Application of Fundamental Patterns for Nursing in Patient Care
The interactions between patients and nurses are defined by complexities with the potential to make delivery of healthcare services challenging. Elimination of such challenges requires a suitable framework that enhances understanding, not just between the nurse and the patient, but also of the role of the nurse in the whole setup. Carper’s (1999) theory of ways of knowing is a typical classification of the sources from which knowledge and beliefs in nursing professional practice originate. The four fundamental patterns of knowing include empirical, aesthetics, personal, and ethical. According to Carper (1978), understanding the four patterns enhances awareness of the complexity and diversity of nursing knowledge, thus improving patient care.
One of the encounters in personal practice that needed application of the fundamentals of the theory of knowing involved a patient who came to the facility with somatic complaints, feeling tired, loss of interest in daily routines, difficulty concentrating, and disrupted sleep. The patient was a middle-aged male of African-American ethnicity. They insisted to be prescribed medication to relieve their symptoms, as they could not get the medicines over the counter. However, the patient was convinced to undergo a full examination, and they were diagnosed with depression. While relevant therapeutic and management measures were taken to address the patient condition, emphasis was placed on application of nursing science to the case. Evidence-based practice was employed in establishing the risk factors behind patient’s condition. After ascertaining the patient suffers from major depressive disorder using the Diagnostic and Statistical Manual of Mental Disorders DSM-IV, attention shifted to empirical evidence linking increased risk of developing depression to an underlying medical condition affecting the body’s regulatory system. Further tests revealed the patient to be hypertensive, corroborating evidence in Ward and Mengesha (2013) citing hypertension as a comorbid medical problem and a predictor of depression in African-American men. The evidence proved crucial in the diagnosis, treatment, and management of the case.
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Aesthetics, defined by Carper (1978) as the ‘art’ component of nursing, was employed to enhance understanding of the patient’s case. One notable aspect was the unwillingness to enroll for comprehensive treatment and management of the diagnosed depressive disorder, and preference for a quick solution in the form of medication. Empathy, which is a central element in aesthetics, played a crucial role in in-depth understanding of the values, attitudes, and beliefs of African-American men that according to Ward and Mengesha (2013) influenced their perceptions on psychotherapy and treatment of major depressive disorder. Aesthetics way of knowing enhanced understanding of the patient’s situation and circumstances unique to them in relation to the wholeness of the case. For instance, it was important to be apprehensive of the evidence on the role of cultural barriers in seeking psychotherapy in relation to its association with weakness and diminished pride. According to Ward and Mengesha (2013), strong African-American families consider mental illness a weakness and do not recognize associated disorders. While African-American men do not hold negative attitudes towards depression, their cultural attitudes and beliefs negatively affect their treatment seeking practices. Empathizing with the patient involved in-depth understanding of the role of Afrocentric cultural values including unity, harmony, communalism, authenticity, and spirituality. According to Carper (1978), the capacity for vicariously experiencing the patient’s feelings is crucial in aesthetic knowing. The fundamental pattern was used to win the patient trust by making them aware of the implications of their culturally informed decisions on the success of treatment and management of the diagnosed conditions.
Nursing practice is highly dependent on experience, which is critical in recognizing and appreciating the complexity and diversity of medical cases. For instance, a nurse must know that patients diagnosed with a similar medical condition may require different treatment approaches. Years of experience in the nursing field reveal that different ethnic groups have differential access to healthcare services and varying attitudes towards treatment. In the case herein, it is important to understand that the Afrocentric values are attributed to increased likelihood of withholding sensitive information perceived as negative or upsetting in the mental health context (Ward & Mengesha, 2013). Cases of discrimination and racism directed at patients of color have been documented in clinical settings. Observations made during years of experience in the field corroborate the assertions because most patients from the group demonstrate extreme anxiety and fear when visiting healthcare settings. Knowledge of personal knowing was instrumental in the establishment of authentic therapeutic relationships suitable for the patient’s case. The decision was drawn from experiences of the effectiveness of a family-centered approach in the treatment and management of the patient’s case owing to perceived protectionist role of marriage and social support for black families.
