Cromeans J Breanan NU-607-818 Theoretical Underpinnings
Cromeans J Breanan NU-607-818 Theoretical Underpinnings
Cromeans J Breanan NU-607-818 Theoretical Underpinnings
Brenan Cromeans
Nursing theory is a complex subject that may be very difficult to understand and explain.
Nursing theory provides the necessary outline to deliver a structured view and explanation of
phenomena, which guides nursing practice. (Butts & Rich, 2022). Advanced practice nurses use
nursing theory to provide quality care while solving patient problems using scientific data and
personal experiences. The phenomenon of interest of this paper is sickle cell disease in African
Americans. The advanced practice nurse can apply nursing theory to obtain a better
understanding of the POI and interventions available to provide accurate care for patients with
the disease. The primary objective of this paper is to explain nursing metaparadigm, grand
nursing theory, middle range theory, and complexity theory in relation to sickle cell disease in
African Americans.
Nursing Metaparadigm
Jacqueline Fawcett introduced the four concepts of the nursing metaparadigm as person,
environment, health and nursing (“Metaparadigm Concepts in Nursing,” 2023). Fawcett believed
that metaparadigm is the most theorized set of concepts for the discipline of nursing including
human beings, environment, health and nursing. (Butts & Rich, 2022). Fawcett believed that
these four concepts were explained within three common themes. The first theme was explained
by the connection between the person and health. A person’s health, rather good or bad, affects
one’s behavior. Another theme is the effect of an environment on a person and their health. The
environment of a person directly affects a person’s health rather good or bad. Lastly, the third
theme can be described as nursing and its effects on a person’s health and well-being. (Fawcett,
1984). The four concepts of the nursing metaparadigm and how they relate to the POI of this
A person is made up of many opponents, not just physically but also emotionally. To
accurately treat a person a holistic approach must be applied. According to Fawcett, personal
theories are concerned with understanding, encountering, and representing the authentic self
(2003). To accurately treat a person with sickle cell disease the advanced practice nurse must
understand the physical disease as well as the mental and emotional strain the disease causes the
patient. The mental well-being of a patient with sickle cell disease must be considered when
treating the patient. The patient needs to be in a state of mental well-being to make accurate
medical decisions about their health. Most sickle cell patients suffer with depression, anxiety,
social withdrawnness, and poor relationships (Anie, 2005). People seek out medical care during
emotional times in their lives, sickle cell patients tend to always be in a state of emotional stress
due to the painful episodes caused by this debilitating disease. The APN should take this into
consideration when treating a sickle cell patient so the physical disease can be treated as well as
the emotional turmoil the disease causes. It is important to understand that patient centered care
Environment
Nightingale believed that a patient’s environment played a key role in the productiveness
of their healing. A person must have a positive environment to prompt their best well-being. The
effect of a person’s social determinants of health in their environment must be considered during
treatment (Thorne et al., 1998). In a rural community, a patient with sickle cell is limited to
usually just a primary care provider. Hematologists are few and far between in rural
communities. According to Mennito, patients in rural locations may face an even larger number
geriatrics. Their access to healthcare facilities, transportation, as well as monetary expenses all
Health
The focus of nursing practice is to bring the patient back to optimum health. This is
achieved through the nursing process. The nursing process guides the nursing practice to assist
the patient in reaching their maximum health potential. Patient education as well as screenings
and preventative care all play a major role in overall health outcomes. Sickle cell patients must
be educated on the importance of routine medications, blood work, and health maintenance when
Nursing
Patient centered care is what nursing is all about. Nurses strive to provide care to the
whole patient and not just the diagnosis. Providing patient centered care to sickle cell patients
aids in the patient’s ability to reach optimum health. Nurses aid in patient recovery and
maintenance while providing support and care to combat the effects of an illness (Thorne et al.,
1998).
