Table of Contents
A summary of the problem
Nurses are confronted by multiple problems in their workplace, with the biggest problem being staffing shortage. The lack of sufficient number of nurses required to handle the huge workload especially in the critical care setting is a cause of stress and problems for the optimal performance of the nurses. This influences the quality of care, hence resulting in more problems such as injuries, compassion fatigue, burnout or workload (Douglas, 2010). According to Health eCareer (2015), the problem is further worsened by the fact that many hospital administrators are now increasingly investing in advanced medical technologies, hence failing to maintain an adequate level of staff required to care for the needs of the patients. Moreover, the Bureau of Labor Statistics (2012a) has projected the need for more nurses to enter the labor market in order to offset the deficit. Hospital CEOs seems to be driven by corporate greed where their main goal is fixated on profit making as opposed to providing patients with the greatest level of car.
Staffing shortage is a serious problem that needs to be addressed especially since it is not just a problem specific in the United States but a worldwide problem. Various nursing bodies have tried to address the problem of nurse shortage by calling for an increase in nurses to allow nurses handle the workload sufficiently. Based on the reports by California Nurses Association (CNA) and National Nurses Union (NNU), staffing problem can be addressed by reducing the nurse-patient ratio, which is required to promote patients’ safety and address the staffing problem. With the surge of baby boomers in the country, the nurse-patient ratio needs to be reduced in order to reduce the pressure the nurses are experiencing as well as relieving the burnout of overworking (Cox, Willis & Coustasse, 2014).
The middle-range theory that has a great potential of addressing this problem is Jean Watson’s theory of human caring. This theory is based on the efficiency of interaction and communication between the nurses and the patient as the basis for care and healing (Watson, 2008). This theory is suitable to assist in the solution of the staffing challenges taking into consideration that the nurses in leadership positions will give the nurses and the patients the caring they require to improve the quality of care, and consequently improve the motivation level of the staff. Since the leaders will have their hands on the work the nurses are doing through interaction and communication, they would be able to manage the work appropriately so that they do not give the nurses too much work than they can safely handle. Jean Watson described caring is a vital part of nursing practice whose foundation is guided by value, moral, ethical and philosophical underpinning (McEwen & Wills, 2014).
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A description of a borrowed theory that could be applied to the problem
The nursing field is a special occupation that requires an ongoing training and continuous education to ensure that nurses and hospital administrators attain the goals of providing patients with quality care. Sometimes, the nursing field is forced to borrow theories that facilitate guiding and expanding the nursing practice for purposes of benefiting the patients (McEwen & Mills, 2014). Despite the mixed perspectives among the health care practitioners on the efficiency of borrowed theories in improving practice, some borrowed theories have a great impact on addressing the practical problems encountered. Bandura’s social cognitive theory is a borrowed theory that is suitable in addressing the challenge of staffing problems in hospitals. This theory is effective in solving this problem as it assesses the manner in which the practice operates from the perspective of the social cognitive theory. Moreover, the theory focuses on other circumstantial conditions and personal factors that may influence each other to impact care delivery (Wood & Bandura, 1989).
Social cognitive theory stresses that learning occurs best through observation, imitation of observed behavior and modeling. In this case, the interaction between the persons involved in an encounter is valued as an environment for learning behavior. Bandura was opposed to behaviorism theories that posited that learning is facilitated by reinforcement or punishment. Instead, he observed that learning took place better when modelled behavior was observed and produced positive outcomes (Wood & Bandura, 1989). Given that the staffing shortage experienced in the health setting is mainly due to high nurse turnover from dissatisfaction, the motivation of the nurses can be reinforced through nurse leaders who exhibit a caring behaviors to the other nurses, which results in modeling of the same behavior to the patients.
A brief history of the borrowed theory’s origins
The social cognitive learning theory was proposed by Albert Bandura. Bandura was born in Canada in 1925 where he attended high school. In 1949, he graduated with a B.A degree from British Columbia University where he had gone to further his studies. His studies did not stop there as he pursues further learning and graduated with a doctorate degree from the University of Iowa in 1952. Throughout his learning, Bandura focused a lot of social learning with a motivation of finding out factors that promote effective learning of new behavior. Bandura is largely recognized as a cognitive psychologist as its major focus on learning behavior is based on self-regulatory mechanisms and motivational factors and how they contribute to impact one’s behavior as opposed to focusing only on the influence of environmental factors. Bandura’s theory challenged Skinner’s behavioristic perspective as learning was perceived to be influenced purely by the environment, thereby setting apart his theory through the introduction of the goal of cognition (Wood & Bandura, 1989). Later, the “Social Learning Theory” was changed to “Social Cognitive Theory” to stress the role of cognition in learning behavior.
Bandura integrated the concepts of behavioral learning theory that stresses the role of the environment and the cognitive learning theory that stresses the role of psychological elements in behavior learning. The social learning theory was therefore the integrated approach to learning. One the landmark experiments performed to illustrate this theory was the use of modelling for spread of violence. Since the premise of the theory is that human beings learning by observing the behavior of others, he viewed experiments as an important way of studying how human beings change and the motivating factors behind the change. He used the famous bobo doll experiment to observe how the behavior of children changed when they observed violent behavior being modelled by adults. Bandura observed that the children adopted a more violent behavior towards the dolls after watching violence. Hence, the theory postulates a causal link between modelled and actual behavior which takes place in three important stages; attention, retention and motivation.
