This post covers Nursing Theory Application, as detailed below.
Case scenario: Gina and Sue (Chapters 6, 7 and 8)
Gina graduated from an associate degree program in nursing and works on a medical-surgical unit. She is considering administrative positions and has returned to school for a BSN. Sue, a nursing student completing a clinical rotation on the unit, works with Gina caring for a client with a myocardial infarction and his family.
Chapter 6: When the client is rushed to the ICU with severe chest pain, Gina asks the wife if she is okay; the wife says “not really,” shaking and fighting back tears. Sue is uncomfortable and asks how Gina knew the family member needed help. Select one question: (1) Gina’s belief in nursing knowledge is based on “hard science.” Which primary process of knowing is it rooted in, and how are the three primary processes of knowing defined? Or (2) Why are the four concepts central to the discipline of nursing important to professional practice?
Chapter 7: The client is restless and unable to sleep in the middle of the night; Gina provides comfort and he falls asleep. (1) Using King’s systems interaction model, what is the purpose of nursing in this situation? (2) Using Neuman’s systems model, what is the purpose of nursing in this situation?
Chapter 8: The client is restless and complains of dull chest pain; Gina suspects angina and discusses with Sue what information to obtain. (1) What is the difference between critical thinking, intuition and reflection in addressing the chest pain? (2) Why is it important for nurses like Gina to use cognitive, interactive and patterning processes in clinical practice?
Person, environment, health, nursing
Goal attainment and system stability
Critical thinking, intuition, reflection
Model discussion post
Original example for study purposes. For Chapter 6, this response answers question 2.
Chapter 6: Why the Four Central Concepts Matter
The four concepts commonly accepted as central to nursing, person, environment, health and nursing, form nursing’s metaparadigm (Fawcett, 1984). They matter because they define what nursing is about and keep practice holistic. In this case, the “person” includes not only the client with a myocardial infarction but also his wife, whose fear and distress are part of the family’s experience of illness. The “environment” includes the sudden transfer to the ICU, the unfamiliar hospital setting and the family’s support system. “Health” refers to the client’s physical crisis and the family’s emotional well-being, and “nursing” is what Gina does: she notices the wife’s shaking, asks how she is and offers support. Without these concepts, a nurse might focus only on the cardiac emergency and overlook the family. They guide assessment, help nurses explain their unique contribution to the health care team and connect practice to nursing theory and research, which is why Gina recognized that the wife needed help.
Chapter 7: King’s Systems Interaction Model
King’s model views nursing within three interacting systems: personal (the individual’s perception, self, growth and body image), interpersonal (interactions, communication and transactions between people) and social (organizations such as the hospital). In her Theory of Goal Attainment, the purpose of nursing is to help individuals attain, maintain or restore health through a process in which the nurse and client perceive each other, communicate, mutually set goals and agree on the means to achieve them (King, 1981). In this situation, Gina perceives that the client is restless and unable to sleep, communicates with him to learn why (pain, anxiety about his heart, an unfamiliar environment) and they agree on a goal of rest. Her comforting actions, such as repositioning, reassurance, dimming lights and addressing his worries, are the transaction that leads to goal attainment: the client falls asleep, which supports cardiac recovery by reducing myocardial oxygen demand.
Chapter 7: Neuman’s Systems Model
Neuman’s model views the client as an open system protected by lines of defense and resistance and constantly interacting with stressors: intrapersonal (pain, fear), interpersonal (separation from family) and extrapersonal (noise, hospital routines). The purpose of nursing is to help the client retain, attain and maintain system stability through primary, secondary and tertiary prevention (Neuman & Fawcett, 2011). The client’s restlessness shows that stressors have penetrated his lines of defense. Gina’s comfort measures are secondary prevention: she identifies and reduces the stressors, strengthens his lines of resistance and restores stability, allowing him to sleep. Longer term, cardiac rehabilitation and education would be tertiary prevention to prevent another event.
Chapter 8: Critical Thinking, Intuition and Reflection
Critical thinking is purposeful, systematic reasoning that uses knowledge and evidence to analyze a situation and decide what to do. Gina uses it to assess the chest pain with a structured approach, such as onset, provocation, quality, region and radiation, severity and time (OPQRST), checks vital signs and an ECG, considers angina versus a new infarction and follows protocols such as giving prescribed nitroglycerin and notifying the provider. Intuition is the immediate, pattern-based understanding that experienced nurses develop without consciously reasoning through each step. Gina’s sense that “something is wrong” when the client becomes restless reflects intuition, described by Benner (1984) as a characteristic of expert practice. Reflection is looking back on an experience to learn from it, either during care (reflection-in-action) or afterward (reflection-on-action). After the episode, Gina and Sue might reflect on what cues signaled the angina, how well their interventions worked and what they would do differently. Together, intuition alerts the nurse, critical thinking confirms and guides action and reflection improves future practice.
Chapter 8: Cognitive, Interactive and Patterning Processes
Professional nurses like Gina need all three processes because clinical situations require more than technical knowledge. Cognitive processes involve knowledge, analysis and clinical reasoning, such as interpreting ECG changes and knowing the pathophysiology of angina. Interactive processes involve communication and relationships, such as asking the client open-ended questions about his pain, calming his anxiety and teaching Sue. Patterning processes involve recognizing patterns across data and experiences, such as noticing that restlessness preceded chest pain or that the client’s anxiety rises at night. Using all three helps Gina detect problems early, respond safely and individualize care, and it models professional practice for students like Sue.
References
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16(3), 84–87.
King, I. M. (1981). A theory for nursing: Systems, concepts, process. Wiley.
Neuman, B., & Fawcett, J. (Eds.). (2011). The Neuman systems model (5th ed.). Pearson.
If you choose Chapter 6, question 1: use your textbook’s exact definitions of the processes of knowing, since terminology varies by text. Knowledge based on “hard science” is generally associated with empirical knowing, which relies on observation, measurement and the scientific method. Cite your course textbook with page numbers.
Related reading: the metaparadigm of nursing, types of nursing theories and coronary artery disease case study.
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