Essay on Promoting Self-Cannulation: Applying Watson's Theory of Caring to End-Stage Renal Disease

Introduction

Because I work in-center dialysis setting where I am tasked with taking care of patients with end-stage renal disease, I am interested in promoting self-cannulation. I believe that if patients have more control over their needle insertion, it will mitigate pain or anxiety during their dialysis treatment. The need to promote self-cannulation is attributed to the fact that one of the top stressors for most patients is needle insertion during treatment.

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Watson's Theory of Caring

Jean Watson's Theory of Caring is primarily concerned with ways through which nurses care for their patients, and the caring proceeds into improved planning to enhance health and wellness, deter illness, and restore health. This nursing theory further states that care for patients can be manifested and practiced by nurses. Nurses' care for patients enhances their professional growth. By caring, nurses show acceptance for the patient no matter his or her condition.

Watson's model is based on seven assumptions (Arnott et al., 2018). First, caring is excellently shown and practiced interpersonally (Curtis & Fegley, 2016). Second, caring is comprised of carative factors that promote the satisfaction of specific human needs (Curtis & Fegley, 2016). Third, the theory posits that effective patient care improves health and individual and leads to the growth of the family (Moran et al., 2019). Fourth, caring responses are manifested through acceptance of the patient's current state and what he or she may become as the treatment progresses. Fifth, the model posits that a caring environment is characterized by the capacity to develop potential while permitting the patient to select the best action for him or her at any stage and time of care. Sixth, Watson's Theory of Caring is based on the assumption that the science of caring complements that of curing (Davis & McMaster, 2017). Lastly, it assumes that caring practice is the core tent of nursing.

Watson's Theory of Caring is comprised of four key concepts- society, human beings, health, environment or society, and nursing (Lundy & Janes, 2016). First, regarding the role of society in nursing and patient care, Watson noted that every society provides values that dictate how a person behaves and what goals he or she strives to achieve. Second, Watson explained that a human being is a valued individual that needs care, respect, nurturing, understanding, and assistance. Third, health is described as the presence of a high degree of overall social, mental, and physical functioning. It can also be defined as the absence of disease or the presence of efforts aimed at eliminating an illness. Fourth, nursing refers to a human science of people and individual health-disease experiences as mediated by ethical, esthetic, scientific, personal, and professional care transactions.

The concept in Watson's Theory of Caring That Could Represent or Include the Outcome

The outcome would be improved patients' self-cannulation skills to ensure that consistency in needling technique is achieved. Proficiency in dialysis patients' self-cannulation skills will also be manifested through a better understanding of the nature of their vascular access, including troubleshooting (Jayanti et al., 2015). This will be achieved through adequate education and support.

The need for education and support to enhance patients' self-cannulation skills is based on Watson's concept of health is described as the presence of a high degree of overall social, mental, and physical functioning. Therefore, caring for dialysis patients with this theory will need attention to all aspects of health through the creation of a caring moment and the use of clinical Caritas processes. The pain and anxiety associated with dialysis require that the nurses show love and kindness and composure when undertaking care. This is the first Caritas process that can help the patient get the necessary relief. In this case, it is crucial or the nurse to show honor for human dignity, respect, attention, kindness, and active listening to patients. By practicing the first carative factor and its related processes, the nurses will be capable of understanding the patients' needs and address those needs with dignity and respect. For instance, when nurses understand that patients complain of pain or anxiety during their dialysis treatment, they will be able to offer a less painful alternative- self-cannulation.

The seventh carative factor- which advocates for the need to promote transpersonal teaching-learning- is also useful in assisting the patients in adopting self-cannulation as a less painful approach to dialysis. The caritas process associated with this carative factor is the need to engage in honest teaching-learning experience aimed at attending to the unity of being and meaning. This will be accomplished by seeking to learn patients' worldview about their illness. After gaining an in-depth understanding of the patients' knowledge of their disease and its determinants, the nurse goes ahead and provides options, tools, and information crucial in addressing the health issue. For example, upon understanding that patients do not prefer needle insertion into their vascular site during dialysis because of pain, the nurse will help the patient to know how self-cannulation works.

