Jean Watson Theory

Overview of the Theorist’s Background

Jean Watson is a theorist who specializes in sensitizing the need to incorporate, human caring, emotions and subjective feelings in the field of nursing. Her formulation of the theory of human care was aimed at ensuring that human caring becomes part and parcel of nursing. The core reason she engaged in human caring theory is her life experiences that included the loss of her husband (Watson, 2015). It is through these challenges that she realized the importance of care and love. Therefore, she made a personal goal of ensuring human care, a phenomenon highly assumed or lost in many professional models, did become an integral part of nursing.

Theorist’s View of the Four Basic Metaparadigms

The four basic metaparadigms are the people, health, nursing and environment (Parker & Smith, 2010). The caring theory highlights the importance of these metaparadigms. In terms of the people, the theory is keen on demonstrating the importance of integrating caring when it comes to dealing with care seekers. The theory is also conspicuously eloquent on the need for nurses to provide a healing environment to the patients. This demonstrates the appreciation of the importance of the patient’s environment for the healing process. Nursing entails actions taken in practice in providing services to the patient. In fact, the theory of human care demands to nurse to be a combination of both science and art (Watson, 2012).

Health refers to the medical status of the patients. To avail the needed help, the caring theory demands nurses to forge healthy relationships with their patients. This enables the patients and nurses relation in a manner that enhances their welfare, which is a phenomenon that was also upheld by King’s Goal Attainment Theory.

Two Concepts Unique To the Theory

The main unique concept of the theory is the caring aspect. The theory demands that for any nursing actions, human caring should be the dominant variable. In addition, another unique concept of the theory concerns the spiritual aspect whereby it agitates nurses first to have personal peace to serve better their patients.

The Basic Theoretical Assertions or Propositions

The primary assertion is the fact that nursing with the human caring aspect in it is dehumanized and a robot-like engagement is not effective (Watson, 2012). It is also the assertion of the theory that human caring is not only vital in helping the nurses provide comprehensive, patient-centered service but also in restoring hope in the patients. Human caring aspect is also said to be a trait that makes nursing a unique profession guided by values geared towards maintaining core mandate and safeguarding humanity.

A Critique of the Model

The model/theory underscores the importance of maintaining a healthy autonomy from the patients that is vital when making hard decisions. When a nurse gets too involved emotionally with a patient, it becomes difficult to make hard decisions, most of which need sobriety and time consciousness. The theory argues that it is healthy to care and that to care enough is to allow one to be vulnerable. However, the vulnerability can indeed lead to clouding one’s ability to make professional decisions in the right manner and at the right time.

Theory of Human Caring by Jean Watson


This is an article that discusses in details the reason behind Watson’s intention to formulate the Human Caring Theory. The main intention was to provide a comprehensive understanding of the variables making up the theory. Along with that, it is also evident that Watson is keen on dissecting the theory to its basic components and provides an additional explanation of the relevance of the components to the nursing engagements.


Put forth by Watson, the article is based on the theory of caring and the intentional changes Watson has enacted with time to ensure it maintains its relevance and applicability in the field of nursing. The primary message lies in the comparison between the component of the original and emergent theory. Over and above, Watson is willing to illustrate the need to ensure that art and science are vital components in nursing. Art is vital in the caring component of the engagement while science provides the conventional knowledge needed (Watson, 2001). She agitates for values, human caring, and knowledge as the most essential components in nursing. According to Watson, there is a need to uphold “Caritas” in the field of nursing. This entails giving in a cherishing manner special attention to another person (Watson, 2001).


The insights brought out by the article support the need to ensure that nursing is guided by science but served in a humanistic manner. This is very relevant in the field of nursing and of interest in critical care nursing where conventional knowledge is not enough. The special care agitated for by the article is also a crucial component in every engagement. It is extra keenness and special attention that at times save lives. Watson’s demands to ensure ensuring that people enhance both the scientific and art components of nursing is thus very significant as this is the only way of ensuring that nursing is a discipline directed by knowledge but above all guided by the special care needed.

The Journey to Integrate Watson’s Caring Theory with Clinical Practice by Linda A. Ryan


This is an article by Ryan who analyzes the journey of integrating nursing theory in the line of nursing engagement, which is a phenomenon discovered in 2003. The article articulates the forces behind integrating nursing theory to nursing practices and the benefits attained as a result of successful integration.


In 2003, there arose the need to ensure that nursing engagement works hand in hand with the nursing theory to guarantee that nursing becomes a unique engagement as it is expected (Ryan, 2005). The rationale behind the integration of nursing theory is to bring forth a better understanding of the nurses on what is expected of them. In addition, the author of the article had an intention to utilize a nursing theory in the formulation of unified nursing practice. The guide theory was Watson’s, which brought forth the usefulness of caring in nursing. The argument from Watson’s theory was without the theory in nursing; the human soul is destroyed by rapid technology utilizing robot-like treatments that are dehumanized (Ryan, 2005). On the other hand, the care theory argues that nursing should be based on cherishing humanity and provision of care.

After integrating Watson’s theory, it was evident that nurses were better placed to handle patients more diligently. Along with that, it was clearer to the nurses what was expected of them as nurses. According to a nurse with 20 years of experience, it was only after integrating the care theory that she said the definition of nursing and the practice had never been clearer (Ryan, 2005).


The primary intention of the article was to illustrate the usefulness of nursing theory in the field of nursing. The experienced nurse saying that even with 20 years of experience, the definition of nursing and nursing practices had never been as clear as after the adoption of the theory is clear evidence. Nursing theory not only provides in-depth insights on the best course of actions but also provides a platform, under which differentiated nursing engagement can be clearly understood. This can be demonstrated by the nurses who were engaged in the pilot program saying that they better served their patients (Ryan, 2005). This was after incorporating Watson’s caring insights in the best way to deal with a patient after utilizing Watson’s ‘creative’ factors.

Applying Watson’s Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment (Suliman et.al)


This is a research-based on Jean Watson’s theory of human caring and conducted with the intention to identify the patient line of thought in terms of being cared for under a diversified cultural environment. The study was done with the participation of Saudi patients, and the researchers aimed at identifying what the patients perceived as caring behaviors and the behaviors that were being manifested by the nurses.


Through a sample of 393 patients drawn from three different hospitals located in different Saudi Arabia regions, 92.7% of the patients did view caring behavior as important (Suliman et.al, 2009). However, from the study, only 72% of them experienced it from the nurses (Suliman et.al, 2009). The major take from the results was the fact that patients representing three different cultures did value Jean Watson’s demands of showing care to the patients. Despite the expectation from the patients, it was evident that the nursing staff underscored in this aspect. The reason behind the unmet caring expectations was traced back to the language and cultural barrier that exists between the patients and nurses across Saudi Arabia. To fill the gap, the call was for the nurses to base their actions as if they were to meet the demands from patients across cultural divides (Suliman et.al, 2009).

The goal of the article is to sensitize on the importance of appreciating cultural differences between the patients and the nurses. It is the facts provided in the article that paved the way to the formulation of Watson’s theory. A theory that agitates for the provision of health care in a transpersonal manner based on a caring relationship between the caregiver and receiver.


It was evident that despite the fact that the study was done in Saudi Arabia, a country in the East, and the guiding Watson’s theory was formulated in the western country, the theory components were still applicable. From the research, it was evident that all patients valued caring behaviors, but not one of them was met due to the cultural barriers. Therefore, it was the call for the nurses to ensure they base their action on nursing theory and in this case Watson’s. The findings encourage consolidating the call by Watson’s theory of ensuring that nursing is based on a caring, interpersonal relation and the need to uphold humanity.

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A great deal has been documented on reflective practice over the years, and it has been heralded by some as a radical new methodology to extend education and practice. According to Basford and Slevin (2012, p. 483), reflective practice dates back to Socrates, who encouraged his pupils to find solutions to philosophical problems from within themselves. In modern times, its use can be traced back to John Dewey (1938) who asserted that ‘people learn by doing and realizing what came of what they did’ (Leonard 2011, p. 56). In the nursing context, reflective practice is used to refer to the ‘application of this reflective tool to an exploration of feelings, thoughts, and beliefs relating to our own practice’ (Alder 2012, p. 98). From this definition, reflective practice comes out as a cognitive act, by which one makes sense of memories and thoughts, implying that it has clear implications for learning, more so ‘deep learning’ (Kolb 2015, p. 67; Quay and Seaman 2011, p. 69).

Reflective practice in itself is a type of ‘deep learning’ from which practice is shaped, it is viewed as retrospective contemplation of practice carried out for the purposes of unearthing the knowledge used in a specific situation through the analysis and interpretation of the recalled information. This paper is a reflective practice on one serious health issue in Hong Kong, which is the lifestyle of alcohol drinking. In order to prompt this reflection, John Dewey’s reflective learning model and David Kolb’s experiential learning theory model will be used.


Reflective Learning Model of John Dewey

According to Basford and Slevin (2012, p. 229), reflection journals are excellent approaches to incorporating conversation with oneself into the leaning process, as it links learning, experience, and writing. In Cossart and Fish’s (2014, p. 95) opinion, reflection is active involvement in the learning process that helps learners deal with ill-structured problems in society. Reflection in itself is a process involving a review of an experience that permits to describe, analyze, evaluate, and inform the learner’s learning and practice (Miettinen 2010, p. 60). In essence, it is the ability to make unequivocal to oneself or uncover what a person has observed, planned, or realized in practice. From the perspective of Basford and Slevin (2012, p. 484), reflection takes place in the cycle of action, reflection, and action where it assists learners in gaining a deeper understanding of the content, acknowledge and grapple with bias and assumptions.

Reflective learning, as put forth by Dewey, focuses on experiences, which implies observation and reflection on it through raising critical questions (Miettinen 2010, p. 63). According to Leonard (2011, p. 57), reflections though questioning the experience will result in new knowledge and learning, bringing together the knower and the knowledge. To Dewey’s mind, experience-reflection-knowledge is a continuous process and not a one-off event. Evidently, reflection has provided a linkage between facts, observations, and ideas. This connection enables people to achieve their life goal by helping them to connect the present with what they have experienced and known. According to Alder (2012, p. 99), this goal may be as fundamental as efforts to make more informed decisions about whether and how to best offer services to communities in the future. Reflection, as a matter of fact, goes beyond experience, and to truly understand an experience, it is imperative that one understands how he/she is connected to or affected by it. According to Cossart and Fish (2014, p. 95), it is vital for one to place him/herself in the middle of the process of reflecting upon service-learning experiences. He/she should also connect the current situation with past knowledge and experiences as a means of realizing the desired goal.

Basford and Slevin (2012, p. 484) presume that the reflective learning model looks into reflection and studies how it takes place by providing skills with the help of which knowledge or processes towards a purpose can be manipulated. In this context, reflection is allied with thinking, where it is described as a kind of thinking that entails turning a subject over in the mind and giving it a serious thought. This approach views reflection as a chain of linked ideas that aim at making a conclusion, which is more than a stream of consciousness (Quay and Seaman 2011, p. 72). In this reflective model, the desired or anticipated outcome could be said to coincide with the purpose of reflection. According to Pawar and Anscombe (2011, p. 46), this model is guided by four key principles:

i. Learning by doing

ii. Bringing together the knower and the knowledge

iii. Constructing knowledge by reflecting on past and current experiences

iv. The continuous process of reflective learning

This model focuses on reflecting on challenging experiences, enquiring or questioning learning, the building of knowledge, wholehearted open-mindedness, and awareness of self-belief (Oermann, 2012, p. 23). The limitation of this model is that it is only limited to learning and thinking, it has no focus on practice/action, and it has no focus on positive experiences (Miettinen 2010, p. 67).

Experiential Learning Theory Model of David Kolb

Moon (2013, p. 56) claims that experiential learning entails a direct encounter with the phenomena being studied as opposed to merely thinking about the encounter or only considering the possibility of doing something about it. Kolb (2015, p. 69) defines experiential learning in terms of an instructional model, which starts with the learner engaging in direct experience followed by a reflection discussion analysis and evaluation of the experience. It has also been defined as a process that helps the learner create meaning from direct experiences. Leonard claims (2011, p. 67) that experiential learning takes place when: (1) a person is involved in an activity, (2) he/ she looks back at the activity and evaluates it, (3) he/she determines what was useful or important to remember, and (4) he/she utilizes this information to perform another activity.

