Applying Nursing Theory to a Practice Problem

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Applying Theory to a Practice Problem
October 3, 2012

Introduction
Our first class in the masters in nursing program, has been focused on nursing theorists. We have learned about Grand Theories, which are theories that are very broad and difficult to test and Middle Range Theories, which are also broad theories but narrow enough to be testable. We have learned how to study the different theories, looking at how we can utilize theories to evaluate practice. I have been in a nursing leadership role for many years. Approximately 8 years ago, I lead a group of nurses to develop a shared governance nursing model in our organization. Shared governance is having staff involved with making decisions related to unit operations. Staff looks at professional practice, staff development and orientation, quality improvement initiatives, and research. We created a three tiered governance model that included a unit council, specialty senate, and nursing congress. This model was implemented; however some units and departments had more success than others. Four years later, I was asked to gather a group of clinicians across the organization to look at how we could enhance the governance model to be an interdisciplinary model. We included clinicians from respiratory therapy, dietetics, clinical therapies, case management and discharge planning, pastoral care, lab and radiology services, pharmacy, and advanced practice nurses. This model was also implemented with varying levels of success. Prior to each implementation, and annually thereafter, the organization provided education to the staff leaders of these unit councils and specialty senates. Educational material varied from year to year, but included how to run a meeting, how to create an agenda, conflict resolution, change management, etc. Teams were included when planning the annual educational sessions. The practice problem I would like to review is how managers lead in a shared governance environment. I feel that it has been difficult for some managers to give up control of making all the decisions on their units. When looking at the units that are successful in the shared governance model, the manager’s leadership style adapted to this model and they were supportive of their staff becoming empowered to make decisions related to their unit operations. Changing leadership styles and / or decision making styles is an important step for managers to be successful when implementing a shared governance model. Managers need to learn how to transition from an autocratic leader to a democratic leader. The manager’s learning curve is as steep, if not steeper, than the staff learning curve. (Brooks) I have read through the literature to identify a nursing theory to guide me in developing strategies to look at this problem, however at this point, I do not have an exact theory to use. I am looking at a borrowed theory that supports shared leadership and staff empowerment and motivation. An organizational and work theory or a systems theory may be an option as well. Application of a Middle Range Theory to Problem

As I continued my search for a theory to guide the development of strategies for managing in a shared governance model, I found a middle range nursing theory, Theory of Interpersonal Relations, by Hildegard Peplau. This theory is also known as Psychodynamic Nursing, which is the understanding of one’s own behavior, (Current Nursing). Peplau was the first published nursing theorist since Florence Nightingale. Peplau was born and raised in Pennsylvania. She began her career in nursing in 1931 and worked as a staff nurse in Pennsylvania and later in New York City. She then became a school nurse at Bennington College in Vermont where she earned a bachelor’s degree in Interpersonal Psychology in 1943. Pepau worked in a private psychiatric facility where she studied psychological issues with Erich Fromm, Frieda Fromm-Reichmann, and Harry...
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