Nurses’ daily operations are characterized by undertaking various tasks that may require them to base their execution on theoretical frameworks. In most cases, nurses apply the nursing theory in daily practices as the latter is tailored in a manner that offers principles that underlie practice and facilitate the generation of more knowledge in the nursing field. The nursing theory gives nurse practitioners a sense of identity and also allows other stakeholders in the healthcare industry, managers, patients and other healthcare professionals, to recognize the unique role that nurses play in healthcare (Alligood, 2017). Additionally, apart from the nursing theory, nurses can also apply middle range theories in patient care, like in the case of helping patients deal with diabetes. Using the argument on the supportive environment in such a situation would enhance the care of diabetic patients through counselling and monitoring patient blood sugar levels, to facilitate the creation of an environment that can foster the betterment of patient well-being (Elo et al., 2013). Similarly, nurses can also apply borrowed theories in daily nursing practices, in which case they use theories from other disciplines like sociology and psychology, to inform their practices (Kenworthy & Verbeke, 2015). Thus, the effective delivery of nursing care relies on the integration of knowledge from nursing and other fields to offer patients high quality and holistic care services.
Problem Statement
The problem in question is one that I have discussed in my previous papers, which is the reluctance of nurses to obtain the daily weight of hospitalized patients. Getting the weight of hospitalized patients daily is crucial because monitoring patient weight facilitates the assessment of patient nutrition and can also be used to inform decisions on the appropriate drug dosage for a patient. Regardless, despite the said importance of the nursing task, it is often assigned to unregistered healthcare staff, who have inadequate training and do not necessarily understand the significance of the job allocated (Evans, 2014). Therefore, to solve the said problem, the application of a middle range theory is proposed. The most appropriate middle range theory would be the one on well-being supportive physical environment. A supportive physical environment is crucial to enhancing the wellbeing of patients, as it acts as a resource that contributes to the betterment of patient health (McEwen & Wills, 2014). Thus, nurses may realize such environmental enhancements through daily monitoring of patient weight to promote patient well-being through proper medication and dosage resolutions as well as the determination of suitable dietary needs for each patient (Crawford, Garvin Coyne & Calder, 2018).
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Borrowed Theory
The solution to the problem stated above may also be realized through the application of a borrowed theory from psychology. The proposed approach is the operant conditioning theory. The operant conditioning theory stems from the proposition that learning occurs as a result of the association of behaviour with rewards and punishments. Thus, based on the consequences that a given behavior is likely to elicit, individuals choose to behave or not behave in a particular manner (McLeod, 2015). The operant conditioning theory is appropriate to resolve the issue of nurses not obtaining the daily weight of their patients because the said tendency among nursing practitioners is a result of behavioural affiliations. Nurses tend to overlook weighing hospitalized patients daily because they believe that the latter would hinder the execution of other important nursing tasks like administration of medication and tube feeding. However, owing to the previously established importance of daily patient weight measurement, nurses must be prompted to realize that assessing patient weight daily is equally crucial to patient care. When done appropriately, regular analysis of patient weight can inform both physician and nursing decisions, leading to the betterment of the care delivery measures employed and the enhancement of patient care and well-being (Aliakbari et al., 2015).
History of the Operant Conditioning Theory (Borrowed Theory)
The operant conditioning theory was promulgated by B. F. Skinner, who was inspired by John B. Watson’s classical conditioning theory. However, skinner’s approach to behavioural modification took a less extreme stance compared to Watson’s argument as he believed that a mind exists, and deemed it more appropriate to focus on the study of observable behavior rather than presumed mental events. So, Skinner’s view aimed at proving that classical conditioning was an extremely simplistic approach to explaining sophisticated behavior exhibited by humans. Skinner believed that the best way to explain behavioural tendencies was to establish the causes of actions and the consequences, thereof, an approach that he called operant conditioning (Aubrey & Riley, 2018).
Hence, Skinner based his work on Thorndike’s (1898) law of effect, which indicates that is behavioural consequences are pleasant, they are likely to encourage repetition of the same and in cases where unpleasant consequences follow behavior, the said action is expected not to be repeated. Therefore, Skinner introduced new terminology to the mentioned concepts, reinforcement. He promulgated that reinforcing behavior increases the likelihood of its repetition, whereas the lack of reinforcement results in its extinguishment. Furthermore, Skinner proposes three variables that affect behavior regulation including neutral operants, reinforcers and punishers. Neutral operants are behavioural responses that neither increase nor decrease the possibility of repeating behavior. Reinforcers increase the chance of repeating behavior, and they can take negative or positive forms. Finally, punishers decrease the likelihood of behavioural repetition. Hence, they weaken specific behavior (McLeod, 2015).
Previous Application of Operant conditioning in Nursing
Since the operant conditioning theory provides practical solutions to human behavior, it is currently being used in the nursing field to enhance teaching techniques, to facilitate learning even among unmotivated or slow students. Moreover, behavioural modification is also applied in various nursing tasks to modify behavior. For instance, in cases of issues like drug addiction, obesity and aggression, nursing practitioners can apply the principles of operant conditioning to encourage behavioral changes among their patients, and, in turn, enhance their well-being. Also, in instances where patients were dealing with eating disorders like Anorexia Nervosa, the application of Skinner’s principles of operant conditioning are recorded to have helped patients gain weight (Kazdin, 2012).
