Discuss and critique 2 different models and /or theories, providing an overview of strengths and weakness of each

 

Assessment Brief

7. Size of assessment	3500 – 4000 words
11. The requirements for the assessment	The task is to write an essay of no less than 3500 words on the use of models and theories in nursing practice. To do this you need to examine models and theories of nursing. Within the course content we will look at a broad range of these as well as newer forms, such as decision algorithms and care pathways. For the first part of this assignment you will be asked to look at 2 theories, and using an evidence-base, draw out the strengths and weaknesses of each. While some of what you present needs to be descriptive, it is important to demonstrate critical thinking and skills of analysis. In addition you will be asked to apply one model or theory to your own area of practice using a case study approach. In order that the reader can understand the background to the case study it may be useful to write this briefly within an appendix. Again by using an evidence-base (some of which you will have found in the first part of the essay), apply a rationale for choosing this model to your own area of practice. As well as evidence-based material, you can use your own reflective account of why you think/feel that this model would be most appropriate. It is important that within your essay you make it transparent what is your own opinion and what is coming from the literature evidence. Learning outcomes 1-4 are assessed via the academic essay. This should focus on the application of a model and/or theory to your own area of practice, and you should critically reflect upon the care management provided. Learning outcome 5 is linked to your on-line activities and discussions in moodle.
12. Special instructions	· Formative detailed feedback is offered on an essay patch (template in moodle). This should be submitted to the drop-box within the ‘assessment” section of Moodle no later than 24th October 2016. Individual electronic feedback will be on the 4th Nov. · Summative work is due on the 5th December 2016. · Coursework should be submitted with the appropriate, completed cover sheet attached/embedded in the file. · Retain an electronic of your coursework.
13. Return of work	Feedback on your essay patch will be available through Moodle by 4th November. Feedback on your summative assessment will be via Moodle by the 10th January 2017.
14. Assessment criteria	This essay should cover learning outcomes below. To be deemed ‘satisfactory’ you should: · Discuss and critique 2 different models and /or theories, providing an overview of strengths and weakness of each · Provide an evidence-based rationale for the application of one of these models/theories to own area of practice. · Cite appropriate literature correctly.

Table of Contents

Page number

Introduction 2

Review of Models

Nightingale’s Environmental Adaptation Theory 3

Orem’s Self-Care Deficit Theory 6

Case Study

Introduction 10

Case Study 11

Assessment 11

Diagnosis 12

Implementation 14

Evaluation 15

Conclusion 16

References 17

Bibliography 20

Appendix 1: Case Study 22

Introduction

Nursing is a profession that is vital to the delivery of health care. In the first century of nursing, much of the knowledge and practices of nursing were unspoken and implied. Nurses were trained as apprentices to physicians, learning by practice at the bedside of patients, depending on knowledge handed out by physicians (Risjord, 2009). Later on, it became clear that a distinct body of knowledge was vital for effective practice of the nursing profession. Florence Nightingale, known as the pioneer of modern nursing, attempted to describe the previously implicit nature of nursing in the late nineteenth century. Through her Notes on Nursing: What It Is and What It Is Not, Nightingale (1969) identified the role of nurses. She stated that the function of nursing is to ensure that the patient is in the best state to allow the reparative process of nature to be enacted (Nightingale, 1969). Her work was important because it identified the scope of a nurse’s work, paved the way for nurse training, and explicitly described an area of practice that differed from that of physicians – physicians addressed bodily problems and diseases, while nurses were concerned with the patient’s environment (Risjord, 2009).

The twentieth century saw the establishment of nursing as a profession, and not merely as a vocation. Nursing organisations such as The British Nurses Association petitioned for the registration, licensure, training, and working conditions of nurses (Risjord, 2009). This drive to professionalise nursing catalysed nursing research, and the dissemination of nursing knowledge. Early versions of nursing frameworks were published from the 1950s to the 1970s, such as Orem’s work in 1971, and Neuman’s work in 1972 (Alligood, 2013). These frameworks were a precedent to the Theory Era in 1980, which saw a proliferation of nursing literature, journals, conferences, and programs. It was during this era that Fawcett (1984) developed a metaparadigm of nursing knowledge, identifying four key aspects in the nursing profession: person, environment, health, and nursing. This metaparadigm has since been widely used as a common context to understand various theories and bodies of knowledge in nursing (Alligood, 2013).