Experiential learning, which is learning by doing or learning through experience, was created by Kolb with Roger Fry (1975) (Kolb 2015, p. 72). This theory comprises four elements: concrete experience, observation of and reflection on that experience, formation of abstract concepts based on the reflection (abstract conceptualization), and testing of the new concepts (active experimentation) (Oermann, 2012, p. 20). These four elements, as described in figure 1 below, form the basis of the learning cycle that can begin with any of the four elements, but it typically starts with the concrete experience.

Source: Adapted from David Kolb, Experiential Learning: Experience as the Source of Learning and Development (Englewood Cliffs, Prentice Hall, 1984) (Livermore 2011, p. 197).

The first phase of this process is concrete experiences, which may be as significant as the trauma of losing a loved one, or as life-transforming as the adventure of travelling to another part of the world, or even as jarring as an interchange with someone from a different generation over a lunch-break (Livermore 2011, p. 197). The second phase in Kolb’s learning cycle is a reflection, where the individual steps back to think about and observe what has taken place in the concrete experience stage. According to Leonard (2011, p. 77), at this stage, awareness, to a large extent, comes into play. Additionally, internal awareness enhances effective reflection in the midst of the experience, creating time and space after the experience to reflect on it. From here, the person moves into the third stage of abstract conceptualization, where he/she starts to come up with themes and ideas related to what was observed.

In the words of Kolb (2015, p. 73), where the learner draws on things like logic sets and category width to help him/her conceptualize the nature of what has taken place in the initial experience. The learner asks how the experience fits with his/her existing categories, does it or does it not fit. If it does not fit, how does it affect the way in which he/she views the experience? Does it need a new category? Which assumptions require deconstruction? And so forth. In Alder’s (2012, p. 99) opinion, the asking of these kinds of questions and starting to hypothesize responses to them form part of the beginning of abstract conceptualization. Finally, the initial concrete experience is formed into active experimentation through future, ongoing involvements, and happenstances. Consequently, this enables the individual to draw on theories generated in the reflective mode as he/ she reengages in action.

According to Pawar and Anscombe (2011, p. 46), this model of reflection is guided by four principles: experiential learning stages, reflecting on experiences, conceptualizing and testing, and the continuous process. This model focuses on reflections on experiences, knowing/concept/theory, integration of doing and knowing, testing, and creation of knowledge (Quay and Seaman 2011, p. 73). The limitations of this reflection model show that it is more focused on individual learning and management, it decontextualizes the learning process, and it does not include other factors influencing learning (Oermann 2012, p. 24). According to Taras (2012, p. 203), real experiences often help the individual learn advanced abstract concepts. These experiences may result in paths, which allow the individual to actively gather information, learn, and become a member of the community. Additionally, reflection and critical thinking may refine ideas or lead the individual to consider alternate possibilities. Each phase of this model potentially leads to another and builds upon the former.

Dialogue on the Current Social and Political Health Issue

This dialogue concerns the “lifestyle of alcohol drinking” as a social health problem. The statistics from the Health Factor of Hong Kong (2015) survey have revealed that the prevalence of alcohol drinking stands at about 3.3% in Hong Kong. In 2007 and 2008, alcohol was a controversial topic in the country, but with the government consistently waiving taxes on alcoholic beverages, its strength diminished by less than 30% (Woo 2014, p. 173). The history of alcohol in the Chinese history dates back to over 5,000 years ago, where it was used as a health product rather than a social beverage, in contrast to this generation (Mathews & Lui 2013, p. 125). In traditional China, alcohol played an important and special role in daily living, not only when there were health issues. In important business gatherings, alcohol was present and accepting it was viewed as a sign of politeness. Still, in this historical context, alcohol was consumed in little quantities and its consumption was regarded as the way to heal the sick, keep people healthy, make them happy and braver, drive away from the madness. Additionally, its consumption was a sign of adulthood and its relationship with socio-economic activities was close.

Presently, in Hong Kong, alcoholic beverages are easily accessible in supermarkets, stores, or food outlets (Department of Health 2015, p. 2). Thus, many people are not aware of the harm that alcohol does to their health. Even though it is widely held that a small amount of alcohol is good for the heart in certain countries, and some evidence exists to support this assumption, there is greater evidence that suggests the contrary. Little evidence suggests that suitable amounts of alcohol intake can prevent coronary heart diseases and ischaemic stroke (Woo 2014, p. 176; Kim, Wong, Goggins, Lau & Griffiths 2013, p. 1220; Huang, Ho, Lo, Lai & Lam 2013, p. 880). On the contrary, the key to the prevention of heart diseases does not imply consuming alcohol, but rather pursuing a healthy lifestyle that includes healthy eating, exercise, and no smoking habits. Alcohol abuse has both short-term and long-term consequences and risks.

In view of its spread, drinking of alcohol is very common in Hong Kong, and it is flagrantly acceptable during social gatherings and celebration events. Despite its harmful effects on the human body, alcohol does play an important role in Hong Kong Chinese culture. It is an important beverage consumed during celebrations like wedding and birthday parties (Department of Health 2015, p. 7). Besides, Chinese people of Hong Kong often use it as a health product and a kind of medication. This embodiment of alcohol in the sociocultural context makes young people have a wrong perception of alcohol. Therefore, it leads to further increment in alcohol consumption levels. The major cause of this shift and adoration of the beer bottle has been linked with the increasing living standards and changes in values. Much of these changes in values have been brought by the western lifestyle influences, where alcohol consumption is the norm (Chung, Yip, Griffiths & Yu 2013, p. 723). Most of the Chinese in Hong Kong have imitated this culture and adopted alcohol consumption as well. In my opinion, I think the Hong Kong Government should do something in order to stop this increasing trend of alcohol consumption. If not, the burden of health care concerns related to alcohol consumption will be heavy.

Alcohol drinking leads to a number of harmful effects on individuals and on society at large. Psychologically, heavy drinking provokes acute intoxication and even death in some serious cases. It may also cause certain types of injuries to a person, emanating from risks like drowning, falling, and road accidents; more so, when people drive after consuming alcohol. Prolonged use of alcohol may result in alcohol dependency and in some instances, non-communicable diseases like cancers of the larynx, pharynx, esophagus, liver, colon, rectum, and breasts.

Psychologically, alcohol consumption may increase anxiety and depression and, consequently, lead to amnesia, memory loss, and dementia (Department of Health 2015, p. 12). Long term and excessive consumption of alcohol will influence people’s ability to cope with stress. Socially, alcohol may affect people’s relationships and create conflicts among family members. Such conflicts could result in family breakages, divorce, couple and child abuses (Department of Health 2015, p. 13). Most aggressive behaviors have their root cause in alcohol. This aggressive conduct could be verbal and physical aggression towards other people. The result of such aggression could be fought, and people may be hit due to their uncontrolled behavior after drinking. Consequently, these alcohol-related acts will increase the burden on society and the healthcare system.

Summary of Dialogue

This dialogue concerns the “lifestyle of alcohol drinking” as a social health problem. Alcohol consumption was once viewed in historical China and Hong Kong as having healing and curative abilities and a sign of social status, where its acceptance was a sign of politeness. In early 2007 to 2008, alcohol consumption was not rampant and was not a serious issue, as it is at present. The influence of reduced taxation on alcoholic beverages and western lifestyles coupled with the increased living standards have led to an increase in the consumption of alcohol. It is easily available in supermarkets, shops, and food markets. This accessibility, together with the belief that alcohol consumption treats various heart conditions, has led to a rise in the number of young people consuming alcohol. Its consumption is a health problem in Hong Kong and has further strained the social and health care concerns of the nation. If this issue is not addressed, the government will feel a substantial burden. Heavy consumption of alcohol has its negative effects that range from social issues like domestic violence to health concerns like serious cancerous diseases.


It is worth recalling that the concept of reflection follows two approaches, Dewey’s and Kolb’s. Dewey’s approach focuses reflection on challenging experiences, enquiring or questioning learning, the building of knowledge, wholehearted open-mindedness, and awareness of self-belief (Oermann 2012, p. 23). Kolb’s approach, on the one hand, focuses reflection on experiences, knowing/concept/theory, integration of doing and knowing, testing, and creation of knowledge (Oermann 2012, p. 24). Using these perspectives, it is clear that increased alcohol consumption among young people in Hong Kong is a health issue that needs to be addressed through recommendations on social changes. Increased alcohol consumption could result in alcohol dependency and addiction, which eventually suck potential and usefulness out the young. Therefore, it makes them unproductive and useless to society. In addition, there is a close link between alcohol and crime and other social evils like domestic violence and abuse (Martin, 2015 p. 56). In addition, there are a number of health complications and serious chronic conditions related to alcohol consumption and the continual intake of alcohol slowly reduces a person’s lifespan. A change in behavior is the only cure for alcohol consumption. The figure below shows the alcohol lifestyle and recommendations for social changes.

Conclusion and Recommendation

In conclusion, the alcohol lifestyle among young people in Hong Kong can be broken with the help of social changes involving seven steps. The first step entails acknowledging the reason behind the drinking problem, whether one drinks because of anxiety, stress, or other life challenges. The second involves thinking rationally on the alcohol lifestyle problem through self-awareness of the health and social consequences of engaging in it, people are hurt because of it, and they do not deny the fact that it is a social evil. The third step suggests making use of alternative coping skills by replacing old habits with new ones like exercises and other relaxation techniques. The fourth one implies identifying the danger zones in terms of tempting situations, environments, and friends who could easily make one revert to the habit. This is followed by a changing lifestyle, like walking with a fixed amount of money, cleaning house of alcoholic beverages, and even avoiding friends with whom one drinks. The sixth step demands to be accountable and have a support network of credible people who can help to pursue the endeavor to change alcohol lifestyle. Finally, there is a stage of rewarding oneself by giving credit for the steps made towards changing the alcohol lifestyle.

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Nursing is a definite professional discipline (Alligood, 2013, p. 22). It presupposes that patients should be provided with individualized high-quality care in order to fulfill their personalized requirements. Thus, the ability to achieve this objective as a health professional, it is highly important to ground individual nursing services on the four fundamental metaparadigms that universally direct the nursing profession (Alligood, 2014, p. 31). Generally speaking, a meta paradigm operates in a form of a spine bone, which can be utilized as a grounding for the nursing profession, as all nurses are able to refer to it prior to making any clinical judgment (Alligood, 2014, p. 31). The four fundamental metaparadigms of nursing regard a person, the environment, nursing practice and a patient’s health status (Alligood, 2014, p. 31). Various scholars utilized numerous nursing theories regarding four fundamental metaparadigms, but each of these theories provides a discrepant perspective concerning their impact on a patient’s well-being and his/her medical state at any given time (Fawcett & DeSanto-Madeya, 2013, p. 54). As a matter of fact, the metaparadigm notions are outlined and connected by these theories in a highly different manner. The current paper demonstrates these metaparadigms separately at the same time providing a personal input regarding the four components interaction and influence on patients’ well-being, which has always been my individual agenda.

The Four Metaparadigms

Person Component

The concept of a ‘person’ majorly focuses on an individual’s health care requirements, spiritual needs and most essentially societal needs regarding family connections and other individual groups concerned as important by an individual (Alligood, 2014, p. 363). The state of individual health is a result of a complicated interaction of both societal and physical facets of life. Different nursing theories present discrepant information regarding this component, but Rodgers theory vividly demonstrates that a unitary human being evolves through three principles, including helices, resonance, and integrality (Alligood, 2014, p. 221). The combination of these principles formulates the concept of hemodynamics (Alligood, 2014, p. 221). Therefore, a person appears as an irreducible, reversible, pan-dimensional, negentropic energy field, which can be defined by patterns and develops through three above-mentioned principles (Alligood, 2014, p. 221). The helices principles help to outline the dubious but incessant, nonlinear evolvement of energy fields, as indicated through a spiral development reflecting the character of alterations (Alligood, 2014, p. 222). Resonance is demonstrated as a wave frequency and an energy field pattern evolution from lower to higher frequency wave patterns, and it reflects the continues variability of the human energy field as it alters (Alligood, 2014, p. 222). The principle of integrity focuses on the incessant reciprocal processes of the person and the environment (Sitzman & Eichelberger, 2011, p. 232). On the other hand, the Watson’s nursing theory and science of caring, the person concept are outlined as an incarnated spirit, which can be characterized as the unification of body, mind, and nature (Sitzman & Eichelberger, 2011, p. 401). The major goal of nursing appears as an ability to assist individuals in attaining a higher level of harmony within the three above-mentioned constituents. Therefore, a person appears as a recipient of nursing care who is composed of biological, psychological, sociological, and spiritual components (Sitzman & Eichelberger, 2011, p. 410).

