Research is a systemic investigation used to answer questions. For nursing, research uses the scientific process to study nursing questions for nursing practice. “Research promotes accountability, which is one of the hallmarks of the nursing profession and a fundamental concept of the American Nurses Association Code of Nurses,” (Haber, 2018, p.7). An example of this would be exploring how patients rate their pain on a numeric scale. This type of research helps with evaluating the experience patients feel post-operative.   Evidence-based practice (EBP) is the collection and evaluation of valid research, clinical expertise, and patient values to make a clinical decision. “The IOM has issued a challenge to change the way nursing is practiced by bridging the chasm between research knowledge and practice.” (Brower, 2017, p.18). EBP can ensure the best practice of care for patients, along with decreasing mortality rates. An example of EBP would be a nurse gathering research based on how health care clinics bring about lowering hospital-acquired infections, and using that evidence from the research to provide the best possible outcome. Quality improvement (QI) is using data from different outcomes of care and improvement processes to improve the quality of health care. Current nursing knowledge and methods are researched, alongside with outcomes of certain care processes to answer a question in order to make improvements in nursing care for patients. An example of QI would be a nurse conducting research for an outcome of care involving patient injuries. The nurse would use already existing studies on how health care facilities prevent patient injuries, compare this knowledge to the methods the health care facility they work at use with the outcomes presented, and then create a possible new method of care that can be an improvement. 

Brower, J., E., & Nemec, R. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18. 

Haber, J., & Lobiondo-Wood, G. (2018). Nursing research: Methods and critical appraisal for evidence-based practice (9th ed.). St. Louis: Elsevier. 

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This article discusses how the critical social theory should be utilized as a framework for academic nursing practice.  The preface of critical social theory is that nurses must maintain a level of self-reflection to maintain the areas of practice without forgetting that patient problems are as important as treating the condition.  This includes being able to assess all of the dimensions utilized as nursing care is delivered.  This is bigger than locating a problem and instituting a solution it also involves a behavioral shift to utilize emotional and behavioral solutions as well.  They discuss how the nurses actions are dictated by actions other than the nurses original intentions such as; the manner the situation is being treated, the view regarding who should be in charge of the interaction, the center of commitment to the client, practitioner, organization, and the nature of communication that is appropriate for that specific interaction (Swartz, 2014).  They further discuss how the nursing profession is somewhat oppressed in that many advanced practice nurses feel that they are powerless without their physician backing them.  They also discuss how nursing has difficulty obtaining support to institute programs such as proper nutrition for cardiac wellness but there is significant backing for bypass procedures.  This is similar to the oppression discussed in the critical social theory.  The discussion of transpersonal learning through active participation from teachers and learners instead of the traditional forms of presenting material.  This learning format promotes respect and collaboration.  Utilizing the critical social theory to assess areas of oppression, in order to open the discussion for change and improvement would greatly benefit any nursing and education in nursing environment.  Empowering the nurses to be actively engaged in the process of change encourages commitment to the organization and allegiance to improvements. 

References

Swartz, M. K. (2014, May). Critical Theory as a Framework for Academic Nursing Practice. Journal of Nursing Education, 53(5), 271-276. https://doi.org/10.3928/01484834-20140408-01

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Reproductive Disorders

Reproductive disorders are common and can affect individuals of all ages.  Benign condition such as Leiomyomas commonly known as uterine fibroids are more prevalent in women, with the highest incidence occurring in black women (Huether & McCance, 2017, p. 816).    Prostate cancer is a reproductive disorder affecting men, and death from prostate cancer are highest in males of African descent within the Caribbean. (Huether & McCance, 2017, p. 886) Although these conditions are different in pathology, they have some similarities especially as it relates to risk factor and ethnicity.  

Similarities and Differences

One similarity is that both disorders are related to hormonal balance within the body.  Although the specific cause of uterine fibroids is unknown, hormonal fluctuation of progesterone, and estrogen can affect the size of tumors and reoccurrence of the disorder (Huether & McCance, 2017, p. 817).  Prostate cancer also has hormonal factors involving estrogen and testosterone, however the role of androgens in prostate cancer occurrence is still being investigated (Huether & McCance, 2017, p. 867).    

Another similarity is the role that diet has in these reproductive disorders.   Like uterine fibroids, prostate cancer is also linked to obesity and is suggested to be a more aggressive forms of the disease (Huether & McCance, 2017).  One if the biggest differences is how the disorders are detected.   Uterine fibroids are detected usually after reports of abnormal vaginal bleeding and complaints of lower abdominal or pelvic pain.  Unlike prostate cancer, which is screen annually beginning at age 50, currently there is no blood test to detect uterine fibroids. (Huether & McCance, 2017).  