The nursing profession relies heavily on nursing knowledge and theories. Clarke and Lowry (2012) state that the continued evolution of the nursing profession is dependent on the development of theories in nursing science. However, there have always been concerns about how theory relates to practice.

Nightingale once addressed nurses, expressing that theory is useful when carrying out practice, but theory without practice is “ruinous to nurses” (Vicinus & Nergaard, 1990). Further, Conant (1967) articulated the concern that nursing theory and research were neither sufficient nor relevant to the nursing practitioner. She argued that theory should support practice, and should be evaluated according to its contribution to practice (Risjord, 2009). This essay will review two theories, discussing the development, central concepts, and core issues of each. This essay will include a critique of the theories, discussing its practical applications. The second part of the essay will examine a case study together with applying Nightingale’s environmental adaptation theory.

Review of Models

Florence Nightingale: An Environmental Adaptation Theory

Nightingale’s theory is environmentally centred. This is evident in her writings, and in her book Notes on Nursing: What It Is and What It Is Not (Nightingale, 1969). Her previous experience in modifying the poorly sanitised environment of the soldiers under her care was the basis of her knowledge, and fuelled her mission to improve environmental conditions in hospitals and health care centres. A devoutly spiritual person, Nightingale believed in the restorative power of nature, and hence believed that the environment of a patient should be changed in order to affect the work of nature (McKenna, 1997).

Nightingale’s nursing environmental theory has four key elements, which align with the four aspects of the nursing metaparadigm. First, the environment in Nightingale’s philosophy is anything that can be altered to position the patient in the best possible situation or condition for nature’s restorative process (Selanders, 1998). The environment includes two components: the physical and psychological environment. The physical environment pertains to ventilation, warmth, light, nutrition, medicine, stimulation, room temperature, and activity (Nightingale, 1969). Nightingale focused on ventilation, in particular, because she recognised the surroundings as a source of recovery and disease—hence, she provided ways to manipulate the surroundings and measure body temperature (Pfettscher, 2013). The psychological environment refers to an avoidance of ‘chattering hopes and advices’—Nightingale believed that this made light of the condition of the ill, exaggerated the probability of their recovery, and mocked their sickness (Nightingale, 1969). Second, the person in Nightingale’s theory refers to the patient receiving care (Alligood, 2014). Nightingale believed that the person is a complex creature, comprising physical, emotional, mental, social, and spiritual components (Reed & Zurakowski, 1996). However, Nightingale described a passive patient, who the nurse was responsible for. Third, health in Nightingale’s theory is implied to be the prevention and promotion of health, as well as nursing patients from sickness to health (Alligood, 2014). Nightingale envisioned that health could be maintained through environmental control and social responsibility (Pfettscher, 2013). Finally, Nightingale believed that nursing was a spiritual calling. She believed that all women would be nurses, at some point in their life, by attending to another person’s health (Nightingale, 1969). Trained nurses, however, needed scientific principles, and skills in observing and reporting patients’ health status. Comment by Nadzeef: This portion may help in the case study below. Comment by Nadzeef: To relate to this in the case study Comment by Nadzeef: To relate below as well. Comment by Nadzeef: To relate below as well

Nightingale’s theory, in practice, includes the essential elements cited above. The diagnostic assessment would include an evaluation of the physical and psychological environment of the patient. The goal of the nurse, according to Nightingale, is to assist nature’s reparative process. The local hospital would be assessed and planned for using the standards that Nightingale listed, including clear air, efficient drainage, lighting and cleanliness (Bolton, 2014). Nightingale espoused documentation, so that the plan can be continued even in the absence of the nurse. Further, the scrub nurse would take charge to prepare the surgery room so as to conform to Nightingale’s environmental plan. This defines their duty in that they get to perform environmental checks before attending to their perioperative duties, such as laying down necessary tools and equipment needed for surgery. Comment by Nadzeef: I like your edits here (: Comment by Nadzeef: ‘The operating theatre would be assessed…’

