For the nurses at San Antonio Community Hospital in Upland, Calif., nursing theory is not just an abstract concept they remember from their school textbooks. Over the last year, the quest for a unifying nursing theory has become a driving force throughout the facility, energizing staff nurses and administrators alike.
The hospital has never had a nursing theory in place, says Chief Nursing Officer Liz Aragon, RN, MHA, although the nurses do adhere to the hospital’s mission and values. But I wanted to have a framework for us to be able to guide some of our practices.
Aragon emphasizes that the search for a nursing theory was motivated by the desire to move nursing practice to a higher level, not because there was something inherently wrong with nursing care. We have an excellent nursing staff here, she says.
Unifying TheoryVeena Varghese, RN, casts her vote as others wait to make their voices heard. From left: Mary Lopez, RN; Maria Mananquil, CNA; Teri Combs, RN; Angelique Weathersby, RN; Linda Brown, RN; Roxanne De La Pena, RN; and Teri Van Fossen, LVN.
Having a single nursing theory to guide assessments, documentation, and patient care can improve outcomes and patient satisfaction, says Mary Lopez, RN, PhD, director of education and clinical research. While many other facilities have identified a unifying nursing theory as part of their Magnet certification process, achieving Magnet designation was not the impetus for San Antonio Community Hospital’s quest.
Rather than coming at patient care from lots of different angles, if we all approach the patient with one common framework, then we would speak a common language to each other, nurse to nurse, Lopez says. We would know what our outcomes would be in a common way. That is really the benefit of having one approach to patient care, rather than having all 500 nurses have a different view of the patient.
Lopez and Aragon made sure staff nurses were a crucial component of the journey toward choosing an overarching nursing theory. It has to come from the [staff] nurses because Liz and I can sit here and pick a theory and say, ‘This is what we’re doing,’ but if the nurses don’t embody it and act it out in their day-to-day workings with patients, then it’s just something in a book, Lopez says. So Lopez and Aragon formed a core group of staff nurses, as well as a few managers and educators, to guide the theory selection process.
The yearlong process started with a literature review of best practices for choosing a theory and continued with animated discussions about which theories best matched the hospital’s culture. The selection process also included analyses about how the nursing process would look from different theoretical perspectives. The core group then narrowed the choices to two nursing theories: the Roy Adaptation Model, developed by Callista Roy, RN, PhD, FAAN, and the American Association of Critical-Care Nurses’ Synergy Model.
The Roy Adaptation Model centers on how patients adapt to their environment, both internally and externally — how the patient adapts to the disease, how the patient adapts to the environment, how the patient and the nurse are adapting together to what is going on, Lopez explains.
Although AACN developed the Synergy Model, it can be used in any patient care setting. In that theory, the competencies of the nurse are matched to the needs of the patients. Together, the patient and the nurse create synergy to get the patient healthy, Lopez says.
The San Antonio Community Hospital nurses were animated in their pursuit of a unifying theory, from their heartfelt descriptions of what nursing means, written during the early stages of the selection process, to their enthusiastic lobbying for their choice during the voting stage, Lopez says.
Aragon credits Lopez with making the quest so exciting for the staff. Mary has the passion for this, Aragon says. She has helped make it come alive. She has engaged the nurses by asking these questions, bringing in their thoughts and values, helping them make the decision.
And the Winner Is
Ultimately the staff voted to implement the Roy Adaptation Model. But that doesn’t mean the journey is over. Now comes the real work, so that the nursing theory is not just a poster on a wall, but an integral part of the nursing process, Lopez says.
That means revising assessment forms, documentation standards, the patient care plan, etc. When you design your patient assessment, you design it with the goals of the theory in mind, Lopez says. So with the Roy Adaptation Model, all of our assessments are going to be, ‘How does the patient adapt to the environment?’ That also means incorporating the theory into any computer documentation, flow sheets, and other processes in place for daily patient care.
This philosophy and theory are going to be threaded through all the steps of the nursing process, as well as how we educate, train, and orient them [nurses], and then how we evaluate them, Lopez adds.
Eventually the theory will be part of the recruitment process as well, so that all new people coming into the organization know this is the approach we have, she says. And when we recruit nurses, we’ll let them know this is our philosophy even before they start working here, so that they know if they’re going to be a good fit for our organization.