The change of america healthcare system aims to progress and improve the quality of medical delivery and patients' health (Krist). Preventive treatment is a substantial aspect of the transformation of healthcare. Cancers remains a top source of the amount of deaths in the United States, although colorectal cancers (CRC) is a preventable disease. The avoidance requires consistent utilization of testing methods as suggested (Spruce). Vast amount of research has extended to establish that CRC testing greatly reduces the event of and fatality from CRC. There are a number of interventions for medical providers to work with that help improve the rates that patients will abide by screening, but eventually health-promoting and preventive activities are a shared responsibility between both patient and doctor. For the expected goal of raising CRC screening process rates to occur, providers should never forget that patients have to be content with their care, and that caring for and about the patient must be forefront (Spruce). This paper will discuss usage of colorectal cancer testing and strategies to increase verification adherence with a theoretical basis from the metaparadigm of nursing, Watson's Theory of Man Caring, and Reigel's Theory of Self-Care, and discuss aspects of colorectal cancer testing in relation difficulty science.
Phenomenon of Interest
CRC verification interventions have targeted different themes in attempts to improve screening process rates including patients, healthcare systems, and healthcare providers (Garcia). Most important attention providers should be targeted for execution of interventions because they are in a distinctive position at the forefront to impact CRC testing rates. Most adult patients have main good care providers that they obtain care from regularly, and principal care providers can use these many opportunities to recommend verification to all appropriate patients (Spruce). A advice of CRC verification from a doctor is significantly influential in identifying if an individual will comply with cancer screening. The process of CRC screening process is intensive and involves creating a interconnection and rapport with the individual, educating the patient and opening discussions about the multiple testing options available to them, and helping the patient's decision (Spruce). Several patient-identified obstacles to CRC screening process are present such as stress and anxiety, embarrassment, dread, and notion of pain, danger, or irritation. The patient-provider romantic relationship can help to dispel most barriers to screening with proper communication and education (Garcia). Ensuring that patients have options to choose from and motivating involvement in their own healthcare decisions has which can raise CRC testing rates (Spruce).
Metaparadigm of Nursing
Fawcett (1984) determined the metaparadigm of medical as the most global perspective of nursing that involves four central concepts of medical as person, environment, health, and medical. Person is thought as the one who gets nursing care, which frequently refers to the individual, but can make reference to more than one person, including sociocultural factors such as family, friends, and community (Fawcett, 1984, 1996). The next part of the metaparadigm of nurse theory engineering is health. Fawcett (1984) defines this as the patient's amount of wellness or condition. Patients' health refers to a sizable variety of aspects of the individuals wellbeing such as genetic factors, and also contains less evident factors such as the patients' intellectual, mental, and spiritual health and fitness (Lusk). In regards to CRC verification, this aspect of the paradigm includes the utilization of preventive health care to maintain a wholesome state. Alas, the underuse of preventive attention is an concern resulting in patients that are most looking for preventive good care only heading to a professional for sick goes to, not for reduction (Krist, 2011). Patients that have emerged in these sessions perceive themselves to be possible within an ill state, reporting signs or symptoms of gastroenterology issues, often leading to providers to initiate CRC screening centered off of symptoms (Garcia). Patients confirming to a provider at a medical facility is an example of the individual interacting with their environment, which is another facet of the metaparadigm. The environment aspect of the metaparadigm identifies all inner and external environment, circumstances, and influences affecting the individual, including the setting up in which nursing occurs (Fawcett, 1984, 1996). Medical is the fourth concept of the metaparadigm which is defined as nursing interventions done with respect to or with the patient and the results where positive changes in health position are infected. Nurse experts are in a crucial position to reshape principal treatment to where it is focused on becoming patient-centered. Reformatting principles of health care practice and presenting more patient-centered models of primary treatment delivery permits patients to receive the screening exams they need predicated on provider suggestion and specific patient choice (Spruce). Providing patient-centered attention allows medical care providers to value and value patient distinctions, morals, choices, and needs while advocating disease protection and promoting wellbeing (Lusk).
Grand Nursing Theory: Watson's Theory of People Caring
Nurse practitioners look after patients from numerous upbringings, cultures, and healthcare problems. Primary prevention of disease and health campaign are great concepts for health practice, but nurse professionals have been encouraged to keep nursing theory and research as a basis for his or her practice. The integration of Watson's Theory of Individuals Caring into advanced practice provides an all-inclusive, humanistic view of the person which allows the practitioner to check out all aspects of the patient in need of good care (Hagedorn).