A review of Nightingale’s theory shows that much of the core principles that she proposed are still applicable today. Nightingale’s theory is useful because it details aspects of the patient’s environment that need to be considered in order to optimise recovery. Nightingale’s conceptualized environment also focussed on health institutions, by taking into account the social, physical and psychological components that need to be understood as interrelated (Almeida, Enders, & De Carvalho Lira, 2015). However, having been written decades ago, her theory lacks some scientific basis, as evidenced by her rejection of the germ theory of disease (Risjord, 2009). Comment by Nadzeef: I like your edits for this paragraph too. (:

In addition, Nightingale’s theory may be critiqued using the eight-point criteria proposed by Johnson and Webber (2010). It can be observed that Nightingale’s theory is succinct and clear, and features understandable language. The theory has a high consistency, and its limits, as pertaining to nursing, are clearly defined. Nightingale took care to define important concepts; however, because it was written over 150 years ago, some notions may be out dated, such as Nightingale’s statement that only women are nurses. The theory’s concepts surrounding environmental hygiene clearly led to proposals such as cleaning to avoid morbidity. The theory’s underlying knowledge leads to an explanation of phenomena, and its hypotheses help to interpret propositions. Finally, the theory has clearly shown a strong support for nursing practice, and in fact serves as a major influence for the nursing profession today (Medeiros, Enders, & Lira, 2015).

Dorothea Orem: Self-care Deficit Theory

Dorothea Orem’s Self-Care Deficit Nursing Theory is one of the nursing theories that is widely utilised in nursing practice (Im & Chang, 2012). Orem’s nursing experience, wherein she aimed to improve the quality of nursing in general hospitals, led to the development of Orem’s notions of nursing practice (Berbiglia & Banfield, 2013). Orem focused on three questions: what do nurses do, why do nurses do what they do, and what are the results of nursing interventions (Orem & Taylor, 1986). Orem first developed a definition of nursing’s goal, which is to ‘overcome human limitations’ (Orem, 1959), and of nursing’s concern, which is man’s need for self-care and the opportunities to manage it in order to prolong life and health, recover from illness, or cope with the effects of these (Orem, 1959).

This initial definition eventually developed into a theory. Orem’s model supports the nursing practice through three central theories: the Theory of Self-Care Deficit, the Theory of Self-Care, and the Theory of Nursing Systems. Self-care pertains to deliberate actions done by individuals to maintain physical, social, and psychological wellbeing (Berbiglia & Banfield, 2013). Hence, the Theory of Self-Care posits that mature individuals consciously perform actions and behaviour that affect their survival, wellbeing, and quality of life (Berbiglia, 2014). However, self-care deficit occurs when a person is unable to perform self-care due to age or related factors (Berbiglia & Banfield, 2013). Thus, the Theory of Self-Care Deficit states that nursing is necessary because of the inability of some individuals to administer self-care due to their limitations (Berbiglia, 2014). This creates a need for nursing. Therefore, the Theory of Nursing Systems is an explanation of how persons with self-care deficits can be supported through nurses and the nursing process (Renpenning & Taylor, 2003).

Figure 1: Orem’s Conceptual Framework for Nursing (Orem, 2001).

Orem’s Nursing Systems can be further classified into three categories: a wholly compensatory system, a partly compensatory system, and a supportive-educative system. The wholly compensatory system compensates for the patient’s self-care deficit and provides complete care for the patient. The partly compensatory system compensates for the patient’s self-care limitations, and provides assistance as needed. The supportive-educative system is one where the nurse guides and supports the patient in regulating and exercising the self-care agency, and where the patient is the one accomplishing self-care (Orem, 2001).

Figure 2: Basic Nursing Systems (Orem, 2001).