Diagnosis and Treatment

Although, prostate cancer is very prevalent in black men, one study examined the underrepresentation of black men in prostate cancer research and screenings.  The study found that black men were less willing to participate based on barriers such as mistrust of health care providers, likening research to the “Tuskegee experiment” (Rogers et al., 2018).  Barrier such as fear can pose issues with early detection of the disease and treatment, if populations are reluctant to seek health care. 

Diagnosis of uterine fibroids consist of bi-manual exam conducted by the clinician, along with ultrasound or (MRI) (Huether & McCance, 2017, p. 817).  In a study examining the link between cardiovascular disorders and fibroids, factors such as stress and increased in alles which promote fibro proliferative diseases such as fibroids and narrowing of arteries are more frequent in women of African descent (Noel, Gadson, & Hendessi, 2019). The study also suggest that African American women have greater treatment expectations, experience more financial challenges, and lack satisfaction with treatment outcomes (Noel et al., 2019, p. 3).  

References

Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology (6th ed.). St. Louis, MS: Elsevier.

Noel, N. L., Gadson, A. K., & Hendessi, P. (2019). Uterine, fibroids, race, ethnicity, and cardiovascular outcomes. Current Cardiovascular Risk Reports, 13(28), 1-7. http://dx.doi.org/10.1007/s12170-019-0622-0

Rogers, C. R., Rovito, M. J., Hussein, M., Obidike, O. J., Pratt, R., Alexander, M., … Warlick, C. (2018). Attitudes toward genomic testing and prostate cancer research among blacken. American Journal of Preventive Medicine, 55(5), S103-S111. http://dx.doi.org/10.1016/j.amepre.2018.05.028

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THIS IS A RESPONSE TO DISCUSSION BELOW, PLEASE USE APA & IN-TEXT CITATIONS. NO MORE THAN 200 WORDS.

  I was always taught in nursing school that pain is what the patient says that it is. We cannot feel what the patient is feeling, so we have to believe the patient and what they are telling us. “McCaffery defined pain as ‘whatever the experiencing person says it is, existing whenever he says it does’” (Huether &McCance, 2017, p.336). Pain effects each and every person differently. There are many different types of pain caused by many different diagnoses and issues. “Acute pain is transient, usually lasting seconds to days, sometimes up to 3 months. It begins suddenly and is relieved after the chemical mediators that stimulate pain receptors are removed” (Huether & McCance, 2017, p.340). When I think of acute pain, I think of getting a shot. A shot hurts while we are receiving the shot but is quickly relieved once the shot is over. “Visceral pain often radiates (spreads away from the actual site of the pain) or is referred. Referred pain is felt in an area removed or distant from its point of origin- the area of referred pain is supplied by the same spinal segment as the actual site of pain” (Huether & McCance, 2017, p.340). An example of referred pain would be left arm pain during a heart attack. Pain that is radiating away from the actual site of where the hurt is. “Chronic or persistent pain has been defined as lasting for more than 3 to 6 months and is pain lasting well beyond the expected healing time”(Huether & McCance, 2017, p.340). We hear of a lot of people struggling with chronic back pain. 

Pain can feel throbbing, stabbing, aching, burning, cramping, squeezing, etc. There are different factors that affect pain as well. “There are important age and sex differences in the clinical presentations of chronic pain patients. Some older patients present with unique clinical profiles that may reflect cohort differences, and/or physiological or psychological adjustment processes. There appears to be a greater number of distinct chronic pain presentations among females” (Cook & Chastain, 2001, para.5). Age and gender are just 2 factors that can affect pain and the way it is perceived. “In general, the prevalence of chronic pain has been found to be 50% or more among people aged 65 years or older” (Karjalainen, Saltevo, Tiihonen, Haanpää, Kautiainen, & Mäntyselkä, 2018, p.6). Different diseases that patients have can cause patients to have pain. Ethnicity can also be a factor of pain. If we think about sickle cell patients, it occurs more in African Americans and can cause pain during a sickle cell crisis. Age does not affect who can get sickle cell but can affect pain. Sickle cell presents at birth but usually patients do not have any issues until the age of 5 or 6. Another example would be having a tonsillectomy. Everyone states that the pain and recovery is so much easier on young children than in adults. These examples just go to show that everyone perceives pain differently depending on different factors like age, gender, ethnicity, and diseases. 

References

Cook, A. J., & Chastain, D. C. (2001). The Classification of Patients with Chronic Pain: Age and 

Sex Differences. Pain Research and Management, (3), 142. https://doi-org.ezp.waldenulibrary.org/10.1155/2001/376352

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, 

MO: Mosby.

Karjalainen, M., Saltevo, J., Tiihonen, M., Haanpää, M., Kautiainen, H., & Mäntyselkä, P. 