Nursing as an interpersonal process involves interactions, relationships, and transactions between the nurse and the patient. Therefore, trust is a major factor defining these interactions. The patient in the case expressed sensitivity to some of the prescribed procedures, and given the vulnerability of their group to values and attitudes that negatively affect treatment-seeking behavior; the nurse faced the challenge of ensuring they understand their predicament. The patient also expressed concerns about their privacy, evidenced in the initial reluctance to engage their family in the suggested family-centered care. In this regard, the nurse faced a moral dilemma because their decisions raised ambiguity and uncertainty, and existing traditional principles and ethical codes offered little assistance. Moral knowing is relation to knowledge acquired through years of practice was applied in the case based on the understanding that the patient’s welfare overweighed concerns for privacy as stipulated in the nurse-patient confidentiality.
Nursing Research in an Area of Interest – Telemedicine in Community Nursing
Telemedicine is a frontier of telehealth with the potential to revolutionize healthcare delivery. Initially, patients understood telehealth as counseling over the phone. However, technological innovations in the modern healthcare settings allow telehealth nursing to reach out to the patients remotely, monitoring their conditions, and interacting with them through electronic devices. Therefore, telenursing refers to the use of telemedicine and technology for nursing practice and delivery of care in remote settings.
Telemedicine has the potential to realize universal access to healthcare, one of the goals each country strives to achieve. Therefore, research on application of telemedicine is imperative to inform comprehensive adoption and implementation. Telemedicine represents a change in the healthcare sector, and like all changes, it has experienced obstacles in adoption due to various factors. For instance, in the UK, adoption of telehealth progressed in a pace and scale not anticipated by policy. According to Taylor, Coates, Brewster et al . (2015), frontline staff acceptance is reported by many studies as the key barrier; though evidence of expansive adoption of telehealth in routine practice is limited. Research in the field of telemedicine and adoption at community level is imperative to establish factors contributing to low-key adoption and implementation. Understanding of the initial barriers to acceptance is instrumental in facilitating learning and increasing adoption.
Research in telemedicine is crucial in demonstrating the value of health care delivered via the platform. Published work on the field highlights the power of the technology and the quality and content of nurse-patient interactions it supports. Research contributions in telemedicine towards the development of its application are evidenced in established benefits of adopting and implementing the technology. Empirical evidence exists showing the potential of telemedicine to improve access to health care by millions of patients in urban and rural settings. The technology also plays an important role in the reduction of healthcare costs, thus addressing one of the most pressing concerns in the sector. While research has consistently demonstrated that services delivered via telemedicine are as good as those provided using the traditional interaction approach, the former has been shown to be superior in some specialties such as mental health and ICU.
Little research exists that explicitly addresses the challenges faced in implementing new telemedicine services. Therefore, research into the field must involve pilot projects extensively rolling out the technology. Focus must also be placed on previous failed and successful projects to understand what works and what does not. A case study approach would be relevant because of the unique factors affecting adoption and implementation in each setting. Such factors include relative advantage, adaptability, complexity, trialability, observability, and costs. Understanding each of the topics is crucial to inform the level of importance attached to it in a given setting, and the necessity for a comprehensive review of the factor in question.
Determining Suitability of a Topic for Research
Research topics are crafted with an audience in mind, implying that they must meet the needs of the intended audience to be considered appropriate. Therefore, a research worthy topic must first pose a problem that is important enough to warrant study. The topic needs to be innovative, implying it must address a new concept about an existing or novel phenomenon. The contribution of the topic is of utmost importance in terms of the number of beneficiaries, size and weight of the benefits, valued addition to existing fields, and must be approved by experts in the relevant field. The benefits of the research topic to the scientific community must be demonstrated in relation to introduction of better alternatives, design guidelines, or principles. In addition, the topic must be feasible in terms of executionability. The research topic must not be an end in itself, but rather an avenue for future directions on research in the field. The importance of credible research topics is that they have a theoretical basis or develop a new theory applicable to the field of interest. The topic must conform to available resources in terms of time, finances, and personnel.
References
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science . 1 (1), 13–24.
Taylor, J., Coates, E., Brewster, L., Mountain, G., Wessels, B., & Hawley, M. S. (2015). Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. Journal of advanced nursing , 71 (2), 326-337.
Ward, E., & Mengesha, M. (2013). Depression in African American men: A review of what we know and where we need to go from here. American Journal of Orthopsychiatry , 83 (2pt3), 386-397.