Orem’s theory, in practice, proceeds from four different operations: diagnostic, prescriptive, regulatory, and control, with each operation encapsulating phases in the theory (Berbiglia, 2014). First, Diagnostic operations starts with establishing the relationship between the nurse and the patient, and proceeds with the nurse identifying self-care difficulties. The patient’s self-care agency is ascertained through an evaluation of the individual’s self-care practices and the effects of related limitations (Berbiglia, 2014). Next, Prescriptive operations involves planning, and refers to the course of action taken by the nurse and client. Prescriptive operations specify aspects of care for the patient (Cavanagh, 1991). Regulatory operations pertain to practical activities, which are completed in order to fulfil what has been prescribed. Regulatory operations are equivalent to ‘intervention’ or ‘treatment’, and emphasises the development of the patient’s self-care agency. Finally, evaluation occurs during Control operations. The effectiveness of the previous phases are evaluated and appraised (Berbiglia, 2014).

Figure 3: An overview of the nursing process using Orem’s model of nursing (Cavanagh, 1991).

A review of Orem’s theory demonstrates that it revolves around the concept and development of the patient’s self-care agency. Rather than emphasising the patient’s illness, it underscores the path to recovery. Hence, attention is not on the nursing intervention, but rather, on how the nursing process can quicken the functions of the client’s self-care agency (Berbiglia & Banfield, 2013).

Case Study

According to Nightingale’s Environmental Adaptation Nursing Theory

(Case: Appendix 1)

Introduction

The application of Nightingale’s environmental theory requires the use of her thirteen canons and the nursing process (Bolton, 2014). Nightingale’s thirteen canons include ventilation and warmth, light, cleanliness of rooms and walls, health of houses, noise, bed and bedding, personal cleanliness, variety, chattering hopes and advices, taking food, what food, petty management, and observation of the sick (Selanders, 1998). An assessment according to Nightingale’s thirteen canons is done first, after which a plan of action is outlined based on the evaluation. Careful observation and thorough documentation is done as well, to ensure the continuity of the plan.

Nightingale’s environmental theory was chosen for this case study because of its emphasis on the patient’s environmental factors and their effect on the patient. The case study deals with a patient suffering from osteoarthritis of the knee, and who will be undergoing total knee replacement. It would be important to modify aspects of the patient’s environment – pre-, intra-, and post-operation– so as to mitigate further injury to the knee, facilitate recovery, and maximise the effects of treatment to ensure quality of life. Hence, Nightingale’s environmental theory is appropriate to use for this case study. Comment by Nadzeef: Can shorten to peri-operatively if required. Word count for this essay should be 3500 +/- 10%. (3150 – 3850)

Case study

When Operating Theatre Nurse Alex visits Mr Tan at home pre-operation, she observes that Mr Tan’s left knee is swollen. After introducing herself, Alex explains that she has been tasked to support Mr Tan prior, during, and post-operation. Alex observes that it is warm to touch, and emits a creaking sound when moved. Alex also notes that Mr Tan experiences difficulty in ascending stairs, walking, and standing after a period of sitting. Alex explains to Mr Tan that she is meant to discuss and decide on a course of action to prepare Mr Tan for the operation, and ensure that he is in the best condition to recuperate after the procedure. Comment by Nadzeef: To replace as written below. Comment by Nadzeef: Sixty- year old Mr. Tan has osteoarthritis of the left knee and would be undergoing a total knee replacement at the local hospital. Operating Theatre (OT) Nurse Alex is in-charge of Mr. Tan throughout his journey peri-operatively.