Additionally, the same principles have also been applied in mental institutions to offer treatment through the token economy method. In a study featuring psychiatric patients who had difficulty in adopting desired behaviors, the researchers chose simple grooming behaviors like combing hair, brushing teeth and washing one’s face, as observable variables for their study. First, the researchers established a baseline that characterized the standard frequency of the occurrence of the said behaviors. Every time a patient performed proper behavor, they received a token that could be exchanged for personal items or food at the hospital’s drugstore. The researchers documented that the patients increased the frequency of the desired behaviour when they were reinforced with tokens (Kazdin, 2011).
Application of Borrowed Theory to Resolve Problem
The operant conditioning theory can be applied in nursing to resolve the issue of inconsistent recording of admitted patients’ weight by emphasizing the importance of tracking patient weight daily. The latter may be achieved by reinforcing the consistency in recording patient weight. For instance, healthcare institutions can decide to reward the nurses that record their patient’s weight daily through tokens that impact their performance records positively. Whenever nurses record the weight of their patients, supervisors can award them a ‘star’, then at the end of a specified period, the number of ‘stars’ can be counted, and the nurse with the highest number can be named nurse of the stated period, perhaps nurse of the month. Further consistency can be used to elicit better rewards like salary increments and promotions, as a means of encouraging the continuous practice of monitoring patient weight (McLeod, 2015).
Moreover, in the case that a nurse has received rewards for maintaining consistency in monitoring the weight of their patients, then they choose to abandon the desired trend, punishers can be employed to rectify the said tendencies to their previous and desired state. For example, if a nurse receives a promotion for adhering to the requirement of monitoring patient weight on a daily basis, when they stop maintaining the trend, they can be demoted to their previous position, as a means of emphasizing the crucial nature of the adaption of the trend of recording patient weight daily to enhance patient care. Applying both reinforcers and punishers to ensure that the desired nursing practice is adopted by nurses in healthcare institutions will highlight the importance of maintaining daily patient weight records. This, will, in turn, result in the betterment of the healthcare system and the enhancement of the care services offered (McLeod, 2015).
Integration of Borrowed Theory and Middle-Range Theory for Problem Resolution
The application of both operant conditioning (borrowed theory) and the argument on supportive well-being environment (middle range theory) would be crucial to eliciting an optimal solution to the patient weight measurement issue. Since the middle range theory proposes that a patient’s environment is the source of their well-being, the latter can be used to define the purpose of nurse practitioners (McEwen & Wills, 2014). The requirement to measure the weight of admitted patients daily is critical to creating an environment that enhances the well-being of patients. Monitoring patient weight increases the accuracy of medical decisions concerning them, thus improving the likelihood of reducing their treatment period, enhancing the quality of care they receive and, consequently, facilitating the realization of the nursing goal of helping individuals, families, communities and societies realize an optimal state of well-being through promoting, maintaining and restoring their health (Bastable, 2017). So, with the expressed purpose determined, the borrowed theory could be applied to discipline nurses to stick to the established plan. Reinforcers could be used to reward those that adhere to the policy whereas punishers would remind those that digress from the mission that they have a part they must play to facilitate the realization of the ultimate nursing goal stated above (McLeod, 2015).
Conclusion
The autonomous application of nursing principles cannot allow nursing practitioners to cater to the needs of their patients effectively. When patients are admitted in a healthcare institution, apart from the medical care they require, they are likely to need other forms of care, whose realization can only be achieved by borrowing knowledge from different areas of expertise like psychology and sociology. Hence, for nurses to offer their patients holistic and high-quality care services, they must integrate nursing knowledge with information from other areas of expertise that concern human existence and the specific issue at hand. Therefore, to resolve the issue of nurses not taking patient weight measurements daily, an integrative solution involving the application of the proposed middle range and borrowed theories would elicit an optimal result.
References
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Aubrey, K., & Riley, A. (2018). Understanding and using educational theories . SAGE Publications Limited.
Bastable, S. B. (2017). Nurse as educator: Principles of teaching and learning for nursing practice . Jones & Bartlett Learning.
Crawford, J. E., Garvin Coyne, C., & Calder, K. (2018). Improving compliance in obtaining daily weights in a large academic children's hospital. Journal of Nursing Care Quality, 33(1), 61-66. Retrieved from https://nursing.ceconnection.com/ovidfiles/00001786-201801000-00009.pdf
Elo, S., Kääriäinen, M., Isola, A., & Kyngäs, H. (2013). Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. The Scientific World Journal, 2013, 1-7. doi:10.1155/2013/945635.
Evans, L. (2014). Accurate assessment of patient weight. Retrieved from https://www.nursingcenter.com/cearticle?an=0000178620180100000009&Journal_ID=54010&Issue_ID=4424962
Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings . Oxford University Press.
Kazdin, A. E. (2012). Behavior modification in applied settings . Waveland Press.
Kenworthy, T. P., & Verbeke, A. (2015). The future of strategic management research: Assessing the quality of theory borrowing. European Management Journal , 33 (3), 179-190. http://dx.doi.org/10.1016/j.emj.2015.03.007
McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins
McLeod, S. (2015). Skinner-operant conditioning. Retrieved from https://www.simplypsychology.org/operant-conditioning.html