The individual practice helped in understanding that low self-esteem and decreased self-regard combined with stress have a tendency to hinder recovery in the majority of cases. Therefore, my individual nursing practice demonstrates that it is significant to utilize personal initiative in order to reassure each individual patient and apply a holistic approach to health care, which ultimately assists in sustaining patients’ calmness and certainty. The assessment of patients’ requirements and individual settings helps to learn how to respect the uniqueness of each patient and their perspectives regarding life.

Environment Component

The second metaparadigm, which regards the environment, concentrates on how interplay with the extensive and general surrounding affects the health of a person as a patient. The environmental impacts might be either external or internal (Fitzpatrick & McCarthy, 2014, p. 142). Apart from the physical setting, which incorporates the geographical location, societal, cultural, technological and economic facets of the setting also perform a significant function in a patient’s wellbeing.

Thus, for instance, Callista Roy’s adaptation model suggests that the environment incorporating earth resources, which formulate conduct, can be utilized to impact health positively via stimulating patients to cope with the environmental facets, which cannot be changed (Alligood, 2013, p. 51). The copying procedure results in optimum health and enhanced caliber of life. This model reveals three adaptation levels, incorporating integrated, compensatory and comprised life processes. These three levels do not sustain as constant due to the fact that alterations appear as inevitable from time to time (Alligood, 2013, p. 52). The major function of nursing, in this case, regards fostering a patient’s successful adaptation. Moreover, Roy’s adaptation model identifies three classes of environmental stimuli. First, it is the focal stimulus, which stands for the external or internal incentive appearing most instantly in the awareness of an individual or a group (Alligood, 2013, p. 52). The second stands for the contextual stimuli, which regards all other stimuli appearing in the situation, which actually contributes to the impacts of the focal stimulus (Alligood, 2013, p. 52). Finally, the third one concerns the residual stimuli, which stands for environmental agents within or outside human systems, the impacts of which appear as obscure in any given situation (Alligood, 2013, p. 52). On the other hand, Kings nursing theory model claims that human beings evolve in regards with their external setting, at the same time, when the internal setting concerns the energy, which provides them with a possibility to cope with alterations appearing in the external setting (Sitzman & Eichelberger 2011, p. 156). Generally speaking, this metaparadigm has altered my individual assessment, providing the ability to focus on both individual perspective and a patient as well. Effective communication helps in understanding patients’ environment better and shows how to advise them in accordance with their external and internal setting. This is a method that helps in achieving a shared goal of a patient’s recovery.

Health Component

The third metaparadigm regards health, and it stands for the general well-being of any person. Benner’s nursing philosophy claims that the genetic composition of an individual usually predisposes an individual to specific diseases but the only interplay with secondary agents ultimately defines whether the disease occurs or not, as these agents might enhance the hazards resulting in disease (Alligood, 2013, p. 45). Therefore, it does not appear as unusual for patients to have a disease particularly during the asymptomatic stage and even being unable to apprehend themselves as ill (Alligood, 2013, p. 47). Therefore, Benner acknowledges that health appears as human experience. On the other hand, Watson defines health as harmony, wholeness, and comfort (Alligood, 2013, p. 107). On contrary to the previous statement, Roger outlines that health and illness appear as a part of a continuum. The practice reveals that all clients have a discrepant inherent approach regarding stress/illness and coping with it (Alligood, 2014, p. 221). The genuine understanding of health, illness, and wellness is a paramount significance for the individual nursing practice because it assists in comprehending that at times it is more appropriate to apply placebos in order to restore the wellness of patients who appear to be ill but actually have no diseases. Moreover, it is highly important to understand that health is not an absolute term but a relative one, due to the fact that what is healthy in one person may indicate weak health in another person.

Nursing Component

The nursing component is the one that incorporates the delivery of high-quality health services to a patient for optimum health results. It encompasses but is not restricted to the operations applied to start from the time of a patient’s arrival, which incorporate therapeutic nursing interventions that are combined with the properties and characteristics of the health worker providing care regarding their clinical judgment capabilities (Fawcett & DeSanto-Madeya, 2013, p. 206). Thus, a nurse who is an active participant attains protection, promotion, and preservation of human dignity. Generally speaking, the major function of a nurse is to assist patients during interpersonal connections and therapeutic management of their setting, which is objected at advocating health and well-being (Fawcett & DeSanto-Madeya, 2013, p. 208). Thus, nursing appears as both an academic discipline and professional practice. Therefore, it is directed by the values of human freedom, the choices they make in accordance with the provided responsibilities. Critical thinking is an integral part of a nursing career due to the fact that it guides a professional into making the appropriate judgments in providing evidence-based care to patients in the attempt of achieving an optimum level of health in discrepant nursing contexts (Alligood, 2014, p. 65). On the other hand, Nightingale’s nursing model suggests that nursing is supposed to alter or manage the environment to implement the natural laws of health (Alligood, 2014, p. 3). Henderson suggests that the main objective of nursing is to assist a person, both sick and well in their performance of activities (which incorporate 14 components of basic nursing care) and assist an individual in attaining independence as rapidly as possible (Alligood, 2013, p. 21). Finally, Watson demonstrates that nursing should appear as a reciprocal transpersonal relationship in caring moments guided by creative agents and Caritas operations (Alligood, 2013, p. 106). The individual practice demonstrated that a nurse should be engaged in a form of an active partner in human care operations with people during the whole life span. Thus, caring appears to be the main source of power, which allows acting autonomously, while attempting to empower patients via sharing their experiences and passing knowledge. Moreover, it is highly important to incorporate decision-making processes, problem-solving, communication, interpersonal, intellectual and technical capabilities in nursing care via collaboration with other health care providers. Nursing suggests that core values should incorporate commitment, mastery of scope and control over the practice in order to obtain attainable standards of health for all clients.

Two Practice-Specific Concepts

The facts demonstrate that concepts are complicated mental formulations of perspectives regarding the personal observation and perceiving of the world. Generally speaking, concepts assist in formulating a specific mental picture regarding different situations. In addition, concepts also perform a function of fundamental building blocks for theories (Marchuk, 2014, p. 266).

The first practice-specific concept concerns health promotion. This concept incorporates individual experiences of communicating with people suffering from chronic illnesses, including cancer and diabetes. The recent years reveal that chronic illnesses demonstrate a capability to provoke negative effects on the national economy. The direct costs incorporated in the search of the medical care combined with the indirect costs (meaning, for example, transportation and the lost working hours in search of medical attention) are actually highly significant. It is obvious that patients suffering from the above-mentioned diseases might not attain recovery, but health professionals, especially nurses can do everything in order to manage cases to prolong life and slows a disease progression rate. Thus, the nurse-patient relationships demonstrate that a nurse is supposed to work to authorize a patient by renovating and retrieving their desire and will to live and not merely give up on life due to the fact that they suffer from conditions that do not have an actual cure (Marchuk, 2014, p. 269). My individual practice helped to acknowledge that health is a matter of social justice and therefore, it should be included in the societal systems of governance. There is no possibility to supply patients with medications or insist on undergoing specific health care procedures without encompassing. Thus, patients should be included in the nurse’s decision-making processes in order to satisfy, while recommendations can actually relieve them of their pain and assist in recovering from a disease. Therefore, the hospital procedures and processes should facilitate a patient’s authorization, as it can enhance a patient’s satisfaction with the provided care (Marchuk, 2014, p. 269). Moreover, the individual nursing practice vividly demonstrates that transformational leadership is significant in regards to health promotion due to its responsive nature. Thus, senior health professionals are supposed to be visionary and work towards affecting the whole health care team to accomplish the set objectives, which are supposed to regard the patient’s health promotion.

The second practice-specific concept regards evidence-informed practices. It can be outlined as the practice that integrates clinical expertise/practice and patient valuables with the best research evidence accessible (Marchuk, 2014, p. 270). My individual practice helped to define several benefits of applying evidence-based practice in health care on the basis of the fact that patients receive and adopt recommended care on a fundamental ground of genuine trust. I have witnessed a situation when one woman went to the hospital and was labeled as having breast cancer. On the basis of this diagnosis, the health professional recommended her to undergo chemotherapy in order to control the existing hazard. Nevertheless, this woman decided to get a consultation in our clinical setting and our health care provider decided to take samples of tissues from the lump. After their research, it was discovered that the lump was not cancerous. The adherence to the first recommendations would actually traumatize this woman together with her family, resulting in serious stress and solid unreasonable financial strain. Therefore, it becomes obvious that evidence-based care can actually support or reject the decisions made by health care providers together with boosting the image of clinical organizations, which embrace this practice as their approach (Marchuk, 2014, p. 272). This practice allows defending the provided and delivered care and justifies required additional expenses (Marchuk, 2014, p. 272).

List of Propositions

A proposition is a structural constituent of a theory that creates a connection between concepts (Alligood, 2013, p. 43). The discussed metaparadigms help to derive the following propositions.

1. It is feasible for any individual to manage their personal health via positive self-image and self-regard, which should be combined with behavioral practices that promote good health.

2. Change-subjected environmental agents should be altered in order to enhance individual health and well-being.

3. Emotional, physical, spiritual, intellectual, and societal well-being should be analyzed and regarded during care due to the fact that they can impact a patient’s well-being and health.

4. The conflict or misunderstanding between a patient’s stress and care provided presupposes that stress might inhibit the recovery.

5. Nursing should regard the care in the clinical setting only, as it should also incorporate a deeper comprehending of all feasible agents, impacting a patient’s health and well-being.

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This paper presents a critique of nursing theory. A case of Florence Nightingale’s Environmental theory has been selected and the main ideas and assumption discussed. The origin of the theory, its testability, and usefulness in nursing practice are also tackled.


Nursing is a science that focuses on improving the health and healing of humanity through effective care. The discipline is based on diversified components of knowledge such as philosophy, science, art, and ethics. The science incorporates several theories that are based on research findings within the discipline. The main purpose of the nursing theories is to improve the art and practice of nursing. This is further driven by the need to generate better health in persons, families, and communities. The theories are, therefore, developed to promote coherent ways of viewing and approaching people’s care in their contextual environments (Parker & Smith, 2010).

Main Ideas of Florence Nightingale’s Environmental Theory

Environmental theory of nursing was propagated by Florence Nightingale and was first published in 1860. According to her, nursing incorporates the restoration of the normal health status of the patients as well as of the nurses. For this to be successfully achieved, the practice evolves around certain environmental factors that are interrelated. The theory states that the process of nursing involves utilizing the environment to assist the patients in their recovery. Nightingale reasoned that when several aspects of the environment were not balanced, patients had to use extra energy to counter the imbalance hence hindering the healing process (Meleis, 2010).

Pure and fresh air is one of these environmental factors that were perceived as significant by Nightingale. This implies that the air that people breathe should be kept as pure as the external air without chilling the patient. Pure water and effective drainage were other factors that she considered significant. For her, the use of impure water for domestic purposes and poor drainage makes humanity be at risk of epidemics. General cleanliness and light are also considered as significant factors that affect health. As a result, general cleanliness and usefulness of good and quality light must be upheld in a nursing environment (Meleis, 2010).

In relation to these, Nightingale concluded that a clean environment that observes all these environmental factors is paramount in the nursing practice. She also emphasized on the quiet and noise-free and warm environment, attending to patients’ dietary needs, effective documentation and evaluation strategies. She, therefore, observed that these factors are interrelated to the extent that any deficiency in one or more of them is likely to impair the functions of the rest (Parker & Smith, 2010).

Origin of the Theory

At the time when this theory was propagated, the society as observed by the theorist was dominated by a number of factors that influenced the theory. These include poor sanitation in health institutions and incompetence of the health workers and nurses. As a result of this, the healthcare services were unreliable and non-satisfactory to the needs of the patients (Nightingale, 1992).

Nightingale’s personal experience, values, and orientation were influential in shaping her theoretical view. As a young woman, she often accompanied her mother to hospitals in order to visit the sick. In this process, she observed that, despite the reputation that the nurses had, the hospitals were dirty, crowded and smelly. She, therefore, joined the profession with the view of creating change and improving the service. She also believed that nursing required special commitment as it is a call from God (Nightingale, 1992).

