NR 501 Week 7: Nursing Theory Applied to Research

I am currently pursuing the track of Family Nurse Practitioner and the area I am interested in is the cervical cancer screening (Pap smear). I consider the self-care deficit nursing theory, which is also know as The Orem’s Model of nursing, valuable in nursing practice and therefore I will apply it to the issue of cervical cancer prevention. This theory can be used in many areas of nursing practice. The self-care deficit nursing theory is a grand nursing theory that was established by Dorothea Orem, which extrapolates from the totality paradigm based on human beings being able to adapt to one’s environment.

An area of interest which I believe is important to the Family nurse practitioner track comprises the screening and recommendations for pap smear in the female population. Pap smear or cervical cytology is mainly associated with the purpose of screening for cervical cancer in women. Pap smear is important since it can detect high-grade variations in cervical cells. If undetected, cervical cells can modify to cancer cells which may bring fatal consequences to affected women. American Cancer Society recommendations that women should adhere to the guidelines to assist in early detection of cervical cancer. As an FNP, I am aware of how important is to follow all screening protocol and recommendations for a pap smear screening test. According to Weng et al. (2015) evidence-based practice encourages nurses to seek answers concerning ways to improve practice and thus can open nurses’ eyes to all the ways to improve patient outcomes. Evidence-based projects have been used as imperative ladders to evaluate the competence of nurses and can be used to drive quality and safety of care. While applying these scientifically proven practices there will be enhanced patient health outcomes, there will be also greater decrease of unnecessary procedures and complications that may risk the patient health status. Evidence-based practice encourages health care providers to seek responses.

According to Evsen & Gülsen (2013) self-care theory incorporates self-care, self-agency, and therapeutic self-care demand, as well as self-care requirements. Self-care is assumed by persons to improve life, and well-being. Self-care requirements are actions needed to preserve the level of well-being or health. Self-care agency is recognized as the power of persons to direct self-care, and it reflects a person’s capacity. Self-care has components reflecting the importance of skills, attitudes and knowledge. Also, self-care agency is influenced by the environment.

The Orem’s Model of nursing is relevant in the area I have selected because the main focus in primary care should be preventing actions and empowering the possible affected population, in this case women to take responsibility for their own health outcome. It is of paramount importance to influence women through health education, so they will have the will to prevent cervical cancer or treated promptly and prevent serious complications that may affect their health status or even provoke death. If we as Family nurse practitioner’s base cancer screening actions on Orem’s theory, and use the point of view that all women once they have the right tool to make informed decisions such as proper health education on cervical cancer screening and prevention, they will have the power to care for themselves accordingly. In Primary care, I believe prevention is the tool to keep our population healthy and free of diseases.

According to MacGill (2017) the focus of women’s health is reproductive health and the prevention and treatment of diseases that are specific to women. Women’s health nurse practitioners (WHNP) provide healthcare to women across the lifespan. WHNP work with patients at the onset of puberty through their advanced years and provide healthcare, prevention of disease, and services aimed at promoting health. Women’s health nurse practitioners (WHNP) is a specialty track that is important since it follows the entire lifespan of women’s health, addresses the many different health issues that are unique to women, provides both acute and chronic care as well as counseling and preventive services. It is necessary for women to receive education on the need for the Pap smear which is a screening test.

According to Korfage et al. (2012) the Pap smear detects changes in cervical cells before they change to cancer cells and therefore it is imperative that all women should commence cervical cancer screening at age 21. The Pap smear test should be done every 3 years for women aged 21 to 29 years. Pap smears should not be performed on women under the age of 21 or women who have previously had hysterectomy for non-cancer disease. The Pap test entails extraction of the cervical cells and then testing them under the microscope. Majority of patients set to undergo a Pap smear test feel ashamed, pain, inconvenience and nervousness during the screening procedure. This area of interest is very important as it enables providers to determine the presence of cervical cancer before onset.

According to Rasul et al. (2015) the four main themes that are relevant to a Pap smear include conflict, belief, awareness about cervical cancer screening, and socio-cultural factors. Patients are mostly at conflict regarding whether to take a Pap smear or not and most patients are hesitant to take the test. Beliefs include health related beliefs and cervical-cancer related beliefs. Beliefs are imperative elements of decision-making. Appropriate awareness is necessary to promote the willingness of individuals to take a Pap smear. Socio-cultural include supportive family, spirituality, role of mass media among others, which all influence the decision to take a Pap smear test.

According to Frellick (2015) the updates by American Colleague of Gynecologist (ACOG) recommends changes in screening and prevention of cervical cancer. These recommendations include the role of screening with human papillomavirus (HPV) testing alone. Cytology testing should be encouraged for women aged 21 to 29 years. Screening with Pap smear alone every 3 years is acceptable according the guidance by ACOG. ACOG recommends against annual testing. The American College of Obstetricians and Gynecologists (ACOG) recommends cytology testing alone every 3 years for women aged 21 to 29 years. Co testing with cytology and HPV testing every 5 years is recommended for women aged 30 to 65 years. The solution to promote women’s health and prevent cervical cancer, is for societies that deal with women’s health to revise their full set of guidelines and promote coverage

I think the selected theory, Orem’s Model of nursing may be used to guide the resolution of empowering women regarding the need and importance of the Pap smear, through the provision of health education geared towards the elimination of certain beliefs, socio-cultural factors and increase consciousness of the importance of Pap smear and all consequences that may take place health wise, if there is not cervical cancer screening and prevention. Therefore, it is of crucial importance to get the involvement and receive support from family and the media.

