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Application of Non-Nursing Theories to Clinical Practice

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jenna hunter

on 27 February 2015

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Transcript of Application of Non-Nursing Theories to Clinical Practice

"Ultimately, the value of any nursing theory, is its ability to extend the discipline and science of nursing. "
"The theories approach health and nursing through many lenses - body systems,interpersonal relationships, behaviour, cultural safety, self-care, goal attainment, science of caring and many more. In the context of modern day practice, the way we nurse is most likely a blend of more than one theory as we adapt our nursing practice to our own work environment, our specialty, our experience, our patient/client type, our gender, our social background, personality, and education (Jones, 2014, p. 56)"
Why choose Erikson & Bandura?
Albert Bandura
As a psychologist,
Bandura's theory
finds it's roots not in
nursing, but in
psychology; exploring
the relationship between
the internal, patient-
centered aspect and the
external environment.
"Bandura's social learning theory
was based on the concept of reciprocal determinism
and concerned with the social influences that
affect learning (McEwen & Wills, p. 399, 2013)."
Origin of Erikson's
Developmental Theory
"Psychodynamic theories attempt to explain the multidimensional nature of behavior and understand how an individual's personality and behavior interface. They also provide a systematic way of identifying and understanding behavior (McEwen & Wills, p. 307, 2013)".
Key Concepts from Erikson's Psychosocial Theory
We grow through each of Erikson's eight stages
In each stage we face a crisis
We can solve each problem faced throughout the stages well or poor
Challenges faced poorly will be faced in later stages
In each stage there are positive characteristics we hope to gain
Stages grow in complexity
Application of Non-Nursing Theories to Clinical Practice
Integration of Non-Nursing Theories
By: Jenna Aldrich, Jennifer Tarsia,
Kasey Whelan & Nikeisha Willis

Key Concepts from Bandura's Social Cognitive Theory
Theories in a Situation
Theory Specific Diagnosis
Risk for disturbed personal identity r/t psychosocial development

Risk for ineffective relationship r/t behavioral adaptation of poor models
Erikson's Psychosocial Development- Interventions
Bandura's Social Cognitive Theory- Interventions
Needs Research
Erikson's Theory-
According to Erikson if a stage is not completed it will be faced again. What happens when multiple stages are not completed? What happens when this patient is faced with being a first time parent and still has crisis of their own on top of taking care of a newborn.

Bandura's Theory
- According to Bandura we learn from observation from models and we adapt/copy the things we learn. What happens when we have a mixture of behaviors from our models? How do we cognitively pick the one we copy? What if a nurse shows you their way to breastfeed and then a patients mother shows the patient the way in which she believes. How does the patient pick between the two models?
Provide needs, consistent care and provide reassurance to infant (watch tone of voice)
Early Childhood-
Keep parents involved in child's care/education, answer questions openly , encourage self care
Play Age-
Specific areas for play, parents involved, schedules repetitive without complexity, specific roles for each child
School Age-
Encourage interactions amongst each other, encourage participation/help, reassurance of work/tasks well done
Provide and respect privacy, support independence, be open to converse concerns with them, discuss the options for the future
Early Adulthood-
Provide respect, help them feel important, incorporate ways to avoid isolation options, interact amongst others
Keep active, see what they are proud of thus far
Old Age-
Answer all questions, discuss the good and exciting things that happened in their life, show they have meaning, respect, dignity, and continuous care, interact with others

We learn through observation
We learn through modeling the people around us
We learn through imitating the people around us
Individuals being observed are the models. These could be parents, teachers, health care providers, coaches, and peers
A 4 year old child is observed on the camera at day care being well mannered, respectful to teachers, and following the rules/schedule/tasks of the day. This child likes to play alone, not share toys, and always be the leader of activities.

His parents and siblings are very well mannered, polite, and follow the rules of the school- according to Bandura's social cognitive theory he observes and copies behavior from his family
According to Erikson he is in the Early Childhood stage and is facing his initiative/guilt crisis well
Demonstrate continuous care, respect, dignity, morals, proper communication amongst others, friendliness, caring, demonstrate right and wrong behavior,and be open for communication/discussion.

Can provide education handouts, incorporate games, and rewards when needed.

