the Metaparadigm of Nursing
Link the theory you developed in weeks 2 and 5 with the Metaparadigm of Nursing. Each of the elements of the Metaparadigm should be represented in your theory. Revise your theory if necessary to include each of the components of the Metaparadigm.
Below are the two theories: 2 & 5: Please use both per the above instruction.
Week 5 â Personal Nursing Theory Improvement
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) refers to decreased or temporary cessation of breathing during sleep and is a common occurrence in both adult and child populations. Its prevalence is estimated to range between 2% to 14%. However, it can be as high as 20% to 90% in some subgroups of patients (Myers et al., 2018; Krishnan et al., 2017). The practice-level theory developed in week two states that in the management of OSA, the use position pillows to elevate the upper body and head, reduces episodes of sleep apnea and improves overall sleep. Herein, the theory remains the same, but the conceptual-theoretical-empirical (CTE) model is advanced with more novel empirical testing methods. Its frequency is, however, highest amongst middle-aged and older populations. Patients in this age group have appreciably frail health statuses owing to physiological changes associated with disease process such as impaired gas exchange, decreased cardiac efficiency, reduced kidney function, among others (Amarya et al., 2018).
In the management of OSA in patients with chronic disease like hypertension, cardiovascular disease, and diabetes mellitus (concept A), use of a higher number of pillows (proposition), decreases the number of episodes of apnea, thereby improving sleep pattern (concept B).
Objective
The aim of this paper is to improve the proposed nursing theory using the conceptual-theoretical-empirical model. The suggested improvement to this theory is presented through the guidelines of Royâs adaptation model, which has been employed with significant success in multiple nursing contexts (Jennings, 2017; Qian et al., 2021). It also provides essential operational definitions and empirical indicators that contribute to the clinical relevance of the theory.
Operational Definitions
Obstructive sleep apnea: a sleeping disorder that is characterized by intermittent cessation of breathing due to blockage of the airway during sleep, with episodes occurring at least five times every night on average and lasting not less than ten seconds (Obstructive sleep apnea 2021).
Chronic disease: a condition that lasts for at least one year that requires ongoing medical attention or limits day-to-day activities, or both (About chronic diseases 2022). Chronic diseases considered in this theory include hypertension, congestive heart failure, diabetes mellitus, obesity, and head and neck cancers.
Empirical Indicators
Congestive heart failure, hypertension, and diabetes mellitus, obesity, have shown to have a causal correlation with the occurrence of obstructive sleep apnea (Kapa et al., 2018; Liang et al., 2020; Subramanian et al., 2019) The use of pillows has been recommended as an effective intervention in the management of obstructive sleep apnea since they help in restricting supine sleep and keep airway open (Kryger & Malhotra, 2019). â
Week 2 â Personal Nursing Theory
Obstructive sleep apnea (OSA) refers to decreased or temporary cessation of breathing during sleep and is a common occurrence in both adult and child populations. Its prevalence is estimated to range between 2% to 14%. However, it can be as high as 20% to 90% in some subgroups of patients (Myers et al., 2018; Krishnan et al., 2017). Its frequency is, however, highest amongst middle-aged and older populations. The cause of obstructive sleep apnea is partial or complete blockage of the respiratory tract secondary to narrowing of the passages of the airway. A definite causal link has been established between obstructive sleep apnea and several diseases, including diabetes mellitus, coronary artery disease, stroke, atrial fibrillation, congestive heart failure (CHF), and hypertension (Semelka et al., 2016). Individuals who experience obstructive sleep apnea end up having fragmented sleep that is usually unrestful. As a result, they tend to have behavioral and cognitive problems such as emotional distress, poor memory and learning, and irritability (Medic et al., 2017). Various treatment approaches have been put forward. Position pillows have been demonstrated to be of particular significance in OSA that is not caused by obstruction of the airway by the tongue.
Theory: in the management of OSA in patients with chronic disease like hypertension, cardiovascular disease, and diabetes mellitus (concept A), use of a higher number of pillows (proposition) is associated with greater relief of symptoms, making breathing during sleep much easier with less episode of apnea (concept B). On the other hand, the higher the number of pillows increase, the proposition, is also indicative of the progression diseases. The more severe forms impose a demand for use of a higher number of pillows to elevate the head and upper body in order to decrease the occurrence of OSA.
Use of pillows helps to maintain the body in an elevated position from the waist up. The American Sleep Apnea Association provides that this helps maintain patency of the airway, thereby contributing to fewer occurrences of OSA (Ambardekar, 2020). Further, pillows help in maintaining proper posture during sleep by keeping the curvature of the spine it its natural position. As such, optimal pillow usage helps reduce disordered breathing during sleep, hence improving the quality, efficiency, and depth of sleep (Liu et al., 2016). As such, pillow design has developed to be guided by research in order to be more effective in decreasing pressure on the cervical spine, thereby help in opening the airway and decreasing instances and symptoms of OSA (Son et al., 2020; Liu et al., 2021). The heterogeneity of OSA in symptomatology and severity has necessitated further research for effective implementation use of pillows for symptom/disease management. Own pillows, memory foam pillows, and generic laboratory pillows are categories of pillows that have been developed to this effect (Stavrou et al., 2022). These advancements have led to lesser focus on the number of pillows as is the norm when using soft pillows in the management of OSA. Wedge pillows have taken precedence and proven to be equally valuable.