With a view to her approach to the theoretical development, Nightingale employed an inmate with human immunodeficiency approach. This involved the need to create an environment that allows people to recover from illness by improving sanitation conditions. She was also guided by her prior knowledge and writings about science. These are mainly documented in her work such as What is Nursing and What is Not. This gave her clear background on the understanding of the concept and the practice of nursing as well as its goals (Parker & Smith, 2010).

The Usefulness of the Theory

This theory has been useful in understanding the foundations of nursing practice in various settings. For instance, Nightingale and other nurses that she had trained implemented this theory during the Crimean war. In this health crisis, she effectively took care of injured soldiers by attending to their immediate needs and also curbing the spread of other communicable infections that were rampant at this period (Meleis, 2010). This theory is also significant to current nursing both in relation to practice and research. Its values, a philosophical basis, assumptions, and beliefs are fundamental in understanding the meaning, elements, and paradigms of nursing (Meleis, 2010).

Testability of the Theory

An evaluation of this theory reveals that it has testable and non-testable tenets. For instance, environmental factors such as ventilation, warmth, quietness, diet, and cleanliness are measurable and their impact on health improvement is testable. However, the universality and timelessness of other concepts such as a nurse, patient, and environmental interrelationship remain pertinent (Parker & Smith, 2010).

Several scholarly types of research have been made on Florence Nightingale’s environmental theory. These have been done by scholars such as Slanders Louise, Flaskerud Jacquelyn, and Edward Halloran and Dennis Karen. For instance, Dennis Karen’s research was based on these propositions: the patient is the focal point of nursing care; nurses concern themselves with disease prevention, health promotion, the physical environment and psychosocial process (Meleis, 2010).


In the overall evaluation, Nightingale’s Environmental theory is both comprehensive and specific. It argues that the interrelationship between environments, external influences and conditions can prevent, suppress or contribute to death. The theory is also specific by pointing out certain environmental factors such as sanitation, clean water, light and drainage that affect health.

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Empowered Women in Film Noir

Film Noir is characterized by the use of femme fatale characters who reject conventional gender roles prescribed by society. These female characters do not want to play the role of devoted and submissive wives and caring mothers; on the contrary, they use their sexual attractiveness to deceive and manipulate men for the purpose of gaining power, financial or social independence and being out of control. Film Noir allows women to break out of traditional gender roles, however, always restores patriarchal order within mainstream society by punishing them for the transgression of social boundaries.

Traditionally, Film Noir divides its female characters into three following categories: boring nurturing woman, a woman to marry, who wants to create a family with the hero and finally, femme fatale, who longs for independence, has ambitions and feels imprisoned in close relationship with a man or within a marriage. Among the above, the femme fatale most directly attacks traditional gender roles and boundaries of all types of noir female characters.

Film Noir empowers women to break free of the roles prescribed to them by male-dominant society. In fact, the image of a conventional woman who obeyed all the rules is rather parodic in film noir. Thus, these films are more sympathetic to the image of an independent and strong woman who is not afraid to stand for her ideas and defend her right to live the way she wants to. The classic femme fatale often chooses murder as the way to set herself free of an oppressive relationship with a man who controls her and views her as his property. In Double Indemnity (1944), Phyllis Dietrichson feels like in a cage in the house of her husband. The woman wants to murder him not only because of money, however, because her husband is indifferent to her and tries to embark control over her. She says, “I feel as if he was watching me. … But he keeps me on a leash so tight I can’t breathe.” Thus, Phyllis refuses to play the traditional role of a submissive wife and powerless woman who can only ask God to help her; on the contrary, she herself decides to make her history. However, the power she gained makes Phyllis a monster who continues to spin a web of lies, greed, jealousy, and death around her. Thus, Film Noir shows that empowered women cannot control themselves and their desires and that their violent behavior should be punished.

The way in which Film Noir portrays the femme fatale type supports patriarchal social order and the gender roles assigned in it. According to Hollinger, “the freedom of movement and visual dominance of the femme fatale admittedly is presented as inappropriate to a ‘proper’ female role and as igniting sinister forces that are deadly to the male protagonist” (246). Therefore, not only a woman that was daring enough to resist patriarchy is punished, however, the male character whom she led to destruction also pays a high price for his affair with a seductive criminal. For instance, in Detour, both Al and Vera are punished for their criminal affair: the femme fatale is accidentally strangled with the telephone cord and the man is subjected to legal prosecution. Restoration of traditional gender roles by Film Noir also may involve the marriage of a protagonist with a nurturing woman or acceptance of her proper part of femme fatale.

However, the destructive struggle of women for independence presented in Film Noir is simply their response to restrictions obtruded upon them by male-dominant society. In these films, the world is depicted as corrupt, unsafe, immoral and irrational where women’s role is narrowed to being a prize or property of men in it. Therefore, the femme fatale, an empowered woman, is a normal product of the world around her, and it is the fault of society that oppressed her that she led herself and her man to destruction. Despite punishing femme fatale for her disobedience to strict gender roles of male-dominant society, Film Noir expresses sympathy to her. According to Hollinger:

“Narratively, this dangerous, evil woman is damned and ultimately punished, but stylistically she exhibits such an extremely powerful visual presence that the conventional narrative is disoriented and the image of the erotic, strong, unrepressed woman dominates the text, even in the face of narrative repression” (246).

In fact, the image of a powerful, brave and independent woman sticks in the mind of the viewer due to her unique fearlessness. In contrast to powerful women depicted in other Hollywood movies of the time, femme fatale of Film Noir remains true to her nature, stands for her independence and refuses to obey even under the threat of death.

Thus, Film Noir empowers female characters to break out of traditional gender roles, however, always restores patriarchal order within society in the end by punishing these women for the transgression of social boundaries. Such films depict femme fatale sympathetically and even worship their strong will at the beginning. However, an empowered woman of Film Noir stops seeing the difference between the good and evil; she seduces the main male character and leads both of them to destruction. Thus, films noir restore patriarchal order by punishing an independent, strong and disobedient woman. At the same time, Film Noir views women’s violent behavior as a result of their low status in the conventional marriage and in male-dominant society in general. Nevertheless, an image of an empowered woman is an unforgettable and most attractive feature of Film Noir.

Existential Motives in Film Noir

Dangerousness, alienation, paranoia, mistrust, and despair of Film Noir is a reflection of the atmosphere that existed within American society after World War II and during the Cold War. Violence, misogynistic attitudes and greed of the Film Noir character metaphorically presented evils of the society along with its injustice, conflict of morality, discrimination, and purposelessness. The feelings of disillusionment and cynicism that predominated in the society found their reflection in the dark films of the time. Such existential themes as alienation, loneliness, meaningless, purposelessness, absurd, chaos, violence and paranoia are presented in GildaDetour and Gun Crazy through their main characters.


The film Gilda communicates such existential themes as alienation, loneliness, meaningless, purposelessness and absurd. The film’s femme fatale, Gilda, is alienated as she does not feel comfortable within the role prescribed to her by society. By refusing to accept, as given, the gender roles as well as moral codes of the other people she feels incredibly lonely even if she is surrounded by a big number of men who worship her. Gilda feels imprisoned if she plays her role of loving and obedient wife; she chooses rather be alienated than to live in a cage of social norms of behavior. The relationship between Jonny and Gilda is not merely the story of love, but of hate. Their marriage is meaningless and absurd: instead of caring for and respecting each other, Johnny and Gilda feel delighted when hurt and humiliate one another. Jonny’s decision to marry Gilda seems logical as he had a purpose of gaining power, however, the intentions of Gilda to become a wife, but not to perform the role and flirting with other men in order to excite jealousy appear to be purposeless. In general, the film creates an impression of that the main characters are not in charge for their actions but are “subjects to darker, inner impulses – at times they seem driven by some fatal flaw within themselves” (Krutnik, “Film Noir” 47). The film shows that Jonny and Gilda are merely the products of corrupt, unfair, meaningless, purposeless and full of temptations world, and that is how it communicates its absurdity.


A highly regarded film of the same genre, Detour includes existential motif. The film and its characters serve as a dark mirror to unjust and wicked society. Al is a quintessential existential character, disparate, lost and confused by the illogical and absurd world around him. Roberts leaves New York to hitchhike and find his singer girlfriend; the protagonist ends up being lost and alienated in the unknown place having no chance to return and live the life he lived in New York. Al’s previous life is lost to him forever, his future is uncertain. The protagonist has nowhere to go, no purpose to achieve and no confidence in his fate. After the accidental death of Haskell, Al loses his identity and adopts dead man’s name and clothes. He could have adopted Haskell’s identity if he knew him better. Generally, Al manifests “‘problematized’ masculinity” (Krutnik, “Masculinity” 85). By stealing dead man’s property and participation in Vera’s evil plan, Roberts loses his innocence and identity that made him a unique man, and from then on he is preoccupied with his victimhood and loses hope for redemption. Al confesses his story to strangers which he has been isolating from the others for such a long time under the threat of death for his crimes. By telling his story, Roberts tries to organize the chaos in his head and make fate responsible for the chances he made in the past.

Gun Crazy

Another example of Film NoirGun Crazy, provides a vivid depiction of chaos, violence, and paranoia seizing human lives. The film opens with the early story of the life of Bart Tare, an alienated fourteen-year-old boy obsessive with weapons and depicts him staring at a gun in a display. He breaks the glass and gets what he wanted, however, is caught by a sheriff and sent to a reform school. After recovery from his mania, he gets attracted to femme fatale and marries her. As with any obsession, love for guns and a woman leads Tare to crime. Bart and Laurie have their own motivations that are not limited to unemployment and lack of money, however, some psychological reasons as well. From the time of their first robbery, the chaos between the wife and the husband increases The protagonist becomes lured into violence because of his obsessive love for his wife and weapon, while femme fatale simply likes to manipulate and have power over the others. Bart is inherently harmless and feels guilty for every crime they make while Laurie remains cold-blooded in all circumstances and rather fascinated by violence. Paranoia within the man arises when he realizes that they will not be able to ask anyone for help anymore as they are out of the law; they are alienated and isolated from the society with no right for return without being punished.

Such films as GildaDetour and Gun Crazy communicate the number of existential themes including alienation, loneliness, meaningless, purposelessness, absurd, chaos, violence and paranoia among others through their main characters. The protagonists and femme fatales are disappointed by their lives, as their dreams do not come true, human relationships do not fit the ideal of trust and innocence and the society is unjust and favors the people who seem not worth it. Therefore, the evil side of these characters is only a reflection of the cursed world.

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Research Critique of the Article “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction” by Amy Witkoski Stimpfel, Douglas M. Sloane and Linda H. Aiken

Research Critique

It is a commonly known fact that the psychological well-being of a person affects his or her work productivity. Nurses are no exception though people often forget about it. Society expects nurses to be responsible, hardworking and altruistic. Not surprisingly, extended work shifts are a common phenomenon in the medical environment. Furthermore, when long shifts evolve into overtime, nurses are at risk of burnout, which is likely to compromise patient care. Thus, meeting social demands can often affect work productivity, job satisfaction, and patient satisfaction negatively. While the cases of nurses’ burnout are widely represented in the existing research, its consequences for patient care lack public attention. Therefore, the study by Witkoski Stimpfel, Sloane and Aiken is worth one’s attention.

In the given research, the authors raise the issue of extended nurses’ work shifts and their consequences. There are four research questions in this study. In particular, the first research question seeks to answer what kind of relationship exists between hospital nurses’ shift length and nurse burnout. The second question determines the type of relationship between hospital nurses’ shift length and job dissatisfaction. The third question is about the relationship between hospital nurses’ shift and intention to leave the job. After that, the authors reveal the relationship between burnout, job dissatisfaction, and patient satisfaction. Moreover, researchers try to unveil whether nurses’ shift length is associated with patient satisfaction.

The hypothesis of the study is that unregulated working shift of nurses negatively affects patient satisfaction. This supposition is grounded on the previous knowledge that nurses who experience burnout and job dissatisfaction are unable to perform their work duties properly. As extended shifts affect nurses’ well-being and may lead to job dissatisfaction, they can contribute to patient dissatisfaction, as well. According to this logic, when the proportion of hospital nurses’ working shifts of more than thirteen hours increases, patients ’ dissatisfaction with care will increase too. The results of the study confirmed the hypothesis. The authors of the investigation discovered that nurses’ shift length was associated with patient satisfaction, based on the indices of the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The latter is a national, standardized data set containing information about patients’ evaluation of nursing care in acute care hospitals.