Allow autonomy in care.
Retrieved from http://www.psychologynoteshq.com/wp-content/uploads/2012/03/erikerikson.jpg
Retrieved from http://www.learn.ppdictionary.com/eriksons.png
Retrieved from http://zanl13.files.wordpress.com/2011/10/social-dev1.gif
McLeod, S. (2013). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html

Johnson, K. D., & Winkelman, C. (2011, March). The effect of emergency
department crowding on patient outcomes: A literature review. Lippincott Nursing Center, 33(1), 1-10. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=1125043

Jones, S. (2014). Putting theory into practice. Australian Nursing & Midwifery Journal,
21(11), 56.

Lenz, R. E., Shortridge-Baggett. (2002). Self-Efficacy In Nursing: Research and
measurement perspectives. Springer Publishing Company. New York, New York.

McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing (4th ed.).
Philadelphia, Pa: Lippincott Williams & Wilkins.

McLeod, S. (2011). Bandura Social Learning Theory. Retrieved
from http://www.simplypsychology.org/bandura.html

McLeod, S. (2013). Erik Erikson. Retrieved from

Retrieved from http://jekscience.blogspot.com/2013/03/social-

Retrieved from http://www.learn.ppdictionary.com/eriksons.png

Retrieved from http://www.psychologynoteshq.com/wp-content/

Retrieved from http://zanl13.files.wordpress.com/2011/10/

The Complete list of NANDA Nursing Diagnosis. (2014). Retrieved
from http://kc-courses.com/fundamentals/week2process/
McLeod, S. (2011). Bandura Social Learning Theory. Retrieved from http://www.simplypsychology.org/bandura.html
Retrieved from http://jekscience.blogspot.com/2013/03/social-cognitive-theory.html
The Complete list of NANDA Nursing Diagnosis. (2012). Retrieved from http://kc-courses.com/fundamentals/week2process/nanda2012.pdf
McLeod, S. (2011). Bandura Social Learning Theory. Retrieved from http://www.simplypsychology.org/bandura.html
McLeod, S. (2013). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html
Mc Ewen & Wills , p.127, 2013
Some may find a combination of several different theories may be the best route to cultivating our best nursing practice.
Here, we discuss Erikson's Psychosocial Development Theory, and Bandura's Social Learning theory.
These two non-nursing theories assist
nurses with two of the most important
aspects of nursing; knowing and understanding
your patient, and teaching. Besides serving as a
model for growth and development, Erikson's psycho-social theory provides nurses with a glimpse into the ego; allowing for an improved fostering of nurse/patient relationships. In addition to establishing a trusting relationship with patient's, a nurse's most critical role is teaching. Bandura's theory on teaching through demonstration, observation and returned
performance helps aid nurses not only with the teaching, but with determining proper nursing interventions (McEwen & Wills, 2013).
Social Learning Theory
Similar to those demonstrated in the nursing field, Bandura recognized three dynamic meta paradigms relative to learned behavior.
"Social Cognitive Theory represents a triadic reciprocal causation model in which the behavior of a person, the characteristics of that person, and the environment within which the behavior is performed are constantly interacting (Lenze & Shortridge-Baggins, p. 9, 2002)".
"The primary purpose theory in
nursing is to improve practice and
thereby positively influence the health
and quality of life of persons, families, and communities. In nursing, there should be a
reciprocal relationship between theory and
practice." (McEwen & Wills, 2014, p. 413
Applying theory to my clinical practice has increased my use of current literature and research findings. An example would be our emergency departments current increase in boarded inpatients. By investigating current research and literature findings, we were able to find out improved ways of taking care of these admitted inpatients in the emergency department setting.
"The effect of ED crowding on patient satisfaction levels, medication administration delays, and mortality is well documented. Studies demonstrate that quality of care is being impacted during crowding, resulting in delays in treatment and medication administration, reduced patient satisfaction, and even death. Unfortunately, ED crowding is a complex problem with no foreseeable solution. Therefore, ED practitioners and administrators need more information about how to provide quality care despite ED crowding.'' (Johnson & Winkelman, 2011, p. 7)
Some of our improvements were upstaffing hold nurses,
collaboration with inpatient physicians, and frequent
leadership rounding of these inpatients for better outcomes and we continue to monitor for further improvement.
By applying theory to daily clinical
practice helps us evaluate and approach patient care.