Watson (1990) declares that caring is regarded as the central platform to the medical profession. According to Watson (1988), nurturing consists of ten Caritas - factors of health care - that all create a composition for nursing research. The ten Caritas factors are: "humanistic-altruistic system of values, faith-hope, sensitivity to one's personal and also to others, helping-trust romantic relationship, expressing positive and negative thoughts, creative problem solving, nurturing process, transpersonal teaching-learning, supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment, real human needs assistance and existential phenomenological-spiritual makes" (Watson, 1988). The first three factors shape the foundation for the science of caring, and the rest of the factors stem from that basis. Caritas Caring is thought as relationships with available communication that induce a caring-healing environment (Watson & Foster, 2003). These connections should be included with the guiding prices of nursing that include upholding humanity, dignity, and fullness of home. The integration of and improvement of real human caring as an initiative in nursing practice is a significant subject (Watson & Foster, 2003).
Watson's Theory of Individuals Caring has several aspects you can use for implications of practice with CRC testing. Colorectal malignancy mortality and morbidity is a significant concern. Interventions as large as community-wide educational CRC verification programs embraces the Caritas through the transpersonal coaching and learning carative factor (Garcia). Interventions that are not as grand, such as individual provider and patient connections to discuss CRC verification are equally as powerful, or even more. Watson (1988) stresses the significance of obtaining an equal collaboration between nurse and patient rather than relationship of imbalanced ability. Shared decision making is applied and efficient in the patient-provider relationship in the discourse of CRC screening strategies, in which the supplier implements a caring attitude and respects the patient's ultimate goals (Underhill). By sharing knowledge with the individual, the patient is able to assist in the decisions regarding their own care, and is the leader of their own plan (Lusk). Patients gain autonomy with distributed decision making, which leads to patients Їnding sense and purpose in their own lifestyle. This brings about a rise in their capability to have inner control and to problem-solve (Watson, 1988). The blunder that providers manufactured in the past is presenting an individual CRC testing option as the patient's only choice as this is not the fact of truly caring for the individual (Spruce). Using Watson's Theory of Caring, the focus shouldn't be to only complete the task of getting the patient to adhere to a testing method, but on all aspects of the patient. This can include offering culturally very sensitive interventions to increase understanding of CRC to help improve testing uptake (Underhill). Providers should present appropriate evidence-based knowledge to the patient that is at their finest interest. Most often, the evidence is and only a particular screening intervention. The patient should be permitted to make a decision, which decision will be based on analysis of the evidence presented but will also entail considering their principals and notion system. The helping-trust romance between the nurse and the individual facilitates the patient's decision, even if the decision is not good provider's advice and data (Lusk). The patient all together should be studied under consideration with CRC interventions to better ensure that the foundation of caring is forefront, and studies show that strategies that are patient-centered improve CRC screening manners (Underhill).
Middle Range Theory: Reigel's Theory of Self-Care and Chronic Condition
Reigel, Jaarsma and Stromberg (2013) deЇne self-care as a process of preserving a healthy state with procedures that promote health insurance and handle disorder. Self-care can be applied in circumstances of health insurance and an ill express. Reigel et al. (2013) clarifies that when a person is sick but steady, they can still maintain health without automatically having to change into another type of attention that focuses on the illness. That is seen in circumstances when patients report to the healthcare provider with signs or symptoms which may be related to colon cancer, the perceived talk about of illness, and want to take activities such as CRC testing to try and regain the express of wellness or take care of their state. Intended results of selfcare include sustaining a healthy talk about, stabilization of health issues, well-being, and standard of living (Reigel, Jaarsma & Stromberg, 2013). The three key ideas that help identify self-care described by Reigel et al. (2013) are self-maintenance, self-monitoring, self-management. Self-care maintenance is defined as actions done to improve well-being, maintain health, or to keep the stableness of physical and mental aspects of the patient. Self-care maintenance tends to be behaviors that represent the tips of providers (Reigel et al, 2013). The conducts of self-maintenance may be performed by patients after strong encouragement by others such as health care professionals or family or the individual might want to perform behaviors on their own to meet personal goals. Referrals of CRC screening process are sometimes initiated with a patient's providers and family. Provider advice of CRC verification is crucial to predicting the utilization of screening methods (O'Farrell). Nurses in any way levels of practice regularly provide advice for preventive attention to patients, and they are in best positions to do so because of increased connection with patients. This allows for improved CRC screening counseling, providing information that will increase knowledge regarding CRC screening recommendations (Bardach). Self-care maintenance is firmly enhanced when a patient reЇects on the effectiveness of the self-care tendencies, is observant in performance of the tendencies, and continues to judge the beneЇts and the effectiveness of the activities (Reigel). The goal of education of CRC testing is for the individual to know about the benefits of screening as well as for the patient to keep with this avenue of self-care by sticking with continued testing as recommended by national rules (Bardach). Adherence is a crucial part of self-care maintenance. Healthcare providers collaborate with patients to discuss integrating to their daily life as much of the data based health-promotion manners as the patient can acknowledge (Reigel). Adherence to CRC testing has been shown to be increased when providers used patient-centered treatment. These findings demonstrate the vitality of communication and a quality patient-provider in regards to screening behavior and have strong implications for scientific practice (Underhill).