Assessment Comment by Nadzeef: This whole portion needs to be edited out. To apply to operating theatre environment. Assessment can be done on the operating theatre environment, eg. 1) Relate to cleanliness of rooms and walls – assessment may find that it’s a messy theatre as the surgical and positioning equipment in the theatre are not placed neatly and not kept properly. (eg. Diathermy machine, bair hugger, surgical trolleys, waste bags, operating table, surgical suction pump)- blood spots on the walls, ceiling, operating lights and floors that may have been missed out during cleaning. 2) Relate to ventilation and warmth – ensure digital thermometer and humidity gauge and air conditioning are working and are at optimal temperature for operation – bair hugger available and working- Blanket available for patient later3) Relate to light – assess operating lights are working for ease of operation 4) Relate to bed and bedding- assess and ensure that operating table has been cleaned and lined with new sheet of clean linen 5) relate to noise- no sound of leaking air from surgical suction pumps that may interfere during surgeryTo Continue at implementation part, and relate to what has been mentioned

Physical environment

Alex’s care begins with an evaluation of Mr Tan’s home environment. She observes the ventilation in Mr Tan’s house, and takes note that the house lacks proper ventilation and the air is stale. Upon closer inspection, Alex takes note that only one of four windows in Mr Tan’s house has working hinges, and as such, there is not only poor ventilation, but also a lack of natural light.

While Mr Tan’s drainage seems to be clean and free from contamination, the cleanliness of his home seems lacking, with observable mildew and excessive dust. Further, the bed and bedding of Mr Tan looks unkempt and dirty. When Alex asks Mr Tan about his methods in keeping the house clean, he admits that due to his difficulty in moving around, he has not been able to maintain the cleanliness of his house, foregoing household chores. Alex concludes that Mr Tan’s situation has affected his physical environment, as his physical limitations are preventing him from maintaining proper cleanliness and hygiene.

Psychological environment

Alex asks Mr Tan about his activities. Mr Tan answered that he used to do strenuous activities when he was younger, such as weight lifting and running. However, these activities have gradually been limited due to his age and physical capabilities. Mr Tan engaged in walking, until the pain in his knee prevented him from moving freely. This restriction has, Mr Tan admitted, made him listless and despondent. Further, Mr Tan disclosed that he has not been able to get adequate rest at night, due to the swelling of his knee and anxiety about his surgery. Alex refrains from commenting on the possibility that Mr. Tan would recover his range of motion after surgery, to avoid making light of his situation and potentially disheartening him should the surgery not turn out as well as expected.

Nutrition

Alex asks for a three-day recall of Mr Tan’s food and medicine intake. By doing so, Alex will assess the nutritional status of Mr Tan. She notes that Mr Tan has been subsisting on a diet of canned goods, instant noodles, and easy to prepare food. When asked, Mr Tan shares that these allow him to eat with minimal effort and movement.

To create a plan of action moving forward, Alex inquires as to Mr Tan’s food preferences. She also asks about Mr Tan’s drink preferences. Finally, she inquires about Mr Tan’s medicinal intake.

Nursing Diagnosis Comment by Nadzeef: I think needs to be removed entirely as it does not relate at all with the operating theatre.

Using Nightingale’s environmental theory, a nursing diagnosis would be made by determining how the patient’s environment affects the condition of the patient. A description of Mr Tan’s environment according to Nightingale’s thirteen canons has been outlined above. Next, Alex needs to create a nursing plan based on her observations and assessment.

Osteoarthritis is an incapacitating condition that causes disability, functional compromise, and loss of functional independence (Talbot, Gaines, Huynh, & Metter, 2003). Mr Tan has osteoarthritis in his left knee, which causes pain, muscle stiffness, and limited range of movement. This results in less mobility and a decrease in activity, further developing into loss of strength.

Alex concludes that aspects of Mr Tan’s physical and psychological environment needs is not conducive for his operation thus needs to be changed to the operating room at a local hospital. This is to allow for the reparative process to fully take effect after the surgery. There is a lack of proper ventilation, lighting, and poor cleanliness in Mr Tan’s home, all of which could affect Mr Tan’s disposition prior to and after the operation. Further, Mr Tan’s lack of movement has disheartened him, as his condition has prevented him from engaging in the activities that he once enjoyed. His emotional disposition may have affected his perspective regarding the operation, rendering him anxious and sleepless. This could potentially have an impact on the operation’s result, as lack of sleep may make the human body more vulnerable and less able to recover quickly. Comment by Nadzeef: His emotional/psychological state can be mentioned and that the scrub/circulating nurse should be the one calming him and easing his anxiety pre-operatively. To mention that the doctors can help in this area of easing the patient’s anxiety.