Example would be providing discharge instructions to a patient requiring incentive spirometry at home status post rib fracture. By applying Bandura's Theory, I understand the patient providing return demonstration of appropriate use deems my instruction successful.
Another example would be the assessment of an infant in the clinical setting. The nurse must understand Erikson's Psychosocial Development Theory in order to identify that the infant is in the trust vs. mistrust age, and assessment may be difficult.

It should be noted that in order to provide safe, effective, and quality care, nurses must have an understanding of theoretical frameworks that they apply to every day practice. Theoretical backgrounds not only allow nurses to implement plans of care, but understand why these plans of care are implemented. We as nurses have a responsibility to our patients to continue to educate ourselves with research studies and literature as it may relate to our current scopes of practice, and beyond.
Concepts of Bandura in Labor and Delivery
First time parents observe nurses and family when learning how to care for their newborn
Nurses are seen as models
Family members with children are seen as models
Siblings observe the newborn and may model the newborn or more attention
Mothers that breastfeed will observe the positions the nurse guided them into and then will try on their own
At times patients in labor with their first child will model the stories they have been told by friends and family because they think that those actions are what is suppose to happen
Concepts of Erikson in Labor and Delivery
We see all stages between the patients and their families
Each patient may be in a different stage than your previous patient
Once a patient delivers we are focused in on more than one stage- newborn, mother, and father
We can help patients face their current crisis. Provide encouragement, reassurance, and education
In his theories, Erikson uses developmental
stages, and what he perceives to be their
greatest corresponding conflict,
as a way to assess the person's ability to cope.
In doing so, Erikson's theory also contributes
supports the modern demands of
furthering the definition related to
the nursing metaparadigm
Some theorist believe this wording should be changed to
"quality of life"
It can be said this theory, although rooted in psychology, is closely related to the environmental nursing meta paradigm; offering an in-depth look not only at a patient's surroundings, but their interpretation and use of them.
"Environment typically refers to the external elements that affect the person;internal and external conditions that influence the organism; significant others with whom the person interacts; and an open system with boundaries that permit the exchange of matter, energy and information with human beings...
A multilayered view of the environment encourages understanding of an individual's perspective and immediate context and incorporates the sociopolitical and economic structures and underlying ideologies that influence reality
(McEwen & Wills, p. 42, 2013)".
Erikson developed his theory in the 1970's as a response on further developing Freud's work on the ego, super ego and the id.
Similar to Bandura, Erikson's theory also closely correlates to the environmental metaparadigm of nursing.
"In Erikson's theory, specific stages of a person's life from birth to death are formed by social influences that interact with the physical/psychological maturing organism (McEwen & Wills, p.310, 2013)
"Quality of life better encompasses a holistic perspective, involving physical, psychological, and social well-being as well as the spiritual and environmental aspects of the human experience (McEwen & Wills, p. 42, 2013)"
In using this definition to assess health, both Bandura and Erikson's theories support a broader interpretation of both the environmental and health metaparadigms. Using these theories allow us a more thorough look at our practice and it's efficiency.
Concepts that apply
to the Pediatric Nurse:
Understanding the stages
of psychosocial development
helps with communication with
the pediatric patients.
Application of the stages of psychosocial development helps with analysis of patient's symptomatic behavior.
Knowledge of the developmental
milestones allows nursing to identify
risks and make appropriate interventions.
Social learning theory has
been applied to the understanding
of aggression and psychological disorders; particularly in the context of behavior modification.
It is also the theoretical foundation for the technique of behavior modeling which is used in many training programs.
Areas that need future refinement in nursing practice:
Use of a Care Plan
; supposed to be used to provide care that's appropriate for an individual patient.
Patient and Parent education;
general understanding of self and others can help with teaching.
belief that one has the power to produce that effect by completing a task or activity.
Intrinsic Reinforcement;
form of internal reward, such as pride, satisfaction, and self accomplishment.
Expanding knowledge
through observational
learning via the use of a live
or verbal
instructional model.
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