The research showed distinct regularities between the length of the shift and other variables. Thus, in a majority of cases, hospital working shifts of more than thirteen hours affected nurses’ productivity and patients’ satisfaction negatively. According to the study findings, the relationship was as follows, “increases in the proportion of nurses working shifts of more than thirteen hours were associated with increases in patient dissatisfaction” (Witkoski Stimpfel, Sloane & Aiken, 2012). Besides, increases in shift length led to enhancements in the levels of burnout, job dissatisfaction, and intention to leave the job. The proportion was preserved even after changing the number of working hours. Thus, the nurses who worked 8 – 9-hour shifts were satisfied with their job, but nurses who worked 10 – 11-hour shifts were more dissatisfied and intended to leave the job. Accordingly, those nurses who worked 12 – 13 hour shifts were even more likely to leave the job and be dissatisfied with it. Naturally, nurses who worked shifts of more than 13 hours were most likely to leave the job, experience burnout and be unable to leave the patients satisfied.

The procedure chosen to confirm the hypothesis was a secondary analysis of cross-sectional data from surveys of three different sources related to the healthcare field. Thus, the authors of the study heavily relied on the data obtained from questionnaires and most likely evaluated via a four-point Likert scale-type question. In particular, these were used for assessment of nurses’ satisfaction with the job. Meanwhile, similar measures were applied to assess patient satisfaction. To examine the relationships between the nurses’ shift length and other variables, the authors used descriptive statistics, namely the statistical analysis software SAS.

Unfortunately, the authors did not provide readers with a literature review. The introduction section of the study has implicit references to the previous research marked by the footnotes. However, the authors did not directly indicate their theoretical framework and other scholars who explored a given issue. As a matter of fact, the authors admitted that their study is the first one to explore whether nurses’ shift length is associated with patient satisfaction. Incidentally, Linda Aiken, one of the researchers, has already explored the topic of job burnout and job dissatisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Still, the issue of extended shifts and patient care was not present there. So far, there is limited research on the influence of long shifts on the quality of care, which nurses provide to patients. Accordingly, it is impossible to present the previous research due to the absence of one. To add even more, none of the scholars has had an adequate understanding of how patients’ satisfaction is affected by the extended work hours of nurses.

The research is current and relevant to the existing health issues, especially because there are no national work-hour policies for registered nurses. Therefore, this problem is still awaiting its solution. This study will hopefully contribute to the existing body of knowledge and encourage the government to take important measures.

Since this research is a cross-sectional study, it belongs to the descriptive studies. It means that compared to experimental research, there are not any experimental manipulation and random selection of groups. Furthermore, this study describes existing information to uncover new facts. To obtain the data, the authors used questionnaires, interviews, and observation. They employed samples of more than 20 000 registered nurses from different hospitals in California, New Jersey, Pennsylvania, and Florida. The sample ranged from 10 to 39 nurses per hospital. Moreover, the authors of the study had specific selection criteria. In particular, they tried to exclude nurses not working directly with patients, including those in supervisory roles. Nurses working in outpatient services, long-term care, and the operating room were excluded, as well. It was done because these nurses did not have the same shift patterns as inpatient hospitals. Thus, Witkoski Stimpfel, Sloane and Aiken collected the data to acquire the description of nurses working long shifts in order to determine the influence of their work on patient satisfaction. Hence, their study can act as a facilitator for other types of quantitative research methods. The sample was appropriate for the research and free of biases.

This work seems of significant practical value to future nurse practitioners. First, it reveals the problem of the negative impact of a lack of national work-hour policies on registered nurses. Therefore, there is a need for restricting the number of successive hours of work. According to the researchers, study results encourage policy development at national and institutional levels. From my point of view, such a study raises awareness of the nursing essence, which is a self-sacrifice. People who choose to nurse as their vocation should be ready to sacrifice their time and energy for the sake of their patients. Without that attitude, hardly ever would people make good nurses and health practitioners. Due to this article, I learned that being a nurse is not trouble-free and dealing with stressful environments is an integral part of this profession. This research is one of those studies that “can influence nurses’ quality of care, productivity, job satisfaction, and retention” (Burns & Grove, 2011). In my opinion, the study could have been improved if it covered several more states. However, the authors claim that their findings correspond to the existing body of knowledge. Thus, I do not consider the scale of a study as a serious flaw.

The language of the article is comprehensible and straightforward. The study is divided into several sections with clear headings, making it easy to grasp the meaning of what authors strive to say. At the same time, further research can be conducted on this subject. This study can become one of a national scale. It would expand even more on the existing body of knowledge and probably elucidate some nuances unnoticeable at first sight.

To conclude, “The Longer the Shifts for Hospital Nurses, the Higher the Levels of Burnout and Patient Dissatisfaction” by Amy Witkoski Stimpfel, Douglas M. Sloane and Linda H. Aiken is a significant study in the field. The authors made the first step into the unknown territory and that is their main contribution. Additionally, the research is contemporary and relevant to the existing health issues. To the best of my knowledge, there is still no national policy regulating nursing working hours. Therefore, the practical value of this article is to stimulate some change. However, the implementation of new regulations usually demands a larger scale of the problem. Probably, the researchers should have tried to cover more states in their research. Besides, their article is easy to read and understand. It gave me some important insights into what a nursing job is and I hope it would help other people to reveal its the most controversial aspects.

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Narrative Structure

“The King’s Speech” was filmed in 2010, directed by Tom Hooper, written by David Seidler. The main parts took Colin Firth, Geoffrey Rush, Helena Bonham Carter. The movie took four Oscars in 2011 for the Best Picture, Best Performance by an Actor in a Leading Role, Best Achievement in Directing, Best Writing, Original Screenplay and about 113 wins in other categories.

“The King’s Speech” is a classic Hollywood story about the struggle of the character to look perfect having severe disease and as a result getting a victory over it. The film is based on a true story of the father of the current Queen Elizabeth, the British King George VI, who became a symbol of resistance of British during World War II. This is a story of overcoming stuttering, which from an early age was the cause of his torment, complexes and low self-esteem. All the corrective speech therapies were useless. And only an eccentric self – taught speech therapist Lionel Logue was able to help the unfortunate.

“The King’s Speech” is a film about the lack of freedom. Hundreds of pairs of eyes were turned on the Duke of York while he was speaking, but he failed. The most powerful man in the country has a speaking defect that makes him so close to others. In the minds of the simple men high ranked people do not know the problems of ordinary mortals. Here is the opposite. Life of the Duke of York (Colin Firth), and later the English King, is directed by numerous rules of decency and prohibitions, and this calls only for sympathy. After the death of their father, King George IV, his elder son David (Guy Pearce) took the throne. He wasn’t able to be a good monarch and he loved a woman twice divorced, so he decided to reject. This idea of the lack of freedom of the royals is seen through the whole picture, without getting dim even in the life-affirming film’s final scene, where the King had finally defeated all his fear and he gives an outstanding speech to all his partials about the beginning of the World War II.

“The King’s Speech” is also a film about love. After all, love and the caring wife of George VI Lady Elizabeth Bowes-Laon (Helena Bonham Carter) helped him get rid of the disease and speak well. Watching after the relations of the royal couple on the screen is a pleasure. They are a model of understanding, tolerance, sensitivity, and support in times of joy and bitterness. This high culture of relations between men and women, more leveled in our time, makes the film “The King’s Speech ” a picture of lost values.

“The King’s Speech” is also a picture of high aesthetic culture, the film is retro styled. Each frame is filled with meaning, and every detail breathes history. For example, a poor interior of the working cabinet of Logue (Geoffrey Rush): a textured wall with several layers of old wallpapers, elegant sofa with sagging seat, a kerosene lamp, the phonograph. It is rare that in films of today attention to detail creates a warm atmosphere and causes nostalgic feelings of the past. This does not contradict the atmosphere and slow pace of the picture, inviting us to continuous dialogues and pauses, sharing the pleasure of the play of British actors.

The film is about a will, believe, support and care. It is being together with true friends and family, tolerating all difficulties and being brave enough to start something new. “The King’s Speech” gives an amazing impression. The narrative structure fully presents the story and the plot by different dialogues and details, humor and irony.

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The article “San Bernardino Shooters Received $28500 Just Weeks Before Attack” details the reports provided by the bodies investigating the attack at the Inland Regional Center in San Bernardino on the 2nd of December. In the course of the attack, fourteen people were killed and twenty-one injured. According to the authors, the attack was conducted by Tashfeen Malik and her husband, Syed Rizwan Farook. The two have been married since 2014, and there have been no criminal investigations opened concerning them prior to the incident. The weapons they had used were bought between 2007 and 2012, five by Farook and two by his friend Enrique. According to FBI reports, the attackers were not members of any organized terrorist organization, but they have been radicalized to violence. They could have been planning the attack for months, and it is suspected that they used the loan of $28500 that they had received from an online lender to facilitate the attack. It is also suspected that they planned to carry out more attacks due to a large amount of ammo and arms they possessed. Security agents are investigating the case to uncover additional leads and information, and President Obama is going to give a speech from the Oval Office. The US government is collaborating with the French government after Obama’s talk with the president of France over the phone.

The authors take neutral ground when covering the issues surrounding the attack. They only seek to provide the public with the available information, without taking a side. The authors do not include their opinion or that of others regarding the attack or the investigation. The article seems shallow because it only repeats the same points, without giving any details. However, the author uses a serious tone that suggests that the available information is not enough and that there is more than the government should do beyond what it has done so far.

The article has great political significance because it involves not only the US government but the world at large. In the modern world, terrorist attacks have become not individual issues but global. The article also sheds light on how much the US government has done to investigate the event that has cost fourteen lives. The authors do not take a personal position, but they hint that the agencies have done rather little for now.

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There is no doubt that nursing is an extremely challenging profession that requires not only a good education but also sincerity and devotion. According to Florence Nightingale, a prominent English nurse, nursing is not a profession, but a form of art that requires compassion and persistent preparation (Kutin, 2003). The essay aims at determining and describing my personal philosophy of nursing, based on such factors as four metaparadigms and peculiarities of nursing. Special focused is made on the strengths and weaknesses of the personal nursing philosophy.

Since early childhood, I have always dreamt to become a nurse. However, at that time, I was deeply convinced that the main responsibility of any health care worker was to wear white uniforms and caps. However, over time, my understanding of the nurses’ roles and responsibilities has drastically changed. In the process of getting an education, I have understood that nursing is a complex activity that involves a huge number of moral and ethical peculiarities. I believe that nursing is one of the most honored, rewarding, and, at the same time, challenging professions in the world. Besides, a skilled and compassionate nurse may be compared to a guardian angel as they provide many people with a second chance in lives. Moreover, because of the fact that their skills are universal, it is possible to state that nursing is crucial in the everyday life of any society. I suppose that I have chosen the right profession because the main mission of nurses is saving people’s lives. Besides, I have always dreamt about helping people from all walks of life, regardless of their financial status, religious beliefs, race, lifestyle choices, and disabilities.

In my point of view, an effective nursing practice should be based on the main theories of nursing or, in other words, four metaparadigms of nursing. These theories are considered important as they turn the nursing occupation into one of the most complicated, time-consuming, and exhausting professions in the world (Masters, 2008). Moreover, these pillars provide nursing practitioners with a direction or guidance them in education, research, and practice. The basic metaparadigms of nursing include a set of theories that describe how the nursing industry should function; they were created in order to help nurses develop their unique nursing philosophy. It should be stated that the basic metaparadigms of nursing focus on such key areas as a person, health, environment, and, finally, nursing itself (Masters, 2008).

In terms of the first metaparadigm – a person, I would like to emphasize that it is extremely important in the nursing process as it focuses on human beings. It motivates encourages nurses to deal or, in other words, cooperate with the patients that need help. In such a manner, it encourages nurses not only to care about patients because of a sense of duty but also to nurture them and help them manage their health issues to the best of the own abilities (Masters, 2008). In my opinion, as a nurse, I have to convince every patient that I am not indifferent and truly make all efforts in order to help them cope with health problems. In general, nurses are responsible not only for the physical health of their patients but also for their spiritual, mental, sociocultural, and, finally, psychological well-being.

