Reply to at least two of your classmates by providing a description of how each group’s theory or model can be applied to a different Healthy People 2030 objective/topic that the original group did not examine. Ensure you include at least two scholarly sources in current APA style in your replies.

Discussion 1

Our group decided to select a shared theory in palliative nursing care written by Desbiens et. al (2011). The shared theory in palliative care is a comparison between Bandura’s social cognitive theory (SCT) and Orem’s conceptual model. Bandura’s SCT emphasizes the importance of observational learning and highlights the dynamic interaction between cognitive processes, behavior, and environmental factors in shaping human behaviors (Desbiens et. al, 2011). A key concept of this theory is self-efficacy, or in other words, the individual’s belief in their ability to successfully perform a task. Bandura theorizes that self-efficacy plays a crucial role in how much a person will invest in a task. Orem’s conceptual model outlines a theory that focuses on the idea that people have the ability and responsibility to care for themselves, but there are times where they face self-care deficits for various reasons. Nurses act as providers to bridge these deficits (Desbiens et. al, 2011). The shared theory proposes that based on Orem’s model, nursing interventions can lead to better palliative self-care behaviors for patients, physical/emotional support and overall better quality of life. It is linked to Bandura’s SCT since it proposes the nursing competence in palliative care leads to better interventions which support this self-care deficit.

Our group evaluated the pragmatic adequacy of this shared theory. As Fawcett proposes, pragmatic adequacy evaluates the extent of how well middle range theory is utilized in clinical practice, how nurses understand the full content of the theory, and how it should help move nursing action towards favorable client outcomes (Peterson, 2020). Nurses do need special training in palliative care as it is an ethical obligation for nurses to provide holistic integrated palliative care for patients (Parekh de Campos et. al, 2022). It requires unique skills to provide competence palliative care. Although this theory requires special education, it is not possible at this time to derive clinical protocols from the shared theory. Without adequate testing and rigor an established protocol would remain invalidated as described by Desbiens et al (2011). The continued evaluation of evidence in the growing profession of nursing is a key portion of maintaining professional standards both in theory and at the bedside (AACN, 2021). In addition, we found that this shared theory had not been used as a basis for nursing research yet. As described in the article empirical testing of this shared theory must be developed prior to its designation as relevant to palliative care nursing (Desbiens et. al, 2011). In the future this may become a validated model, as the work continues to generate interest. Granat et. al (2022) reference Desbiens et al (2011) in recent research on validation of a palliative care scale in Sweden. It is important to distinguish however that the article aims to examine the works of Bandura and not specifically the works of Desbiens et al (2011). The shared theory does indicate favorable outcomes from using the theory as a basis for nursing actions. The two favorable outcomes are more patient centered care and enhanced interdisciplinary collaboration. The Healthy people 2030 goal our group picked for this model is improved health and wellbeing for older adults.

The healthy people 2030 goal I chose to connect to the shared theory on palliative care competence is to reduce the proportion of adults with chronic pain that frequently limits life or work activities. The shared theory of palliative care described by Desbiens et. al (2011) is fundamentally aligned with reduction of debilitating chronic pain. The shared palliative care theory aides in the identification of self-competence and its relation to measurable outcomes modeled by Bandura viewed within the lens of Orem’s conceptual theory on self-care. Viewing the healthy people 2030 goal through this shared theory, one can identify their direct relation. In the setting of self-care deficit secondary to pain, an effective intervention is often educating individuals on the role of self-care to reduce pain related deficits. For instance, early ambulation improves post-operative healing, thus reducing pain for the patient; but without education via nursing many patients lack this self-competence and are unable to ambulate to reduce their pain.

Discussion 2

The theory chosen was the crisis theory and we aligned this theory with the Health People 2030 objective of health care access and quality. This objective was chosen as the lack of access to mental health care is a nationwide concern. The lack of quality care is related to an increase of mental health emergencies. Patient outcomes are negatively affected due to the lack of timely mental health services. 

Our group thoroughly reviewed severe and emergent mental illness situations and how the crisis theory relates to this clinical emergency. The crisis theory was assessed, evaluated, and connected to clinical practice. The theory was analyzed by determining the effectiveness and limitations that come with the crisis theory. The theory was then connected to Healthy People 2030 by relating the mental health crisis to the lack of resources the nation can provide for those suffering with mental illness. Our group also discussed how the tool can be appropriately used, by whom, and what goals our nation should meet to promote the well-being of those who cope with mental distress. 

When reviewing additional Healthy People 2030 objectives/topics I chose the goal to improve mental health. This objective clearly connects to the crisis theory, as the goal of the objective and the theory is to improve mental health. The expected or wanted client outcomes of improving mental health would be to see the crisis theory utilized as a tool in preventing mental health crisis and negative outcome from a mental health crisis. The theory should be used as a preventative measure, to assist those in learning healthy and effective coping skills. Nursing interventions should focus on prevention, screening, assessment, and treatment of mental health disorders (Mental Health and Mental Disorders – Healthy People 2030, n.d.). 

Examples of nursing interventions include: assessing the patient’s medical history and currently risk factors to a mental health crisis, assessing the patients cognitive abilities, reviewing the patients laboratory values and medication regimen, reorienting the patient, providing safety measures to prevent harm, assessing the patients current coping strategies, establishing trust and a therapeutic relationship, encourage therapy. Some examples of expected outcomes for improving mental health: the patient will recognize and implement healthy coping strategies; the patient will demonstrate effective coping strategies. Nursing interventions and expected outcomes will vary patient to patient depending on the nurse’s assessment, skills, and the patient’s needs.