Nursing Theories....help please!

[rnbb84]

Hello everyone! For a project, I had to create an educational program for my local hospital. When patients present to the ER requesting detox for substance abuse, the RN is supposed to assess the patient and score” their symptoms accordingly. Patients must be in active withdrawal to be admitted to the unit. They then notify the detox unit of their assessment, and request for admission. It was discovered that the RNs were not scoring the patients appropriately. When the patient would arrive to detox for admission, the RN would assess them and find that the patient is not eligible for admission, as they were not in withdrawal. This is a cause of concern as there are many patients who present requesting in-patient detox ( in active withdrawal) and are being denied due to a lack of beds. My program is going to institute proper training and educational information for the RN's in the ER.

I have to identify a theory (nursing or non-nursing) that frames this project. I have a non-nursing theory that I could use; however, I can't help but wonder if there is a nursing theory I am overlooking. I have spent the past 2 days researching a nursing theory, and I still come up short. Am I missing something? Would anyone be able to offer any suggestions in regards to a nursing theory that may be applicable?

TIA!

[nursej22, MSN, RN]

The first one that comes to my mind is Watson's theory of caring. Of course, that is the one emphasized in my BSN program, so its pretty ingrained in my head.

And there is Peplau, which I believe is often used in the behavioral health setting.

[bgxyrnf, MSN, RN]

I understand that you're doing a school project but, if you're actually going to present it to real ED nurses, do understand that of all nursing specialties, ED nurses are among the most disinterested and considerate of nursing theories.

The preceding is offered up for your consideration about the significance and emphasis to place on any nursing theory beyond the walls of the classroom, and especially for the ED.

[TriciaJ, RN]

I'm not sure if I'm understanding the problem. The ED nurse assesses and scores the patient for admission to the detox unit? And the detox nurses deem the patient ineligible? How big a factor is a need to move patients out of the ED and a lack of bed space on the detox unit? Are the nurses working against each other because they all face a lack of resources? Are patients trying to get into the detox unit because they have nowhere else to go?

Symptoms of withdrawal aren't that hard to assess. Is it really a training issue for the ED nurses? I think this is another situation where staffing and bed availability are the issues, but someone is trying to come up with a creative "theory" solution.

[PNCC2001]

I realize you assignment is to come up with a theory for training; but if this is an actual scenario, my feeling is that it is probably not that the RN is not accurately assessing them, but that the patients know the symptoms of withdrawal and are not being candid. They likely are trying to get admitted because they know withdrawal is coming and they are trying to get something to take the edge off of the symptoms. I would suggest maybe redoing the assessment to include more objective signs in the criteria, because using patients generally are not honest. That way withdrawal will be more obvious and patients will not come in jumping the gun (word will get around). You stated that you are going to be involved in training the ER nurses; and I think there needs to be a re-focus.

[Here.I.Stand, BSN, RN]

I'm very confused... wouldn't the physician have determined that the pt DOES need detox and ordered said admission? I have never heard of RNs having the decision making authority regarding ED pt disposition, or disposition based solely on the nursing assessment.

How is it that students have aquired proper knowledge of the hospital's scoring tool, yet the professionals' knowledge is deficient?

Have you considered that the pt may have been given an anti-emetic and/or an anxiolytitic while in the ED, which could account for their lack of sx upon admission to detox?