Mr Tan’s dietary habits need to be modified as well. His food intake results in poor nutrition, which may have an effect on the operation. Moreover, the composition of his diet has rendered him more sluggish and lethargic, and increases his body mass index (BMI), putting more weight on his affected knee. The lack of proper nutrition also has an effect on his disposition.

Nursing Intervention

Knee replacement is a major surgical operation that necessitates inpatient physiotherapy and outpatient rehabilitation (McDonald, Hetrick, & Green, 2008). Surgery is stressful, and can compromise the patient both physically and psychologically – pain perception and anxiety is often heightened when the patient feels a lack of control over the situation (Bastian, 2002). This anxiety may affect the patient’s physical recovery and psychological wellbeing, prolonging it and thereby increasing the cost of care (McDonald, Hetrick, & Green, 2008). Hence, the nurse’s role is vital in preparing the patient for surgery through education, decreasing the risk of post-surgical complications.

According to Nightingale’s theory, a nurse’s task after the initial observation and assessment would be to create and implement a plan of care (Bolton, 2014). Alex’s plan of care, pre-operation, would be to advice the scrub nurses at the local hospital to take into account environmental changes need to suit Mr. Tan’s physical and psychological and dietary needs prior to the surgery. These modifications should come before the perioperative duties of scrub nurses in order to put him in the best possible condition for nature to complete its reparative process after the operation. Comment by Nadzeef: Alex is the nurse in-charge, ‘Alex advises her team of scrub and circulating nurses…’

Alex also constructs an educational plan for the scrub nurses to effect immediately after the post operation process to reduce the incidences of complications. This plan should also include preparation of the recovery room by the nurses to support a smooth recovery of Mr. Tan. Patients who are not educated properly may not follow post operation protocols and recommendations, resulting in injury or disease. This may be avoided through preoperative education.

Implementation Comment by Nadzeef: This whole portion needs to be edited out. To apply to operating theatre environment. For implementation: 1) Relate to cleanliness of rooms and walls – surgical equipment (eg. Diathermy machine, bair hugger, surgical trolleys, instruments, waste bags, operating table, surgical suction pump) have been placed in an organized manner during surgery- ensure health attendants (or cleaners, just for your understanding), mop the floor before the surgery and blood spots have been cleaned. Ensure interim cleaning is done before the next case. Eg. Cleaning of walls, floors operating lights for blood stains- sharps and biohazard waste has been disposed of appropriately 2) Relate to ventilation and warmth – ensure digital thermometer and humidity gauge and air conditioning are working and are at optimal temperature during operation – bair hugger to be placed on patient (not directly) at appropriate temp (37 degrees celcius), Blanket covered on patient- ventilation: ensure doors all closed (induction room, disposal room especially) during surgery and not to open doors to the main corridor that may introduce ‘unclean’ air into the operating room. To only enter operating room via the scrub room3) Relate to light – adjustment of light during surgery for optimal view of surgical site, ensuring safety of patient Continued below

The day after her initial observation and assessment, Alex returns to implement the nursing care plan. She enlists the aid of the local hospital management to service the air conditioners and replace the lighting fixtures, for the operating room and the recovery room respectively. Alex educates scrub nurses to apply healthy habits and advice on proper ventilation and lighting, and suggests that the blinds in the recovery room need to be open during the day time.

With permission from operating room management, Alex should advice on cleaning days and methods suitable for Mr. Tan’s preparation for surgery. Alex educates scrub nurses about mould and mildew, and possible health hazards in the environment. Alex also requests the recovery room nurse to observe the environment for potential health risks that could prolong his recovery.