Therefore, the second metaparadigm of nursing that is usually referred to as the environment is no less important in my practice area (Masters, 2008). I am convinced that this theory considers the surrounding that may affect the health of patients either positively or negatively. It is important to note that the environmental component consists of numerous internal and external factors that should be controlled and managed effectively by nurses. Interactions with relatives and friends are included in the environmental paradigm. In addition, culture, geographic location, and even economic conditions are the other integral parts. I believe that one of the vital responsibilities of nurses deals with controlling and regulating the negative environmental influences because they may impact the recovery process or wellbeing of patients. Thus, as a nursing practitioner, I should create positive internal and external conditions in order to improve the life of patients in their environment. Moreover, I believe that every professional nurse should remember that such external environmental factors as fresh air, quietness, as well as cleanliness,  should be successfully managed. The failure to provide these benefits destroys the harmony in patients, as well as affects the external and internal environments that influence their health.

I suppose that such metaparadigmatic factor as health should be included in the personal nursing philosophy of every nurse that values this profession. In general, the health component refers to the access of patients to the quality healthcare services (Masters, 2008). The absence of illness is not always a direct synonym to such terms as physical and mental health and general well-being. The health metaparadigm motivates professionals, as well as beginners, in the sphere of nursing to contribute not only to the physical health of patients but also to their feelings of happiness, contentment, and pleasure. In many cases, intellectual, spiritual, and, finally, the emotional wellbeing of patients depends on nurses and the ways they treat their patients.

Finally, according to the fourth metaparadigmatic principle that involves the nursing component, the delivery of healthcare services by nurses influences the optimal health outcomes for patients (Masters, 2008). I believe that such efficient tools as communication, as well as well-developed personal skills and knowledge, will assist me in the process of maintaining good relationships with my patients and, consequently, in contributing to their physical, mental, and emotional health.

Taking into account the four basic metaparadigms of nursing, I would like to stress that my personal nursing philosophy is based on such beneficial features as fulfillment, patient-centered care, and, finally, professional clinical competence. To be honest, looking back at my nursing education and practice, I understand that caring for patients brings me a sense of fulfillment and pleasure. In my opinion, intelligence, knowledge, respect for dignity, care, and involvement in the processes of decision-making are the most widespread patients’ expectations of professional nurses. My nursing philosophy is characterized by such features as holistic and culturally sensitive care for people who need my help. Furthermore, I try to do my best in order to be not only a nurse but also a friend, teacher, effective leader and manager, and even a patient advocate. However, like any other person engaged in the sphere of nursing, I make mistakes. In other words, except numerous benefits, my philosophy of nursing is characterized by several weaknesses or limitations. For example, such negative features as nervousness and inability to cope with external pressures or stressors are my biggest weaknesses. Taking into account the limitations of my personal philosophy of nursing, I would like to confess that it does not allow me to disguise the feeling of anxiety, fear, despair, regret and to fight back the tears when I look into the eyes of patients knowing that he or she is hopeless while I am powerless. In other words, the so-called psychological and emotional exhaustion is the biggest limitation of my nursing philosophy. Moreover, despite the fact that such positive features as care, compassion, and devotion are the pillars of my philosophy, these values blur the line between my professional duties and personal feelings and hopes.

As a result, having analyzed the nature of nursing, I can summarize that nursing is not an easy profession and involves numerous hardships and challenges. However, at the same time, it is one of the most emotionally and mentally rewarding occupations in the world. According to the nursing metaparadigms, every professional nurse is responsible not only for the physical health of the patients but also for their emotional and spiritual wellbeing. In general, nursing is not a job, but a way of life that involves compassion, patience, love, respect, care, and altruism.

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Nurses constitute one of the main professional groups in the health care sector. It follows that they have a profound impact on policy formulation and implementation. Additionally, their numbers and role also have a significant influence by changing the existing policies where necessary. For this reason, nurses should advocate on behalf of the other health care professionals across health care various health care roles and environments. In this case, they would have captured and exploited emerging opportunities. Logically, it is important for any nurse to work with others in ensuring that necessary policy changes are made where necessary. Despite the profession’s strengths intrinsic to its diversity, size, and distinctive relationship with the public, the nurses’ full potential of key stakeholders or influencers have not been fully exploited. Rationally, most of the problems faced by the nursing profession and the entire health care sector are rooted in policies. Focusing on this aspect, this paper explores some of the nursing policy areas that need attention.

Nursing Policy Areas that Need Attention

One of the key changes or reforms that need attention regards educational and staffing policies. There is an urgent need to increase the number of nurses with baccalaureate degrees and encourage nurses with diplomas and associate degrees to join baccalaureate programs soon after graduation. In recognition of the observation that education creates a difference in clinical practice, baccalaureate programs should be a central educational pillar of the professional. Baccalaureate degree holders have impeccable patient outcomes in terms of lower failure-to-rescue and mortality rates (AACN, 2011). Besides, proficiency in making nursing diagnoses and evaluating interventions helps nurses demonstrate professionalism and improved research skills. To achieve these changes, nurses should co-operate with the government to ensure that investments in nursing career ladder programs are increased. Additionally, the government should improve its support for baccalaureate programs through funding frameworks like the Nursing Workforce Development initiatives.

The other area that warrants every policy maker’s attention regards leadership development within nursing education programs. At the same line, nurses should champion improved interdisciplinary education (AACN, 2011). In that respect, the health care system will improve quality, affordability, and efficiency delivered by qualified professionals who employ the full scope of their nursing education and training. As highlighted above, high-quality care depends on the adequate supply of nursing professionals. Therefore, nurses must campaign for the increased investment in a mix of highly skilled providers, especially nurses prepared for both leadership and clinical roles (Huber, 2013). Consequentially, nurses will complement their colleagues’ skills and knowledge. In that line of thinking, inter-disciplinary learning should be supported from various fronts.

Lastly, nurses should gather enough data concerning remuneration to ensure that policies regarding their salary and benefits packages provide sufficient information. Timely and accurate data would be used to create competitive packages, which would, in turn, be used to address the nursing shortage. Reasonably, competitive remuneration packages would encourage more students to undertake the nursing profession. In the same context, nursing educators should be well compensated to improve the number of educators. A good salary would not only lure nurses to undertake doctoral degrees but also limit the number of potential nurses moving to private clinical settings due to higher salaries.


Nurses can only impact policies within their profession and the entire health care sector if they change their attitude and style. They need to be more creative and illustrate their natural abilities and insight to impact on their duties where and when necessary rather than being rigid-bureaucratic. Additionally, they should stand as pillars of critical thinkers, leaders, and patient advocates. Furthermore, nursing leadership should have an influence on policies determining staffing, administrative work, workload, skill mix, and educational programs among other key issues ailing the sector. Finally, nurses would have improved their impact on nursing policies. Thus, nurses must be able to shape policies within the health care settings rather than see it as a change induced by the other stakeholders in the health care sector.

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The Gibbs framework for reflective essay writing is a model created in 1988 by Prof Graham Gibbs. The model provides a way of reflection which learners and anybody can use to have a clear overview of the activities they have undertaken in the recent past. The model, which is sometimes known as an iterative model, implies that the student learns through repetition of the same activity and is required to reflect on the steps through which the activity is done (Department of Health 2007, p. 2). Gibbs framework has six stages that can help the student to evaluate and reflect on the actions or activities within a given setting. Because of its repeating cycle, the model is effective for understanding routine activities such as nursing in a medical ward.

Description of framework


The Gibbs model is a popular six-stage model used in reflection. The model is mostly applied in nursing reflection because of its continuity and its applicability to repetitive activities. This section of the paper will provide a description of the stages of the Gibbs framework.

Gibbs Framework

The model has six main stages. The first stage is the description of where the student is supposed to know precisely what happened. The second stage is the feeling that the student experienced while performing the said activity (Ely & Scott 2007, p. 15). The third stage is the evaluation of the activity including what went right and wrong. In this stage, the student will be able to identify improvements that might be essential for the future process. The fourth stage is the analysis. It includes critical analysis, where the student tries to make sense of why the certain activity was undertaken and what was done (Bulman & Schutz 2013, p. 76). The fifth stage is the conclusion where the student is expected to outline exactly what has been learned throughout the experience and identify areas that might require improvement or changes in the future (Moon 2013, p. 17). The last stage is the action plan where the student identifies the requirements for better preparation in the future experience, he/she identifies possible areas of improvement, priority areas, and the specific steps that must be taken in the future to meet the suggested improvements.


This model is particularly important when the student or the person involved in doing some activity wants to challenge the underlying assumptions. It is also essential where there is a need to explore new ideas and approaches as well as promote self-improvement. Most importantly, the student can also identify areas of strengths and weaknesses and thus, take essential actions to address them.



The use of the Gibbs framework in reflection means that the process is broken down into stages. In this section of the paper, I use the six stages to reflect on the successes of my work as a nurse in a medical ward. The model will be helpful in identifying the successes and failures and also how to improve later.


Working as a nurse in a medical ward is one of the most fulfilling but also challenging tasks one may hold in a health institution. For a start, it is sometimes a repetitive activity as you find patients lying on the same bed and sometimes suffering from the same illnesses as the others. As a result, there is a strong tendency to base the work on assumptions about the patients and the work that is done in a medical ward (Price & Harrington 2010, p. 9). However, it is important to understand that each patient is unique and presents new challenges or new opportunities for the nurse to offer their care services. As a nurse working full time in a medical ward, I have had to deal with many patients on a daily basis, which has given me a sense of appreciation for good health and also spurred in me the need to serve people regardless of their medical condition. I consider my presence in a medical ward as a work of passion whenever I think about the patients I have served and who left the medical ward with smiles on their faces (Butts & Rich 2015, p. 21).


As a part-time masters student, I am always pressed for time. In most cases, I leave the medical ward at 5 pm irrespective of what is going on there. On a particular day, we were going in for our continuous assessment and I did not want to miss it. When the time came, I immediately rushed out. However, at the door, I met an old woman who seemed to be in much pain from the way she was screaming (Bulman & Schutz 2013, p. 19). I knew my partner was running late and, therefore, would not be in time to help the poor woman. Thus, I decided to stay longer and attend to her regardless of what I was going to do next. The woman had broken her leg when she fell in her house. Based on the fact that she lived alone, it had taken long for her to be discovered and taken to the hospital (Quinn 2000, p. 32). The accident happened in the morning and she came in for treatment in the evening. Thus, she was in great pain and needed immediate attention.


Working in a medical ward can be challenging sometimes. For me particularly, the incident with an elderly woman screaming at the top of her voice was challenging and emotional. I am glad that I was able to be the first to react against my routine of having to leave the medical ward no matter what the situation was when my time arrived. Particularly, I am impressed because, apart from acting ethically to save the elderly woman from pain, I also did not miss any exams since there had been communication of postponement due to this situation. During the treatment of the patient, I am glad that I was around to assist the doctor in examining the patient and quickly providing the necessary treatment. Indeed, within a half an hour of examination, the elderly woman was feeling relaxed and comfortable and was not screaming any more (Daly 2005, p. 11). Other patients in the hospital felt confident in our services and I could see that some of them actually waved at me when I was finally leaving for home. One lesson I learned from the incident is never to act selfishly when it comes to providing the services to patients in a health care institution. I had the right to leave since my official time of leaving had come but the situation demanded that I had to stay a little longer, which was worthwhile.


The ethical practice for nurses requires that nurses work with passion and unselfishness. There is also the Hippocratic Oath, where medical officers vow to serve their clients without looking down upon them (Callara 2008, p. 2). Many health care professionals tend to overlook small but very important policies and requirements for one to become a nurse. The Nursing and Midwifery Council Code of Professional Conduct (2004, section 8) requires nurses to act in a manner that will minimize the risks to the patient. This is largely applicable to my situation as a nurse working in the medical ward.


Analyzing the incident, I am glad that I acted quickly and within the policies set for nurses. I can now see that my action saved the client from much pain and also brought comfort to the medical ward, where there were many clients. Discussing this with my mentor, later on, revealed that my performance in the medical ward had been above average even though I needed to work closely with my colleagues to pass the same skills and perceptions about working in a medical ward (Brotherton & Parker 2013, p. 35). I discovered that I needed to support my colleagues more to understand the challenges in their work environment so that they would be able to provide better services.