According to Butts & Rich, grand theories are broad theories that are less concrete and
specific. They are the starting point for nursing theories because more detailed theories are
usually developed from them (2022). A grand nursing theory that correlates with this POI topic is
Dorothea Orem’s Self-Care Theory. Orem’s theory is broken down into three different parts
which include, the theory of the nursing system, the self-care deficit theory, and the self-care
theory. Orem’s theory describes the patient’s ability to provide care for themselves as well as
describing how the nurse can provide prevention of disease related illnesses, health maintenance,
and recovery (Leal et al, 2019). Sickle cell disease is a chronic illness meaning that it will be a
part of the patient’s life forever because there is no cure. Therefore, sickle cell patients must
learn how to provide self-care and it is the nurse’s job to provide the patient with education on
how to care for themselves outside of healthcare facilities. Knowing how to care for sickle cell
disease will limit readmissions to hospital and overutilization of emergency services by these
patients. Patients with sickle cell disease must build a new “normal”. They must take control of
their disease outside of medical institutes and this includes learning the proper diet,
understanding periodical studies, and learning daily medications needed to control their disease
A middle range theory that correlates with the POI topic discussed in this paper is
Barbara Riegel’s Theory of Self-Care and Chronic Illness. Riegels theory focuses on three major
maintenance is defined as the behaviors a chronically ill patient uses to promote physical and
emotional steadiness. Self-care monitoring refers to the signs and symptoms a chronically ill
patient knows to look for. Self-care management refers to the actions taken by the individual
once a change in signs or symptoms of their illness occurs. (Riegel et al., 2012). Self-care
maintenance, monitoring, and management are all aspects that should be taught to sickle cell
patients. If the nurse can utilize this theory while caring for the sickle cell patient, positive
changes in their overall health will correlate. Sickle cell disease brings episodes of acute pain
syndrome, stroke, MI, and other emergency medical conditions (Reis et al., 2021). If Riegel’s
theory is put into practice when caring for these patients these emergency episodes can be greatly
reduced.
Complexity Theory
Complexity science is a developing concept that is being integrated into the healthcare
literature as a new approach to view clinical care and healthcare organizations (Butts and Rich
2022). Complex adaptive systems (CAS) are ever changing systems that adapt and evolve with
their environment. CASs related to healthcare can include both organizations and organisms.
Practicing as a nurse often leads to complex situations, as well as complex diseases. Complexity
Understanding complex science in relation to the key role of nurses in the healthcare
environment can improve nursing work. Understanding the environmental effects on sickle cell
patients can greatly influence the care provided by the medical team (Olsson et al., 2020).
A CAS within the POI of this paper could be the wide-ranging healthcare team needed to
care for sickle cell patients. This large healthcare team must be able to grow, adjust, and perform
tasks to care for patients holistically. Sickle cell patients call for multiple health care providers
Conclusion
Using nursing theory and complexity sciences, advanced practice nurses can provide
effective and sympathetic nursing care to patients with chronic illnesses like sickle cell disease.
Nursing theory provides an outline for healthcare professionals to continue to adapt to better
health care practices and provide optimum patient care. Complexity science and nursing theories
provide evidence-based practices needed to provide accurate patient care for chronic illnesses.
References
com.libproxy.usouthal.edu/eds/detail/detail?vid=3&sid=9e5fbfe0-ea96-4b9f-89b5-
e15f18340402%40redis&bdata=JnNpdGU9ZWRzLWxpdmU
Fawcett, J. (2003). Orem's self-care deficit nursing theory: actual and potential sources for
Thorne, S., Canam, C., Dahinten, S., Hall, W., Henderson, A., & Kirkham, S. R. (1998). Nursing
1257-1268. http://doi.org/10.1046/j.1365-2648.1998.00623.x
Mennito, S., Hletko, P., Ebeling, M., Amann, L. A., & Roberts, J. (2014). Adolescents with sickle
cell disease in a rural community are they ready to transition to adulthood. South Med
J, 107(9), 578-582.
Leal Lacerda, F. K., Ferreira, S. L., Rosendo do Nascimento, E., Oliveira Costa, D., & Cândida
Cordeiro, R. (2019). Self-care deficits in women with leg ulcers and sickle cell
org.libproxy.usouthal.edu/10.1590/0034-7167-2018-0005
Hartweg, D. L., & Pickens, J. (2016). A Concept Analysis of Normalcy within Orem’s Self-Care
Cordeiro, R. C., Ferreira, S. L., & da Cruz Santos, A. C. (2014). Experiences of illness among
individuals with sickle cell anemia and self-care strategies. Acta Paulista de
Enfermagem, 27(6), 499–504. https://doi-org.libproxy.usouthal.edu/10.1590/1982-
0194201400082
Reis de Sousa, A., de Jesus, A. C., de Andrade, R. C. S., de Almeida Lopes, T. F., Jenerette, C.
M., de Santana Carvalho, E. S., & Pereira, Á. (2021). Being a man with sickle cell
disease: discourses about falling ill and self-care. Acta Paulista de Enfermagem, 34(4),
1–8. https://doi-org.libproxy.usouthal.edu/10.37689/actaape/2021AO03384
Kiviliene, J., and A. Blazeviciene. “Review of Complex Adaptive Systems in Nursing Practice.”
www.extrica.com/article/21169.