I can recall an example from my personal experience as registered nurse. While I was working in a clinic as an RN, we were attending to a patient who was 38 years old, who was diagnosed with Cervical intraepithelial neoplasia (CIN III), unfortunately due to a mixture myths and misconceptions on Pap smear. She thought Pap smear was done to detect STD and she argued she had only one sexual partner, so she did not need to have this test done. After provided information, this patient finally consented to have the Pap smear done and this was the result we found. If the Orem’s Model of nursing had been used, this patient would have had the proper information to make the right decision on time to prevent many complications affecting her health as well as her finances. The importance of health education plays a key role in patients like this one in this example to make informed decisions regarding their health status and she would definitely have been empowered to have self-care in order to improve and maintain life, and well-being.

Reference

Evsen, N., & Gülsen, E. (2013). The Prevention and Reduction of Postpartum Complications: Orem’s Model. Nursing Science Quarterly, 26(4), 360-364. DOI: 10.1177/0894318413500402.

Frellick, M. (2015). Updated guideline on cervical cancer screening issued by ACOG. Retrieved from https://www.medscape.com/viewarticle/856431 (Links to an external site.)

Korfage, I. J., van Ballegooijen, M., Wauben, B., Looman, C. W. N., Habbema, J. D. F., & Essink‐Bot, M. L. (2012). Having a Pap smear, quality of life before and after cervical screening: a questionnaire study. BJOG: An International Journal of Obstetrics & Gynaecology, 119(8), 936-944.

MacGill, M. (2017). Gynecologists: What do they do and what should I expect? Retrieved from https://www.medicalnewstoday.com/articles/288354.php (Links to an external site.)

Rasul, V. H., Cheraghi, M. A., & Moqadam, Z. B. (2015). Influencing factors on cervical cancer screening from the Kurdish women’s perspective: A qualitative study. Journal of medicine and life, 8(2), 47.

Weng, Y. H., Chen, C., Kuo, K. N., Yang, C. Y., Lo, H. L., Chen, K. H., & Chiu, Y. W. (2015). Implementation of Evidence‐Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan. Worldviews on Evidence‐Based Nursing, 12(1), 22-30.

I have learnt to appreciate this course and I am trying to fully comprehend the theories, so I will be able to utilize them during my daily clinical practice, When I graduate and practice caring for patients as family nurse practitioner, all actions I carry out during clinical practice to prevent diseases, promote health and maintain individual’s good health status will be based on evidence-based criteria.

According to Evsen & Gülsen (2013) self-care-agency is defined as the personal power to lead self-care, and it reflects an individual’s capacity. Self-care agency has components reflecting the significance of skills, attitudes and knowledge.

According to Pickens (2012) there are basic conditioning factors that affect Self-care agency as well as self-care. Self-care is described as activities put in place by individuals to make better choices, which allows them to commence, sustain and accomplish care on their own behalf which will have as its final result the maintenance of life, health, and well-being.

According to Pickens (2012) self-care is the fundamental and main concept of the self-care theory. Self-care agency is defined as the enhanced ability to meet one’s ongoing requirements for self-care; it is the human aptitude to perform specific type of actions.

According to Sousa (2002) self-care agency is a person’s competences to distinguish his or her requirements, to appraise personal and environmental resources, to determine and achieve self-care activities to attain a desired result.

According to Pickens (2012) self-care agency is labeled as having three kinds of personal characteristic components: foundational, enabling, and operational. Foundational characteristics comprise personal competences concerning sensation, perception, memory, and orientation. Any disturbance in one of these competences disturbs one’s intentional actions. Enabling characteristics are the self-care agency’s power components comprising the specific personal competences involved in self-care, such as knowledge, self-care skills, health value, energy, mobility, enthusiasm, decision-making, interpersonal skills, perseverance, and determined goals. Individual and basic environmental conditioning aspects impact self-care agency as well as selfcare needs.

The level of self-care agency will determine the capabilities one will have about their health, health issues or stressful situations. Also, looking at self-care agency from the health care provider point of view, the level of self-care agency healthcare providers undertake will also regulate their skills to manage clinical practice situations, and stressors. The environment will also influence self-care agency, because if there is readily available information within the environment, the individual will have the opportunity to acquire the necessary knowledge which will empower this individual to carry out certain types of activities.

Reference

Evsen, N., & Gülsen, E. (2013). The Prevention and Reduction of Postpartum Complications: Orem’s Model. Nursing Science Quarterly, 26(4), 360-364. DOI: 10.1177/0894318413500402.

Pickens, J. (2012). Development of self-care agency through enhancement of motivation in people with schizophrenia. Self-Care, Dependent-Care & Nursing, 19(1), 47–52. Retrieved from https://static1.squarespace.com/static/55f1d474e4b03fe7646a4d5d/t/55f35f1de4b0fb5d95ae3a21/1442012957855/Vol19No01Fall2012.pdf (Links to an external site.) Sousa, V. D. (2002). Conceptual analysis of self-care agency. Online Brazilian Journal of Nursing, 1(1), 3-12. Retrieved

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