Action Plan

In future, I will want to develop the skills of my colleagues concerning working in a medical ward and ensuring that they put everything about the patient before their selfish interests (Doel & Shardlow 2009, p. 12). My goal of learning will be about how to work with colleagues effectively, and about the strategies that I need to use to achieve this.

To conclude this section of the paper, the six stages of the Gibbs framework are essential when it comes to reflecting on nursing work. They allow the reflection to be systematic and to identify areas that were done appropriately and those that require improvement.



In this section of the paper, I will provide the critique of the Gibbs framework and how it has contributed to my understanding of the situation I have experienced in the medical ward at my place of work.

One criticism of the Gibbs framework is the assumption that the events are repetitive in their very nature and, therefore, the student meets the same sequence of events. It is a faulty assumption because even though the activities might seem similar, they are always different (Davies & Bullman 2011, p. 13). Thus, the model cannot be used to understand unique events that are not repeated. Despite this, Gibbs framework offers the student an opportunity to have an action plan in case the same incident is to happen. This is especially important for areas like nursing, where learning from experience is an important aspect of acquiring professional skills. Moreover, the framework provides identifiable steps through which a user can identify the lessons learned and the challenges experienced during the execution of a certain task (Speedy & Jackson 2009, p. 32). This is particularly important as it provides an opportunity to learn each step independently and identify what could have been done differently in the respect of the outcomes. It provides the opportunity for somebody looking at an incident to evaluate it against the strengths and weaknesses demonstrated and to have areas where improvement should focus.

In conclusion, the critics of the Gibbs framework do not acknowledge the fact that the model is suited to some repetitive functions such as nursing. In my evaluation, the framework can help nurses to understand the dynamics in their place of work.


Gibbs framework is a good model for understanding the experiences that nurses are likely to have inside the medical wards. To begin with, they may not be able to describe the situation that they are experiencing in clear terms. They may also not be able to provide an analysis or even an action plan on how to handle future incidents (Jasper 2010, p. 22). However, using the Gibbs framework, they will have a guideline upon which they can build their understanding of their experiences and be able to reflect on such experiences in a manner that could improve their future experiences.

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This paper examines the outcomes of learning and experiences that I gained in the course of my Associate Degree in Nursing Program. The paper takes a keen interest in analyzing the experiences that I gained in safe patient-centered care, caring for behavior, communication techniques, clinical judgment, collaboration, and leadership.

Safe Patient-Centered Care

Safe patient-centered care refers to the process of providing health care services to patients with a key objective to meet their health demands and ensure that they get satisfaction from the services offered to them. All healthcare workers strive to give their undivided attention to their respective patients. The major aim is to ensure that patients fully recover from their illnesses and derive some satisfaction from the care given to them. In the course of my Associate Degree Nursing Program, I was able to gain clinical experience. Patient-centered care is one of the services that I offered with much passion and commitment. I actively interacted with patients, staff members, and the clinic’s administration body (Arnold & Boggs, 2015). I learned that, for effective and satisfactory services, I had to follow the nursing principles and values. Therefore, I have incorporated into my work the consideration that all healthcare workers are caregivers. This view has helped me and my coworkers in providing professional services to all patients.

I have also learned that healing does not occur instantly. Patients take time to recover from their illnesses after receiving medical care. It is, therefore, important that I establish a professional relationship with patients to enable me to carry out a follow-up of their healing processes. I worked hard to ensure that the type of care offered to patients was in line with their tastes, values, and demands. An effective safe patient-centered care demands a clean environment that does not comprise the healing process of patients (Wang, Hailey, & Yu, 2011). To achieve this, I realized that I needed to give my patients emotional support by counseling and encouraging them to have a peaceful mind that would enhance the process of healing. During my practice, I participated in the community and voluntary activities that provided me with more time of contact with patients. The activities also gave me numerous opportunities to practice my skills in providing services to different patients. In several occasions, I anticipated the needs of patients and worked out ways to help them. I never failed to remind myself that patient safety should always be my number one priority under all circumstances.

Caring Behaviors

Caring behaviors are the features that nurses are required to put into practice while offering services to patients. They are expected to show some sense of passion and care to their patients. For instance, nurses should learn to be good listeners, pay attention to the needs and demands of the patients, show respect, and provide a wide range of information that will assist patients in decision making. Nurses should learn to show responsibility and sensitivity to patients as well. Calling patients by their names, showing them directions within the hospital premises, helping too weak patients to walk around the hospital are some of the caring behaviors that are expected from nurses (Wolf, Giardino, Osborne, & Ambrose, 2012). Moreover, they may try to soothe and calm their patients by touching them while making consultations.

I had experienced an occasion during my field practice that required me to illustrate my caring behaviors as a nurse. I was taking my rounds in a hospital in Memphis when a patient started weeping because his family members could not afford the cost of the hospital bills. She was giving up the fight for her life because she felt that she had become a sort of a burden to her family. I comforted her and listened to her explanation of the situation. I also offered the patient various options for raising money for such expenses. I encouraged her to be strong and have faith in herself. When she recovered from her emotional breakdown, she appreciated my assistance to her. I was impressed with myself because I had just put into practice the values that I had learned during my Associate Degree Program (Smith, Wolf, & Turkel, 2012).

Communication Techniques

The nursing profession puts much emphasis on developing and maintaining a good communication system between patients and their caregivers. Nurses should learn and accept that patients are the most delicate persons that they have to deal with throughout their profession. Therefore, good communication skills and techniques are paramount to their practice. Communication is essential for a successful outcome of personalized nursing care to patients. Nurses should, therefore, demonstrate a good sense of confidentiality, sincerity, courtesy, and kindness. Some of the essential basics of communication include proper timing, accuracy, and the mode through which communication is conducted (Smith & Turkel, 2012). While communicating with patients, nurses should ensure that patients are comfortable with them and offer adequate space that protects their privacy. For instance, in a mental hospital, nurses should practice proper therapeutic communication techniques in finding out the problems that respective patients have and find skills that will help them cope with the situations.

Clinical Judgment

It involves decision making that is geared towards providing solutions to problems that arise in the process of offering nursing care to patients. It is based on the needs and responses of patients. Clinical judgment assists nurses in making sound decisions that do compromise the health conditions of their patients. It also helps in limiting the chances of making mistakes while offering health care to patients. For instance, during my practice, I took care of a patient who was admitted to the ICU following an accident that he was involved in with other family members. Given that he was the only one surviving, I had to keep the information from him till he achieved a stable health condition (McSherry, MSherry, & Watson, 2012). It worked effectively to avoid more complications that would have resulted.


Collaboration among nurses requires deliberate sharing of knowledge and responsibility in taking care of patients. It helps nurses offer quality services because they assist each other in managing their duties. Collaboration also enhances sharing information and conducting discussions that help nurses find effective solutions to problems that they face in caring for patients (Smith, Wolf, & Turkel, 2012). Collaboration helps in setting goals, sharing responsibilities, and problem-solving. During my practice, I witnessed a great deal of collaboration among nurses and doctors in the operation room. I watched them share responsibilities and coordinate duties, and I was inspired.


Leadership is the ability to influence other people to follow your beliefs and way of action. Effective nursing leadership calls for a commitment to duty, building a culture of service, focus on patient satisfaction, and accountability (Arnold & Boggs, 2015). This type of leadership incorporates nursing values for its success. For instance, during my practice, I learned so much from charge nurses as they delegated duties and ensured that they were performed effectively.


I have learned much in my nursing practice. I have learned that the most important thing to be a successful nurse is passion and setting priorities. Sound decision making, collaboration, and responsibility are essential qualities of a nurse. Now I feel that I am ready for the profession of nursing and I can also contribute to delivering quality services to patients and the community.

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A nursing care delivery system identifies how the nursing staff works, its organization, and the distribution of the duties for providing appropriate nursing care. Care delivery systems are in charge of the successful nursing care and clinical results. They provide the organization, rules, and structure that determine responsibility and control. This paper studies the newest models of nursing care delivery and discusses the role of the innovations in this sphere.

Unfortunately, health care is still expensive and inaccessible to many people all over the world, especially in undeveloped countries. Current health care system lacks the innovative business models. However, nowadays, the business models in health care gradually develop (Skolnik, 2012).

Before speaking about the innovative methods of nursing care delivery, it is important to mention the standard models and why the innovations are better and improved. The typical system for organizing nursing care is Total Patient Care. It plans, arranges, and implements all aspects of nursing care. It is autonomous, united patient care with a clear distribution of responsibilities. It combines all the aspects of nursing care delivery. However, this method is not profitable. It is costly as it needs the employment of many nurses. The second model is Functional Nursing. There must be a specialist for each assigned task. Team Nursing is the third standard model. There are several teams of nurses with the leader; each team has to provide care for the appointed group of patients. Primary Nursing is another type of care delivery that involves not only nursing, but also documentation, and so on. Primary Nursing means total and complete care. The essence of this method lies in the fact that one nurse provides full care for a small group of patients who stay in the hospital.

One of the newest nursing models of care delivery is the so-called Partners in Caring. This model is a new way of nursing care delivery; it lies in the nurse-nurse assistant partnership. The reason for its increasing popularity is that this approach increases the retention rates of the new nurses as it is based on joint efforts. It is the goal of this program. The professional development and opportunities for new nurse graduates are also important aspects (Seifer, 2001).

The nursing partners focus on the patient. They organize different parts of complex patient care. There are three goals in the work of this method: improving the health of the patients, developing and supporting an improved system, and providing low-priced but high-quality health care. This model is a great benefit to time management. Changing the work roles and transforming communication patterns are the characteristics of this new model. The patients feel the positive results of this method as well.

It is also important to mention another innovation in the sphere of nursing care delivery – the so-called Program of All-inclusive Care for the Elderly (PACE). The principal goal of this program is the prevention of the unnecessary use of hospital and nursing home care. Every month, Medicare and Medicaid programs pay or give grants to PACE. This program helps the patients in the day centers and clinics, their homes, hospitals, and nursing homes. Patients who are unqualified for Medicaid pay on their own. The consequences of the Program of All-inclusive Care for the Elderly are quite positive. The customers are very satisfied as this innovation helps to decrease the use of institutional care; it controls the use of medical services. The great advantage is that it tries to save the costs of not only private customers but also such public organizations as Medicare and Medicaid Minnesota Department of Human Services, 2011).

In conclusion, the number of older people in the United States gradually increases, and it arouses the healthcare providers to provide high-quality care. Nowadays, it is essential for people to get sufficient but not expensive medical support. The PACE model and Partners in Caring method are comprehensive. They work without the involvement of a big staff of nurses. This system of care delivery is good not only in the aspect of the appropriate patient care, but it is also financially effective.

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Nursing is a career that combines the art of caring for patients with definite knowledge and skills obtained through learning and occupation. Over the past years, the United States of America has faced a shortage of nurses. The inadequate number of skilled nurses has an adverse impact on the general patient outcome including mortality. Therefore, there is a need for the government to address this issue so that it does not impair the health and wellbeing of millions of people (Rubin, 2015).

Many factors have combined to produce a nursing shortage in the United States. Short staffing and restructuring are the factors that put off many nurses. They lack professional resources to fight back these threats. Most of the nurses are not ready to face their growing job burnout. The realization that they are not meeting their responsibilities toward their patients is demoralizing and makes them turn away from their occupation. Also, many hospital administrators, whenever faced with financial complications, tend to degrade the role of nurses. They increase the workload of registered nurses time after time (Allen, 2015). They also allow unlicensed assistive workers to perform critical nursing duties. Such issues make nurses feel insignificant to the extent of resigning.

Nursing also has been regarded as a profession for womankind. Today, many females in the United States are presented with a wider variety of career choices than in the past. Men are still not joining the nursing profession in significant numbers. The nursing workforce is also aging, and few new nurses are being trained to replace them. Insufficient financial support has also hindered efforts to train enough numbers of new nurses, and the working nurses are underpaid. Some nursing schools have therefore turned down or waitlisted many competent candidates (Carthon, Nguyen, Pancir, & Chittams, 2015).

The nursing shortage comes along with some consequences. The available nurses suffer from heavy workloads. They work long hours to meet the demands. The nurses suffering from such working conditions are prone to mistakes and medical errors. Therefore, the quality of services offered to the patient is diminished and the number of readmissions increases which only builds up the daily workload of the nurses (Aydin, Donaldson, Stotts, Fridman, & Brown, 2015). The mortality rate also tends to rise as some patients receive the wrong diagnosis while some are left unattended. The labor force also may reduce affecting the country’s productivity and general outcome.