Alex prepares Mr Tan for the surgery by altering his nutrition and psychological environment. Alex educates Mr Tan about low intensity activities that he could complete both pre-operation and post-operation. Alex requests assistance from scrub nurses to equip Mr. Tan with crutches to help him move around the house with more ease. Further, Alex educates Mr Tan about postoperative rehabilitative activities that he could accomplish independently. Alex also allows Mr Tan to speak freely of his anxieties about the surgery. However, Alex avoids chattering hopes and dreams in order to avoid making light of Mr Tan’s condition and possibly exaggerating the positive outcome of the surgery. Instead, she provides factual information about health, exercise, and other topics of importance related to the surgery. Finally, Alex constructs a dietary plan for Mr Tan that consists of easy to prepare nutritional food to a clinical dietician in the local hospital. She also educates Mr Tan of the benefits of a well-balanced diet, both in preparation for surgery, and as a means to recover faster. Comment by Nadzeef: 4) Relate to bed and bedding- assess and ensure that operating table has been cleaned and lined with new sheet of clean linen 5) relate to noise- minimize talking unnecessarily before operation when patient has not been anesthetized

Finally, Alex educates Mr Tan about reporting any experienced pain to the recovery room nurse. This would be particularly helpful after the surgery, where pain management is necessary. The recovery room nurse recovery report will allow Alex to develop a plan for managing pain.

Evaluation Comment by Nadzeef: Hence relate evaluation to the above mentioned. Thanks! Any other questions feel free to ask me.

Nightingale’s theory emphasised that observation and documentation is vital in the evaluation process, so as to inform any necessary modification of the nursing plan (Bolton, 2014). For six weeks prior to surgery, Alex visited Mr Tan every other day in order to evaluate the operating room environment and provide him education, psychological, and emotional support. Alex noted that Mr Tan reported less anxiety, and better sleeping habits. Alex also observed that Mr Tan had developed better eating habits, and was less sluggish. Finally, Alex noted that Mr Tan had a more positive perspective going into his scheduled operation. All these, perhaps, contributed to Mr Tan’s short hospital stay after the surgery.

After the surgery, Alex visited Mr Tan daily over the course of four weeks to provide support and assistance at the local hospital. She consulted the recovery room nurse on the rehabilitative activities and continued to provide nutritional and emotional support. Alex noted that the preoperative education had not only lessened Mr Tan’s anxiety pre- and post-operation, but also made it easier for him to understand his condition, and retain important information about his recovery.

Conclusion

It can be seen from the above that nursing theories are a necessary knowledge base when providing care. Both theories discussed above provide structure and guidance when delivering care, although the methods are different. Nightingale’s theory emphasises adapting the environment in order to allow the patient to recover and achieve optimal health. Further, Nightingale posited that the nurse’s role is to place the patient in the best condition to avail of nature’s reparative process. On the other hand, Orem’s theory focuses on improving the self-care agency of the patient. According to Orem, this is done by determining a patient’s self-care deficit, and providing compensatory support to address this deficit and facilitate the development of a person’s self-care agency. Nightingale’s theory was chosen and applied to the case study cited above because of its emphasis on the environment and its effect on the patient’s health. As can be seen above, the patient in the case study needed much altering of his environment in order to prepare him for his operation, and facilitate his recovery both as an inpatient, and after being discharged from the hospital. The case study discussed above shows how the patient’s physical, mental, and emotional condition improved due to changes in his environment. Moreover, the case study examined above shows how the operating nurse successfully modified the environment and educated the patient in order to ensure his wellbeing and quality of life both prior to the surgery, and after the surgery.

This essay demonstrates the importance of nursing knowledge in practice. It is necessary for practicing nurses to be knowledgeable and informed about various nursing theories and models in order to be able to apply the appropriate one for each case. These theories are beneficial for guiding the professional nurse, offering a systematic framework for the delivery of care and intervention, and ensuring positive results.

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Appendix 1: Case study

Sixty- year old Mr. Tan has osteoarthritis of the left knee and would be undergoing a total knee replacement at the local hospital. Mr. Tan had been, when younger, an enthusiastic sportsman who lifted weights. This interest had led to a previous knee injury. Operating Theatre (OT) Nurse Alex is in-charge of Mr. Tan throughout his journey pre-operatively, intra-operatively and post-operatively. Comment by Nadzeef: To match as above.

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