Theoretical Framework of Advanced Practice Nursing

Brenan Cromeans

College of Nursing, University of South Alabama

NU 607: Scientific Underpinnings of Advanced Nursing

Dr. Jo Ann Watts

October 10, 2023

 POI and Theoretical Framework

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

person are discussed further in this paper.

Person

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

should not be omitted from medical treatment of an illness, it is equally important.

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

of difficulties, including a lack of dependable transportation and a lack of access to an adult

healthcare provider (2014). Sickle cell patients must be followed from pediatrics all the way to

geriatrics. Their access to healthcare facilities, transportation, as well as monetary expenses all

play a role in their care.

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

dealing with this chronic disease.

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).

Grand Nursing Theory

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

(Corderio et al., 2014).

Middle Range Theory

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

points, self-care maintenance, self-care monitoring, and self-care management. Self-care

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

science was developed as a theoretical framework in healthcare to better understand complex

situations (Kivilene & Blazeviciene, 2023).

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

such as nurses, primary care physicians, as well as specialists like hematologists.

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.
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