The nurse shortage is a threat to healthcare. Therefore, there is a need to lay down strategies to solve the problem accordingly. Career progression inventiveness needs to be developed to move nursing graduates through graduate studies more rapidly. Healthcare employers need to be supported to create and sustain staff development programs and lifelong learning for continued competence (DesRoches, Buerhaus, Dittus & Donelan, 2015). Counselors and youth organizations should be established in high schools to recruit more young and diverse population into nursing. In work environments, strategies to retain experienced nurses should be put in place. They should enjoy the appropriate salary and benefits programs. Those who serve as mentors to the new workforce should also be rewarded. Decision-makers in hospitals should redesign work to enable the aging workforce to remain in direct care roles (Seldomridge, 2015).

In conclusion, to inspire growth and deployment of the nursing staff with skills suitable for a healthcare organization, the public, administrators, and professionals should take part in the ongoing long-term workforce planning. This is regardless of the perceived or real pressures related to the short-term demand for nursing services (Allen, 2015). Without agencies to enforce these changes, the nation is in danger of facing serious failures in the healthcare system. Strategies to recruit and retain are costly but notwithstanding must be implemented. Some measures must be imposed to ensure that these efforts will be accompanied by specific strategies to overcome workforce concerns acknowledging the long-term obligation to a career in nursing.

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This paper explores the establishment and development of the nursing curriculum. The nursing program in educational affiliations is considered to be the sum of nursing and supportive courses aimed at achieving professional skills. It becomes the consequence of content-related, evidence-informed and unified process with clearly defined goals, as well as methodology and outcomes learning. Grounding on philosophical approaches and coherent learning theories, and in accordance with stakeholders’ recommendations, faculty members generate the curriculum that will fit the needs of society in the best way. Moreover, stakeholders are described as the main triggers of changes in response to contemporary challenges. The development of the curriculum starts with the foundation of institutional vision statements that express the mission of the educational curriculum. The efficacy of the program results in the correspondence between vision statements and terminal objectives. Behavioral, cognitivist, and humanistic learning theories support the continuity of the acquisition of professional skills. Vertical and horizontal threads of curriculum structure, which contribute to the specific professional and common social values, provide relationships among the courses. Therefore, this paper examines how all the defined elements of the curriculum relate, supplement each other and reflect contemporary healthcare.


Nursing is considered one of the most changing professional activities related to the broad set of specific skills. Thus, there is a constant need for a flexible, comprehensive and contemporary nursing curriculum. Its development means finding the optimal balance between theory and practice. Moreover, professional nursing education should respond to the need of time and social values. All the challenges are manifested in the establishment of the faculty’s curriculum work and stakeholders’ support, precise vision statements, and meaningful outcomes. The dynamic structure of a curriculum based on learning theories and congruent threads within the courses contributes to permanent improvement.

Curriculum Model

The nursing curriculum is supposed to be a program of courses designated for the learner to achieve the desired knowledge and skills in the field of competency. The curriculum is manifested in the sequence of written plans in central and supportive courses that allow achieving experiences in response to the envisioned goals of the profession (Iwasiw, Goldenberg, & Andrusyszyn, 2009, p. 4). The required experiences are developed within the theoretical and practical systems. Moreover, the efficacy of curriculum implementation highly depends on its adaptability to the current social demands. Hence, the generation of the curriculum involves concise planning of the educational process based on social, humanistic, and learning theoretical frameworks reinforced by the students’ past experiences and current needs of the community.

According to the abovementioned definition, the nursing curriculum should include the institutional mission, or purpose, strategy, context, experience, and evaluation of the program. Iwasiw et al. (2009) consider the nursing curriculum as a set of philosophical approaches, goals, program frameworks, educational courses with resources, methodologies, and close interactions in the learning environment. Moreover, the logistics of the educational process, which refer to leadership, decision-making, and the functional structure of working groups, produce efficacious outcomes.

The nursing curriculum is supposed to be a three-dimensional scholarly endeavor. It is centered on the evidence-informed, context-relevant and unified properties of the educational process (Iwasiw et al., p. 4). Evidence provides a dynamic and realistic character for curriculum development. Its relevance to the context involves the analysis of the environmental factors that shape the program of the institution. Social and professional trends of the outer environment are taken into account as well. The unification of the curriculum means close relationships and feedback of the philosophical approaches, curriculum concepts, and curricular objects.

The Role of Stakeholders

The application of nursing curriculum to the real world means taking into account the needs and interests of all participants of the healthcare system. This system incorporates the strategies of policymakers, the needs of the community, the work of medical and social organizations, as well as the missions of teaching units. The latter respond to the needs of all the mentioned stakeholders while generating the curriculum in the field.

A vibrant curriculum requires a permanent reanalysis of the programs and courses by the nursing faculty. According to the research by Keogh, Fourie, Watson, & Gay (2010), the involvement of the stakeholders in the curriculum process generated changes, broader discussions, and consideration for the needs of social groups. Nurse practitioners, doctors, and policymakers can direct the development of curriculum in the needed way. As a result, it will become context-relevant.

The reports of stakeholders on the global – such as World Health Organization – and national – like the Institute of Medicine and the American Association of Colleges of Nursing – allow the curriculum to correspond to the contemporary needs of the society (Sonenberg, Truglio-Londrigan, & Mcleod-Sordjan, 2014, p. 2). In particular, a national healthcare reform involves comprehensive population-based practices in nursing. The continuous process of implementation suggests the upgrading of the nursing curriculum in educational affiliations. The evaluation process suggests the engagement of stakeholders in the provision of accreditation standards and the monitoring of healthcare delivery.

The consensus between the stakeholders’ and the faculty’s vision can be effective only in the case of strong leadership. Leadership and collaboration during the curriculum preparation enable the stakeholders to find their places in the process. Bringing the recommendations of stakeholders into reality means making curriculum development a shared and democratic endeavor (Keating, 2011, p. 189). Therefore, curriculum developers construct some general mission and vision statements. Vision statements are fulfilled by being rooted in the terminal objectives.

Institutional Vision Statements and Terminal Objectives of the Nursing Curriculum

Institutional mission and vision statements create the grounds for terminal objectives of the nursing curriculum to be achieved. Educational affiliations provide the environment required for the generation of professionals in nursing. As a rule, vision statements of American colleges and universities refer to the learning, research, and services domains (Keating, 2011, p. 190).

The implementation of terminal objectives relies on the institutional mission. The overall mission of the institution is manifested in the generation of modern, student-centered education, the primary experience in nursing practice and research products. This approach allows the terminal objectives to be achieved. The stated vision of the institution serves as the guiding principle for curriculum development and the future of an institution. Mostly, the mission directs educational activity towards the desired outcomes and expectations of society.

Depending on the baccalaureate or master’s level of the program, terminal objectives of the nursing curricula can differ or supplement each other. Although, the core professional properties of a nurse are under consideration in all curriculum. They include the broad spectrum of acquired “skills, knowledge, and attitudes” (Keating, 2011, p. 87). The theoretical knowledge and practical skills must represent the variety of relevant learning actions that incorporate curriculum’s goals and strategy (Iwasiw et al., 2009, p. 14). Terminal objectives are the final interpretation of institutional mission and vision statements. They are assessed at the end of the modules or courses on the basis of acquired competencies.

In particular, most healthcare educational affiliations distinguish a number of common terminal objectives in nursing. According to them, students have to able to apply advanced knowledge and skills of holistic care in clinical and community settings, as well as incorporate theory, research and practice while delivering health care (Billings & Halstead, 2010, p.147). In addition, in response to the current demands of the healthcare field, terminal objectives should include such competencies as leadership, participation in the policymaking, and life-long self-development (Billings & Halstead, 2010, p.147).

Philosophical Approaches and Learning Theories

Educational objectives are based on the domains of philosophical approaches and learning theories. Institutional strategies of the curriculum depending on the theoretical framework shaped by the learning theories. The unified character of the curriculum supposes philosophical approaches to the courses threads and goals, as well as the quality of learning interactions (Iwasiw et al., 2009, p. 8). The process of finding an appropriate set of theoretical approaches requires the evaluation of past experiences in nursing teaching and practice. It means that the faculty responsible for the curriculum has to do profound work.

As a result, philosophical approaches help make the learning process more adjustable to practical needs. Successful implementation and development of nursing courses suppose the application of a set of learning theories. This theoretical framework includes classic theories and their adjustments. Classical ideas concern behavioral theories, social cognitive theory, cognitive learning, and humanistic theories, which explain how the learners and teachers will interact in the most effective way.

On one hand, behavioral concepts concern the construction of desired behavior and the processes of conditioning. Classical conditioning is manifested in the responses to the distinct stimuli, such as an emotional response of the learner to the objects and environment of learning. Operational conditioning deals with “rewarding desired behavior” to reinforce its reiteration (Keating, 2011, p. 67). This theory suits the purposes of skills acquisition well.

On the other hand, cognitive theories imply the importance of an internal character of learning based on “understanding, thinking, organizing, and consciousness” (Aliakbari, Parvin, Heidari, & Haghani, 2015). In the process of information evaluation and the exploration of new issues, the learners become able to analyze and make decisions. Moreover, students acquire skills that are essential for educational activities. Gestalt theory explains how the well-established patterns of training, instead of repetition, provide continuity of thinking and understanding (Aliakbari et al., 2015). Piaget’s theory stresses the role of the exploratory process in teaching, which is the guiding principle in the constructivist theory (Aliakbari et al., 2015). The observation of nursing practices as a new experience constitutes the key meaning of social learning theory.

Finally, the humanistic theory sustains the humanistic values of the teacher as the role model for the purposeful teaching-learning interaction. The concept of humanism means growing positive people to make them discover their potential. The humanistic approach supports student-centered learning where positive emotions and self-actualization reinforce the desired outcomes (Billings & Halstead, 2010, p. 224). Keating (2011, p. 79) supports the idea that teachers are facilitators who help students find meaning and stimuli on the way to significant learning. However, the theory appears to be almost impossible to implement. It requires high professionalism and creativity from the teacher and empathetical attitude to all the learners.

Strands and Threads in the Curriculum

The development of a curriculum requires the establishment of the educational structure, where the basic elements of the nursing program are congruent with each other. Consequently, vertical and horizontal strands of the curricular matrix should maintain context at all educational levels. They are manifested by major threads, which are related to the program’s goals and terminating objectives of the curriculum (Billings & Halstead, 2010, p .515). Well-established strands guarantee the continuity of professional knowledge and principal skills throughout the courses. Those basic elements establish the integrity of the nursing curriculum while being involved in the set of courses. Moreover, such points focus on health, caring, critical thinking, patients and professional behavior.

Vertical strands change over time in complexity, thus directing every next level of learning to the terminal objectives. Past experience of the learners and its reiteration constitute the meaning of the vertical strands (Billings & Halstead, 2010, p. 515). They may differ in response to the specialty and course requirements. Such threads are designated for both theoretical and practical application. However, there are still some essential issues that require focus while preparing nursing professionals. “Nutrition, pharmacology, individual/family/group, care (acute, rehabilitative, chronic), primary/secondary/tertiary prevention, hospital/community settings” constitute the most common threads (Novotny & Griffin, 2011, p. 87). Leadership has become an essential vertical strand over the past decades.

Meanwhile, horizontal strands provide the flow and share of specific and supportive knowledge. They refer to the processes that contribute to the application of the curricular content on all levels of mastery. Horizontal threads may focus on clinical activities as well as communication issues. Horizontal strands often serve a supportive purpose on the way to making nursing courses meaningful and successful.


Altogether, modern nursing curriculum appears to be the product of a long-term analysis of nursing practices, learning processes, and social functions. All these factors generate the model of evidence-informed, context-relevant and unified program that consists of professional and supportive courses. They are interconnected by the common vision of faculty and stakeholders and based on the theoretical and practical frameworks of learning and desired outcomes for nursing students. Therefore, the components are combined in one curricular matrix, which is dependent on the current societal and learning attributes. The multi-dimensional structure of the nursing curriculum is supported by theoretical and practical threads. As each component of the curriculum influences the efficacy of the educational system, its development should become an essential part of the preparation of nursing professionals.

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