The second facet of self-care as stated by Reigel et al. (2013) is self-care monitoring. Self-care monitoring is thought as a process of routine security and observation of one's body. Reliable and orderly monitoring creates the best final results (Reigel). Reigel et al. (2013) clarifies that monitoring one's self applied, understanding the importance from it, and reporting abnormalities makes it possible for for appropriate medical interventions to occur before a situation becomes detrimental. This facilitates the provider's potential to provide the best care and attention (Reigel). This idea is critical to one aspect of the purpose of routine CRC testing. Signs or symptoms that might be indicative of colon cancer signify a dependence on CRC screening, which communication with the service provider can facilitate the proper screening solution to be carried out to potentially capture a situation prior to the devastating illness is rolling out (Bardach).
The third idea of self-care is self-care management. That is defined as involving an evaluation of any changes in signs and symptoms - physical or mental - to decide if an treatment is necessary (Reigel). Reigel (2013) points out that decision making is one of the underlying principles of self-care. Reigel () suggests that distress, mistaken values, and inadequate knowledge can all come into play and distort decision making, leading to limited self-care. This further reveals the importance of the relationship between patients and the providers (Reigel). Interventions that aim to inform and reduce obstacles such as dilemma are the most effective interventions targeting the individual for increasing contribution rates in CRC testing (Garcia). Reigel () shows that self-care is not always done by the individual alone. Most patients acknowledge the value of contributions of their environment or community and make use of the welcomed input-a process Reigel et al. (2013) explains as shared health care.
Reigel et al. (2013) expresses that determination is one of the final results of self-car. Patients can be motivated to execute self-care, and identifies motivation as the power that influences people to achieve their goals. The determination can be intrinsic - motivated by an internal desire - or extrinsic, referring to changing a action because it contributes to a specific result that is predicted (Reigel). Many patients contain the extrinsic motivation to move forward with colorectal cancer tumor screening with the hope that the outcome will be either left over clear of CRC or getting a potentially deadly disease early enough to discover the best prognosis (Atassi).
Complexity science views systems as complicated, having many parts that interact and are unstable, but can be versatile. A intricate adaptive system is a significant style of complexity science. Complex systems must have the ability to adapt, if not it will not make it through (Florczak). Most systems involve layers of assorted subsystems - microsystems - that intermingle with one another (Florczak). A complex system can adapt its behavior overtime, and its parts respond to their environment by using adopted rule models that stimulate its habits (Plesk). This theory can be used to explain an organization's office systems improvements to implement medical suggestions of CRC verification. Evidence has shown that CRC screening is on the rise due to modifications and improvements in screening process strategies (Atassi). As the screening rates remain not where nationwide guidelines are concentrating on, further adaptations and improvements are executed to increase adherence to screening process, such as including patients in the decision making, and using it for more correct screening rate monitoring (TriantaЇllidis). This model is provided by monitoring performance studies from EMR data, using special alerts inserted in the EMR that remind providers to start CRC verification as well as patient reminders, guaranteeing providers are culturally skilled and implementing the idea of patient autonomy in decision making (Triantafillidis). According to the complexity science theory, providers in medical facilities which may have a goal of increasing cancer of the colon screening will act accordingly with work to recommend CRC screening to patients.
Healthcare systems are moving toward implementing practices that emphasis of preventive good care. Colorectal cancer is a disease that is preventable disease that remains a way to obtain the most amount of deaths in the United States. Preventing colorectal malignancy, as well as any preventable tumors, requires consistent use of recommended testing methods. Using simple strategies and adapting primary health care practice to more patient-centered good care will make a notable difference in the incidence and mortality from CRC. A alternative view of patients should be studied under consideration with CRC interventions to help ensure that caring remains a staple in medical. Nurse practitioners have a distinctive position that could allow for transforming primary attention to where it is focused on becoming patient-centered.
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