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Discussion Board #3 Applying Nursing Theory to Practice
Post an initial posting of their own that is TWO or THREE paragraphs (250-275 words) and includes at least TWO scholarly references to support the posting. One of the references should be the TEXT BOOK McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer Health. And the other a scholarly, peer reviewed, article. References must be in APA Style (7th edition) and included at the end of both postings.
Follow the general instructions above. Prepare a response using one Case Study (below).
Briefly describe a theory that can be used to guide the patient’s care or address the situation
Can use any nursing theory: grand, middle, specific
Briefly explain your rationale and how it might be applied. Be specific in some nursing actions (Consider the Nursing Process: Assessment, Diagnosis, Outcomes/Planning, Implementation, Evaluation). Can use bullets.
Case 1: A Pediatric Nurse Practitioner (PNP) who manages three middle school health programs is told that a 14-year-old student came to the clinic intoxicated for the second time in a month. The PNP knows that there are substance use issues among the students and has concerns about meeting their needs. The PNPe wants to set up an intervention and educational program regarding teen drug and alcohol use.
Case 2. A 30-year-old woman arrives in the emergency department. The ED Clinical Nurse Specialist (CNS) diagnoses her with a drug overdose. The woman reports she took 25 diazepam tablets (2 mg/tablet), which her doctor had prescribed prn for stress. During the assessment the woman shares she has become depressed due to many factors in her life. She has three children (14 years, 4 years old, and 2 years old) and the father of her two youngest children is currently incarcerated; she lives with her parents but has been unable youngest children is currently incarcerated; she lives with her parents but has been unable to find work which is causing stress in the home. She feels alone and incapable of caring for herself and her children.
Case 3. A certified nurse midwife (CNM) volunteers to precept a CNM graduate student for clinical hours. Due to Covid-19 restrictions, limitations have been imposed on the hospital that are preventing a ‘normal’ clinical experience.
Case 4. As a master’s prepared public health nurse you make home visits to at risk clients. Mrs. Smith lives with her 85 year old husband. She recently sustained a hip fracture and is now home after surgery and rehabilitation. She is responding well to physical and occupational therapy. Mr. and Mrs. Smith are happy that the surgery was successful and are hoping that she will get back to “normal.” Mr. Smith states,” On good days she is able to ambulate alone with a walker around the house and showers and dresses herself with minimal assistance.” Before the fracture, Mrs. Smith visited members of her church who were unable to go out and was active in the local senior citizen group. When you arrive you observe Mrs. Smith sitting on the sofa with her head down. She tells you this morning was frustrating because she had difficulty putting on her shoes. She states, “I used to be able to do everything. Now it is harder and I am afraid that I will fall. I want to get back to normal, but I don’t think I will.”

You may use this example to guide your work, but not this case.
Example Case. A 52-year-old man is admitted to the hospital for uncontrolled hypertension for the third time in the past year. His BMI is 30 and reports smoking 4-5 cigarettes and drinking 2-3 beers a day. Each time he stopped taking his medications because he was “feeling good” and didn’t like how the medication made him feel low energy and lightheaded sometimes. The case management adult nurse practitioner (ANP) is considering current care and follow up care after discharge.
Example of an Initial Discussion Post with APA
Case Study 4: In the case of a 52 year old male patient who is admitted to the hospital for uncontrolled hypertension, I will be applying Orem’s Self-Care Deficit Nursing Theory to address this patients’ situation. According to McEwen and Wills (2019) this theory focuses on meeting the needs of the patients and the care that will be provided to ensure effective outcomes. Hypertension is one of the leading causes of morbidity and mortality and this patient needs to be adherent to care for overall improved quality of life and not only when he ‘feels good’ for the moment (Khademian et al., 2020). The concept of deviation from self-care requisites within the theory are applicable due to the health deficits within this patient’s disease process (McEwen & Wills, 2019). Uncontrolled hypertension whether from lack of knowledge or noncompliance is related to one not taking care of self in a proper manner (Khademian et al., 2020).
Assessment: Middle age, male, chronic hypertension, nonadherent, knowledge deficit, sedentary lifestyle, history, laboratory tests
Nursing Diagnosis: Self-Care Deficit r/t uncontrolled hypertension (this doesn’t have to be ‘official’ nursing diagnosis – just your conclusion following the assessment)
Planning/ Outcomes/Intervention:
Teach about the disease process, complications if poorly controlled or untreated: symptoms can be absent, but may present as HA, dizziness,
chest pain, blurry vision
Taking BP daily and reporting deviations, participate in exercise, alcohol/smoking education and/or cessation, appropriate written/printed handouts
Medication adherence, routinely & reporting of side effects/ adverse reactions to any particular medication – other medications can be tried
Social and support groups
Nursing visits, telehealth
Evaluation:
Blood pressure will remain within acceptable limits for patient, self care and knowledge will be appropriate mentally and physically
Patient will adhere to the medication schedule, follow up with HCP in 3 months and quarterly thereafter.
References
Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing & Midwifery, 8(2), 140-149. https://doi.org/10.30476/IJCBNM.2020.81690
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th Ed.). Wolters Kluwer Health.

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