonal and intrapersonal, temporal, and transpersonal limits.

Self-transcendence is the central concept of the theory. It is the aptitude to develop personal restrictions through a connection with the self, others, and the environment, followed by a developmental imperative. The human resources which demand expression so do the progressive processes such as intellectual reasoning, becoming aware of the environment, and grieving the loss of a loved one, among others (Heinze & Jappe, 2020). Well-being, another concept of the self-transcendence theory, is a sense of the being whole. A healthy and whole person portrays life satisfaction, optimism, contentment, and self-care and finds meaning in life.

Furthermore, the vulnerability concept involves personal cognizance of mortality or the danger of not being well. The developmental capacity of an individual relates to the natural-health experiences and life events that come with issues of mortality or immortality (Meyfroidt et al., 2018). The events should heighten the sense of mortality, inadequacy, and when one's inner self is not crushed, they can develop and expand their self-boundaries.