(2018). Frequent pain in older people with and without diabetes – Finnish community-based study. BMC Geriatrics, 18(1), 73. https://doi-org.ezp.waldenulibrary.org/10.1186/s12877-018-0762-y

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The Neuman System Model uses a systems approach that is focused on the human needs of protection or relief from stress (Neuman & Fawcett, 2009). Neuman believed that the causes of stress can be identified and remedied through nursing interventions. She emphasized the need of humans for dynamic balance that the nurse can provide through identification of problems, mutually agreeing on goals, and using the concept of prevention as intervention. Neuman’s model is one of only a few considered prescriptive in nature. The model is universal, abstract, and applicable for individuals from many cultures (Neuman, 1995; Neuman & Fawcett, 2009).  Neuman used concepts and theories from a number of disciplines in the development of her theory. In her works, she referred to Chardin and Cornu on wholeness in systems, von Bertalanfy and Lazlo on general systems theory, Selye on stress theory, and Lazarus on stress and coping (Neuman, 1995; Neuman & Fawcett, 2009).

In her work, she defined human beings as a “client/client system, as a composite of variables … physiological, psychological, sociocultural, developmental, and spiritual (Neuman & Fawcett, 2009, p. 16). Environment in the model represents the three environments, internal, external, and created environments, which influences the client’s adaptation to stressors. Neuman’s System Model in the nursing realm, is to maintain client system stability through accurately assessing environmental and other stressors and assisting in client adjustments to maintain optimal wellness. Neuman model consisted of  a three-step nursing process model in which nursing diagnosis (the first step), nursing goals as determined with the client and family (the second step), and lastly, nursing outcomes that confirm and evaluate the client’s healthcare goals. I have always look at the total picture when encountering individuals from a personal standpoint, professionally in the clinical setting, and in the community to address issues that constitutes the total person outside of the health/illness continuum.

Neuman’s System Care Model can be used in a practical setting where I work on the stepdown unit.While caring for a 67 yr old AA male who was post-op day1 prostatectomy with a hx of hypertension, diabetes, colon cancer, TIA, anxiety, and depression became symptomatic during shift change. The patient’s family called to the nurse’s station because he became weak and unable to ambulate back to his bed. Upon arriving to the patient’s room I found him sitting on the commode with c/o nausea and vomiting which is common after this type of surgery. With further assessment, I noted the client became diaphoretic and dizzy while attempting to stand. Vitals were stable at this time but I my intuition told me that something just wasn’t right.First thing that came to mind was that the pt vasovagal while trying to have a bowel movement. The Scip protocol was in place at this time, IV fluids infusing, foley in place with adequate urinary output noted, telemetry on with no ectopy noted. I told the family to call the nurse’s station to bring a wheelchair to the room to assist with transferring the pt back to bed. The patient had expressed to me that he was under a lot of stress due to  the lost of his mother, his second bout with cancer, and the financial strain he was under for being out of work for his health conditions. While attempting to place the patient in the bed he had another diaphoretic episode with generalized weakness. My intuition lead me to believe this patient was having an MI. I took an additional set of vitals, revisited the lab work, placed the pt on oxygen at 2 liter, and ordered a stat EKG. I viewed the EKG and noted an elevated ST segment and paged the cardiologist on call; while simultaneously informing the house supervisor of my findings. Within 10 minutes or less the client was in route to the cath lab for stent placement.

Re examining Neuman’s System Model, I was able to utilize the three step nursing process to 1.) identifying a nursing diagnoses that includes but not limited to: risk for decreased cardiac output, anxiety, activity intolerance, ineffective coping, risk for falls, nausea, and imbalanced nutrition just to name a few. 2.) Establishing patient/family centered goals that constitutes their beliefs, values,and  customs such optimizing cardiac output with stent placement, ensuring the client is hemodynamically stable, addressing nutritional status with the interdisciplinary team to ensue dietary requirements are met, providing counseling to assist with helping the client cope with his loses that internally and externally precipitated stress. 3.) Evaluation and clarification of the client’s outcomes. The patient underwent angioplasty with stent placement and was transferred to the ICU without incident. Neuman’s model allowed me to assess the patient from a holistic point of view that lead to favorable outcomes. The physicians, house supervisor, and staff was so impressed with my knowledge and skills that I received the Daisy’s Award for exceptional nurses that year. 

To this present day, that patient stills comes to the facility I work at to thank me for saving his life. Often healthcare professional become overwhelmed with the everyday task of the discipline that little signs such as nausea/vomiting goes unnoticed. The patient did not complain of pain at anytime during the assessment. Neuman’s model can be used in any nursing setting because it directly ties the patient to the nurse and the environment that are in constant motion either propelling towards health, where energy is conserved or towards illness that depletes the storage of energy. The clinical and critical skills I’ve acquired and taking an holistic approach while caring for patients and families allowed me to be present with the patient and family thus addressing his healthcare needs while optimizing his overall quality of health.

References:

McEwen, M. (2014). Theoretical Basis for Nursing, 4th Edition. [VitalSource Bookshelf version]. Retrieved from http://online.vitalsource.com/books/9781469899992

Neuman B, Fawcett J. The Neuman Systems Model. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2010.

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