How the borrowed theory has been previously applied
Previously, Bandura’s theory of social cognitive learning has been applied in many fields to improve the training and upgrade skills in different practices. Wang and Lin (2007) applied the theory to web-based learning where factors that influenced web-based learning were examined from the perspective of interaction between psychological factors, behavior and the environment. In the medical field, an application that is mainly influential was examined by Compea and Higgins (1995) where social cognitive theory was applied for training of computer skills. This study acknowledged that there was very little information on the training of computer skills yet it was an essential contributor to enhanced productivity in the workplace. The research examined the different methods of training and the efficiency of each method. The research then compared these methods with learning of computer skills based on modelling of behavior according to Bandura’s social cognitive theory. According to this theory, watching others perform the desired skills, which in this case involves interaction with the computer itself, impacts greatly on the perception of such an individual and influences their perception about their personal ability to perform the same functions and achieve the modelled outcomes. Moreover, it provides such individuals with workable strategies that allow for effective presentation of the learned behavior.
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The application of the borrowed theory to the identified problem
The application of Bandura’s social cognitive theory will diminish the problem of staffing shortage in hospitals. Since the premise of Bandura’s theory is that people observe what the others, then imitate the same behavior, this belief is a major strategy that can be adopted by nurse directors, managers and administrators to offer relief to the nurses. The efficiency of this method as a strategy of improving productivity has been proven by numerous studies that have been conducted involving videos and television commercial characterized by violent scenes (Wood & Bandura, 1989). By applying this theory, unit managers in hospitals should be able to devise approaches of motivating the nurses by modelling the behavior they want to be exemplified. These leaders will be able to interact with the nurses, see how their day to day activities run and how they struggle to cope with the overwhelming workload. Through this interaction, these leaders will also see how the shortage of nurses negatively impacts on the quality of care and the health outcomes of the patents. By trying to identify with the nurses, the leaders will realize that it is almost impossible for the nurses to function at such as stressful working environment, thereby prompting them to find a solution to the problem of staffing shortage. This is because the efficiency of the desired behavior is influenced not only by the psychological factors, but also by the environment where the behavior is expected to be learned. Nursing leaders will examine the working environment of the nurses and realize the danger the patients are in when the nurses are overworked. This will result in the solution to the problem as they will resort to a quick modification to alleviate the nurses from the stress, and consequently improve the safety and quality of care of the patients.
Integration of both the borrowed theory and the middle-range theory
The integration of Jean Watson’s theory of human caring and Bandura’s social cognitive theory can be effective in eliminating the problem of staffing shortage that the nurses are struggling to deal with today. Nevertheless, it is important to understand the premise of the two theories before trying to merge them and apply them in the solution of the current problem. According to Bandura’s theory, improvement of care through disease prevention and health advancement is viewed from the perspective of social cognitive ground. This is key to helping unit managers acknowledge the importance of providing an enabling environment for the nurses to spend more time as required to help patients deal with their illness and improve the outcome of a treatment program. When nurses spend very little with their patients, it becomes very difficult to identify other factors that influence the patient’s healing due to lack of trust in their relationship. Spending a considerable amount of time with the patient means that the nurse is able to listen to the patient and gain a great sense of the things that the patients is going through, thereby helping the patient gain a full recovery sooner.
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The theory of human caring can help improve the personal factors that prevent nurse turnover by also focusing on the working environment and how it impacts the nurse-patient relationship. Since the social cognitive theory helps nurses gain more time to spend with their patients, it therefore helps in the application of theory of human caring where nurses are able to establish a strong relationship with the patient during their interactions and communication, thereby establishing the feeling of care and empathy. By implementing the principles of the ten caritas processes, leaders will be able to empower nurses so that they can foster the spirit of caring in the hospitals. Some of the empowerment practices that can be adopted in this case include creating healing support systems for the nurses, reducing the number of hours on call every day and allowing for rejuvenation or rest hours to prevent compassion fatigue.
- Compeau, D. R., & Higgins, C. A. (1995). Application of social cognitive theory to training for computer skills. Information systems research, 6(2), 118-143.
- Cox, P., Willis K., & Coustasse A. (2014, March). The American epidemic: The U.S. nursing shortage and turnover problem. Paper presented at BHAA 2014, Chicago, IL.
- Douglas, K. (2010). When caring stops, staffing doesn’t really matter. Nursing Economics, 28(6), 415-419.
- Health eCareer (2015), Healthcare Recruiting Trends Survey, Health eCareer Network.
- McEwen, M., & Wills, E.M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN-13: 978-1-4511-9031-1
- Wang, S. L., & Lin, S. S. (2007). The application of social cognitive theory to web‐based learning through NetPorts. British Journal of Educational Technology, 38(4), 600-612.
- Watson, J. (2000). Leading via caring-healing: the fourfold way toward transformative leadership. Nursing Administration Quarterly, 25(1), 1-6.
- Wood, R. E., & Bandura, A. (1989). Academy of Management Review, 14, 361-384.