Introduction
Using theories and theoretical models is an integral part of nursing practice. They contribute to the systematization of the nursing activity, guide research, and improve practice (McEwen & Wills, 2023). The purpose of the presentation is to consider grand theory, theoretical models, and mid-range theories that may apply to the advanced role of psychiatric mental health nurse practitioners (PMHNPs).
Specialists in this position provide a full range of primary mental health care services, including assessing and diagnosing patients and developing treatment (“Psychiatric/mental,” n.d.). PMHNPs can work in various settings—in communities, inpatient facilities, and emergency services (“Psychiatric/mental,” n.d.). They should develop competencies corresponding to their advanced role (“PMHNP,” n.d.). Applying theories from different levels helps to develop and apply the competencies required at each level, thereby advancing the nursing discipline.
Grand Nursing Theories
Human Becoming Theory
Rosemarie Rizzo Parse introduced a grand nursing theory called the Human Becoming Theory. It offers alternative approaches to understanding humans, health, and the environment by presenting them as united, not separate phenomena. The theory offers insights into human and becoming, whose relationships comprise three fundamental principles: meaning, rhythmicity, and transcendence (McEwen & Wills, 2023).
A human is seen as unique, choosing specific meanings for events and contributing to their health. Becoming, in turn, is the unification of human, living, and health, as well as personal values and priorities. Nursing is care practiced in relationships with a person in the process of becoming. Health is closely tied to the values and priorities people acknowledge and implement in their lives, as well as how their experiences are shaped. The theory distinguishes the following:
- Meaning. Humans assume that people can choose a meaning for a situation and that experiences acquired in the environment become the basis of humans’ understanding of reality.
- Rhythmicity. Manifested by the fact that the person and the environment are co-creating, following rhythmic patterns.
- Transcendence. Means that a person can go beyond self-established limits and change.
Such a holistic vision of human health and the environment allows for focusing on people’s experiences and the quality of life in which those experiences are formed, which is why the theory was chosen.
Human becoming theory can be successfully applied in the practice of PMHNPs, as its assumptions contribute to a deeper understanding of mental health. Given the importance of a patient’s experience, a specialist may include their assessment in diagnosis and treatment (Hart, 2018). Moreover, the theory suggests that health is closely related to life priorities and values.
Studying how the patient’s life aligns with established expectations can also inform the assessment of the condition and treatment. The theory aligns with my views, as I also attach great importance to the experience. Moreover, the approach suggests that people play a significant role in shaping their own fate and influencing their health. Understanding the importance of life control and making decisions is critical to mental well-being. In my advanced role, the theory will enable me to guide patients in making informed choices for a healthier life.
The Neuman Systems Model
In her systems model, Betty Neuman sees a person as a system in which sociocultural, spiritual, psychological, physiological, and developmental variables are intertwined. At the same time, a person exists in an environment that is divided into three levels: internal, external, and created (McEwen & Wills, 2023). Health is understood as the stability of a given system, which must be supported by defined variables and can be disturbed by stressors.
Variables determine which lines of defense in the system—flexible or normal—can be disturbed by stressors (McEwen & Wills, 2023). Maintaining all five variables is crucial to strengthening protection against stressors. Thus, the critical characteristics of the model can be distinguished—it indicates five dimensions necessary for human health, encompassing both physical and mental aspects. The model can be used for diagnosis, treatment, and preventive measures, which is why it was chosen.
The considered model may be helpful for both enhancing service provision and improving the working conditions of medical personnel. The systems model promotes a holistic approach to patients’ treatment. PMHNPs need to pay attention to external stressors affecting clients and their internal state to identify directions for work.
Moreover, PMHNPs’ critical competencies include improving the quality of services through refining work processes (“Psychiatric/mental,” n.d.). The Neuman model can be used to assess employee well-being (Idowu et al., 2022). This measure is necessary to support work efficiency and personnel retention. Thus, the model enhances patient experience and promotes practice quality in advanced roles.
Middle-Range Theory: The Comfort Theory
Comfort theory is a mid-range theory that draws attention to patients’ need for comfort. According to the theory, health disorders are stressful events; therefore, it is essential to provide comfort, including ease, relief, and transcendence (McEwen & Wills, 2023). Several contexts ensure the need for comfort, including sociocultural, environmental, psychospiritual, and physical.
Comfort reduces negative tension and improves cooperation between the patient and employees, contributing to better treatment results. The choice of comfort theory is justified because it is applicable in all areas of health care and promotes a patient-centered approach, significantly improving health outcomes. The key concepts of the theory include:
- The theory encompasses several key concepts that form the basis for its assumptions and are outlined in the conceptual framework.
- The staff assesses the patients’ comfort needs and develops interventions to address them, taking into account the intervening variables.
- The intervention promotes enhanced comfort, pushing for involvement in health-seeking behavior.
Subsequently, patients are more satisfied with the services and results, promoting institutional integrity. Comfort theory is helpful in the application and has been repeatedly proven by research. For example, a study by Duque et al. (2021) includes interviews with psychiatric unit staff who noted the importance of comfort.
According to the team, although it is often perceived as a sign of politeness, comfort significantly improves patients’ conditions. As a PMHNP, I can utilize Comfort Theory and its tools to clarify patients’ comfort and needs, educate them, develop treatments tailored to their comfort needs, and, as a result, enhance their health.
Informing Advanced Practice
The theories considered help inform the PMHNP’s practice and, simultaneously, overlap in certain aspects. They all contribute to a holistic approach to patients, highlighting the importance of the environment to their health. The human becoming theory considers the’ influence of experiences,’ which correlates with the’ effect of stressors’ in the systems model.
Comfort theory and the systems model distinguish similar directions for providing comfort or personal stability, with differences in the developmental variable present only in the model. The human becoming theory emphasizes the importance of quality of life to health, which can be seen as a correlation with comfort in the narrower perspective of Kolcaba’s theory. Thus, these theories guide practice in assessing patients’ experiences and support a better environment in several ways.
Conclusion
Thus, the use of theories is significant for the practice of advanced nurses. PMHNPs can apply different theories and models; examples of these include the human becoming theory, the systems model, and the comfort theory. They can serve as a framework for research, guide the approach to patient care, and contribute to improving workflows.
Several aspects correlate with each other, such as prioritizing practice activities. In particular, one can highlight a person’s experience and the importance of its influence, ensuring health in several dimensions and the essence of a favorable environment. Considering the identified factors will improve treatment outcomes and promote improvements in practice from the perspective of an advanced nurse.
References
Duque, M., Annemans, M., Pink, S., & Spong, L. (2021). Everyday comforting practices in psychiatric hospital environments: A design anthropology approach. Journal of Psychiatric and Mental Health Nursing, 28(4), 644-655. Web.
Hart, J. D. (2018). The living experience of suffering: A Parse method study. Nursing Science Quarterly, 31(2), 139-147. Web.
Idowu, O. A., Oyekunle, A. A., Fajemilehin, B. R., & Idowu-Olutola, O. M. (2022). Applying the Betty Neuman model to explain the relationship between workload as stressors and shift work disorder among nurses: A conceptual model. South Asian Research Journal of Nursing and Healthcare, 4(3), 41-44. Web.
McEwen, M., & Wills, W. (2023). Theoretical basis for nursing (6th ed.). Wolters Kluwer Health.
PMHNP track competencies. (n.d.). Indiana University School of Nursing. Web.
Psychiatric/mental health nurse practitioner (PMHNP). (n.d.). UCSF School of Nursing. Web.