Teaching and learning of self-cannulation can be accomplished by coaching and educating the patient on relevant self-cannulation knowledge and skills. The caritas process associated with the seventh carative factor works from others' frames of reference (Zaccagnini & Pechacek, 2019), This implies that the nurse assesses patients'' understanding of self-cannulation to identify gaps in knowledge and skills. Following the identification of the gap, he or she imparts the patient with the necessary training or coaching aimed at making him or her self-cannulate.

Identification of a Practice That Can Be Changed or Implemented That May Influence the Outcome

In self-cannulation, the outcome would be improved patients' knowledge and skills regarding the practice of self-cannulation. This is accomplished by educating patients on the most effective ways of taking care of their condition. The teaching of self-cannulation involves four key steps. The first stage is known as pre-cannulation education and is aimed at helping the patients overcome the fear of needles (Mott, 2017). This involves teaching the patient size and type of needles used, how access works, blood flow rate, the importance of access flow on the appropriateness of dialysis, and assessment of access before every dialysis session (Mott, 2017). In the first step of self-cannulation, the patient is also taught hygiene practices.

The second stage of self-cannulation education is known as tandem-hand cannulation (Mott, 2017). This involves a practical method where a nurse works hand in hand with the patient to insert the needle. First, the patient is taught to make correct manipulation of the needle, especially how to "set" and use a cannulating hand. After the second stage, the patient should be capable of self-cannulating. The third stage of self-cannulation training is known as touch cannulation. It is characterized by the patient's holding of the tubing instead of the needle wings. In the fourth stage, the buttonhole technique, the patients will be taught to place the needles at a similar position and angle rather than rotating needle sites (Mott, 2017).

Identification of Concept in Watson's Theory of Caring that Includes the Practice.

The core concept in Watson's theory of caring that informs the proposed practice of improved patients' knowledge and skills regarding self-cannulation is a transpersonal caring relationship. This concept is characterized by a moral commitment to the protection and improvement of human dignity. It is also manifested through respect for the patient's wishes and needs. In the current case, the patient's needs are reduced pain and anxiety associated with dialysis. This will be achieved by teaching the patients self-cannulation skills.

Measurement of the Concepts

The first concept that will be measured is the transpersonal caring relationship. This can be operationalized as the act of showing authenticity in the care of a patient, respect for patient's wishes and needs, and commitment to protect and improve human dignity. A nurse who shows these indicators will be deemed to have manifested a transpersonal caring relationship. The second concept is self-cannulation- which refers to the patient's use of his or her needles to perform hemodialysis rather than being assisted by a healthcare professional such as a nurse.

Patients' self-cannulation skills will be assessed by asking the patient to demonstrate what he or she has learned at the end of each of the phases of the training. A patient who makes a mistake at each of the assessment will be corrected to ensure that he or she develops hands-on skills needed for self-cannulation. Overall, it is proposed that a nurse who shows competence in a transpersonal caring relationship is more likely to help a patient develop self-cannulation knowledge and skills.

References

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Arnott, N., Paliadelis, P., & Cruickshank, M. (2018). The road to nursing. Cambridge University Press.

Curtis, C. M., & Fegley, A. B. (2016). Psychiatric mental health nursing success: A q&a review applying critical thinking to test taking. F.A. Davis.

Curtis, C. M., & Tuzo, C. N. (2016). Psychiatric mental health: Davis essential nursing content + practice questions. F.A. Davis.

Davis, J. B., & McMaster, R. (2017). Health care economics. Taylor & Francis.

Gonzalo, A., BSN, & RN. (2016, January 5). Jean watson: Theory of human caring. Nurseslabs. https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/

Jayanti, A., Foden, P., Wearden, A., Morris, J., Brenchley, P., & Mitra, S. (2015). Self-cannulation for haemodialysis: Patient attributes, clinical correlates and self-cannulation predilection models. PLoS ONE, 10(5). https://doi.org/10.1371/journal.pone.0125606

Lundy, K. S., & Janes, S. (2016). Community health nursing: Caring for the public's health. Jones & Bartlett Publishers.

Moran, K. J., Burson, R., & Conrad, D. (2019). The doctor of nursing practice project. Jones & Bartlett Learning.

Mott, S. (2017). A How-To Manual: The Art of Teaching Buttonhole Self-Cannulation. https://homedialysis.org/documents/pros/StuartMott_ButtonholeCannulation_06_19_17.pdf

Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new model for advanced practice nursing. Jones & Bartlett Learning.