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A theory is a set of procedures and concepts that gives an orderly means of viewing phenomena. In both philosophy and nursing, the character of concept is a long-standing issue. The foremost outstanding question is how theories relate to a concept. Walker & Avant say that concepts are normally considered as the building blocks of theories. In most occasions, concept analysis suggests that a concept can be developed before theorizing of the concept is done. In the history of nursing, there are several nursing theories. Common concepts are engraved in these theories. The core concepts involved in these theories are people, environment, nursing, and health. Core concepts identification allows the nurses to establish appropriate research questions, discover nursing priorities, and develop theories. They help nurses to establish actions that lead and guide their actions. These concepts are incorporated as nurses review, formulate, and deliver their nursing care to people. In nursing, nursing theories are a common core concept. Analyzing and comparing the definition of nursing theories in the nursing concept help to distinguish the deviations among them (Taylor, Lillis, LeMone, Lynn, 2008).
Various concepts have been developed in the nursing profession, and then applied by the different theorists in order to develop the profession. These concepts provide the basis, on which the field of education in nursing is built and engraved. Educational programs that make up nursing profession are associated with these concepts. In nursing the concept defines the way care is provided and the way the relations between nurses and patients should be maintained. Human being, as the basic concept, describes human being as an entity that is made up of the various aspects that constitute the whole being. The aspects that make up human being are social, psychological, physical, and spiritual ones. They combine to make up the whole being. This concept requires the understanding that human beings are complex entities made up of the various elements. In the environment concept, the surrounding of the human being is encompassed. They include the physical and social economic factors, as well as the people living with that person. The people and the environment, to an enormous extent and mostly concerning the access of health care services, affect the health of a person. Health, as a nursing concept, pertains to the relation and concerns of health conditions that are not of immediate concerns. Nevertheless, these conditions are fundamental aspects to consider when designing the best regime to treat the patient. Finally, the last concept involves the conceptualization of the perfectly nursing profession as an art and science of the well-being of people involving more than just taking care of the health but also offering skills, such as leadership and decision making (Current Nursing.com, 2011).
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The major aim of this concept analysis is to highlight one core-nursing concept and its relationship with a nursing theory. The concept will create the basis of the nursing theory that will be highlighted.
The missing nursing care is the new concept that refers to the measures that were omitted, while giving health care to a patient. It is normally an act of omission by the specialist offering the care. Two significant errors have been discovered: the act of exclusion and the act of commission. The acts of the commission have been substantially addressed in literature, while those of omission are rarely addressed. The phenomenon of missing nursing care was first realized in a qualitative study of nursing care. Nine elements are mostly missed in this missing care. They are ambulation, delayed or missed feedings, turning, discharge planning, patient teaching, emotional support, input or output documentation, hygiene, and surveillance. About seven themes are related to the reasons given by the nursing staff, as to why there is missing care. They include too few staff, poor utilization of existing staff resources, poor teamwork, ineffective delegation, and time required for nursing intervention, denial, and habits. However, delineation of missed nursing care is supposed to be clarified, and the ways it differs from other nursing concepts and theories defined (Kalisch, Landstrom, Williams, 2009).
Missed nursing care is a fundamental concept in nursing. Nurses working in a variety of settings have been observed to be thoroughly conscious of the truth that there is missed care, and they can fully identify it. Nevertheless, they do not acknowledge it openly or even discuss it. The most probable reason for this is the fact that they may feel guilty of their failures. This is because of the fear of repercussions, blames for raising the issue, and to some extent perceptions that the concern will not be dealt. These facts are further validated by the nurse’s reactions, when the concept is introduced to them in personal interactions, formal interactions groups, or in focus group discussions of nursing care. Emotions, such as anger or frustrations, are virtually some of the reactions of nurses when this topic is introduced to them. Low self-esteem is described by most of the nurses as the motive as to why there is missed care. However, majorities are glad that the topic of missed nursing is straightforward and can be discussed. Failure to acknowledge missed care is similar to the tradition, where patients and near misses were hidden. The failure to acknowledge missed care has led to few studies being done and documented on this area. Therefore, there is little knowledge available on what is happening at the stage of care delivery (Kalisch, 2006).
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Identification of model cases is involved in the concept analysis, where an example of the concept and the ways it demonstrates all its attributes is checked.
Case: Sudden Increase in Demand for Care
A surgical nurse is assigned to the four patients; three of them require administration of medications at 09.00. On the other hand, the last patient requires an extensive wound dressing at the same time. On this scenario, the nurse thinks that to complete this care between 08.30 and 09.30. However, the emergency department calls the unit with the information that they need to admit three more patients. This is to be done with an immediate effect, and one of the patients is assigned to this nurse. Immediately a nursing assistant informs the nurse that one of the patients has high blood pressure. Immediately the nurse calls the physician, who says that the patient should be admitted to the department known as intensive care unit. Therefore, the nurse in the next one hour is involved in the paper work and activities required to transfer the patient. The emergency department unit’s patient arrives at the same time the nurse gets back from the transfer. At the same time, the nurse receives a report from the emergency department nurse and admits the patient. At this time, 09.00 had already passed. Therefore, the nurse had delayed the dressing change and missed the 09.00 medication, because most of them were on the hourly basis, and it was approximately time for the subsequent administrations (Kalisch, Landstrom, Hinshaw, 2009).
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Case: Impact of Team Norms on a new Graduate
A graduate nurse joins the staff of an orthopedic unit. A well-experienced nurse receives him. Being the first day, he is assigned a load of five patients. All are at least 24 hours post-operative patients. They need to be ambulated three times a day and two of these occasions fall on a 12-hour shift. He plans that each ambulation takes around 20 – 30 minutes; thus, using approximately 3-5 hours in the ambulation. He approaches his receptor and complains about his inability to complete all his work. The experienced nurses tell the person that he cannot get everything done and that ambulation takes long. On the next shift, he works in a normal way and is less stressed, because he has the knowledge that not all nurses complete their duties (Kalisch, Landstrom, Hinshaw, 2009).
Antecedents and Consequences
Antecedents are events or incidents that must occur before the occurrence of a concept. In this concept of missing care, antecedents are occurrences that lead to nurses determining care aspects that will be given and that shall not be given. Consequences are events or incidents that are the outcome of the occurrences off the concept. Missed care consequences affects on the patients. For example, if ambulation is the missed care, the patient may be discharged in a debilitated condition thus requiring months of therapy (Kalisch, Landstrom, Hinshaw, 2009).
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These are classes of the real phenomena and through their presence the existence of the concept is demonstrated. The defining attributes of missed care are identical to the empirical referents. Variety of methodologies can be use to study missed care. The data collected in such studies can be used to correlate staffing variables that affect the nursing care (Kalisch, Landstrom, Hinshaw, 2009).
The phenomenon of missed care is universal, and it can threaten the safety of nurses throughout the world regardless of the culture. The definition and model of the missed care-nursing model can be applied to test interventions in nursing that can be used to counteract the negative effects in cases of omissions. There is a need to develop policies that will deal with the broader health and economic consequences of missed care.
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