Integration of Nursing Intellectual Capital Theory and Social Exchange Theory in Reducing Medical Errors in Hospitals

Essay 2017 9 Pages

Medicine - Medical Frontiers and Special Areas




Summary of the Problem and the Potential Middle-Range Theory

Middle-Range Theory: Nursing Intellectual Capital Theory

Borrowed Theory: Social Exchange Theory

Origins of Social Exchange Theory

Previous Applications of Social Exchange Theory

Applying Social Exchange Theory in Reducing Medical Errors

Integration of Nursing Intellectual Capital Theory and Social Exchange Theory in Reducing Medical Errors



In retrospect, nursing practice seems to have experienced a remarkable evolution from the classical nursing to evidence based practice. This evolution has expanded the scope of nursing and improved the quality of care to patients. Of great importance is the provision of safe and quality care whose ultimate results are high patient outcomes. As envisaged in core nursing theories and bioethical principles, healthcare is meant to reduce the burden of disease and improve the quality of life of patients. This been the focus in nursing practice, education and research, and the outcome is a transformed nursing practice. Based on this objective, new interventions and nursing guidelines have been developed to promote the delivery of safe and high quality care. Despite this remarkable advancement in nursing care, a number of medical issues have remained as significant barriers in healthcare. Of concern is the problem of medical error which has become a compromise to safe and quality care across the continuum of healthcare system. In principle, medical error is defined from the medical perspective as actions which are done by healthcare providers that can lead to the occurrence of adverse events (Grober & Bohnen, 2005). In other words, medical error is simply a preventable outcome adverse resulting from inappropriate action by a healthcare provider (Van Den Bos et al., 2011). As such, it is apparent that the issue of medical error has an immense implication to nursing practice. Therefore, this report seeks to provide a focused analysis of a mid-range theory and a borrowed theory which when integrated can provide an appropriate solution to medical errors.

Summary of the Problem and the Potential Middle-Range Theory

Across the continuum of healthcare, medical errors have emerged as a challenging medical issue in public care. They occur so often within the clinical setting where healthcare providers encounter difficulties in dealing with the issue. For instance, nurses are adversely affected by the issue of medical errors because it arises as a negative outcome associated with their actions. The fact that nursing practice is based on the core tenets of bioethics implies that any negative outcome associated with their practice is undesirable. Therefore, the occurrence of medical errors in the clinical setting, especially clinical placement, laboratory simulation and nursing practice undermines advancement of the nursing profession. A focused systemic review reveals that the problem of medical errors impairs the quality of care, as well as compromising patient’s safety (Grober & Bohnen, 2005). It has both economic and health implications. As the focus of the 21st century healthcare leans towards reducing the cost of healthcare and reducing deaths, medical errors continue to cause deaths which could be prevented. In the United States, it is reported that medical errors cause over 250,000 deaths, annually (Makary & Michael, 2016). Earlier in 2008, preventable medical errors were estimated to cause 200,000 deaths compared to 98,000 deaths reported by the Institute of Medicine in 1998. On the other hand, the cost of medical errors is quite high. Currently, it is estimated that medical errors account for over $20 billion, annually (Andel, Davidow, Hollander & Moreno, 2012). Elsewhere in the UK, medical errors are estimated to cost £2 billion each year (Ker et al., 2010). This implies that the issue of medical errors has an immense impact on healthcare, and specifically on nursing practice due to its association to clinical handovers, nurses’ burnout, nursing leadership, and professional competence.

Middle-Range Theory: Nursing Intellectual Capital Theory

In this context, the nursing intellectual capital theory, a middle-range theory has the potential for solving the problem of medical errors within the clinical setting, especially in nursing practice. This theory is designed to address issues related to nursing intellectual capital. In principle, the nursing intellectual capital theory combines nursing human capital and nursing structural capital as the core theoretical concepts. From a theoretical perspective, the concepts exhibit interdependence in nature, and they are perceived to influence both patient and organizational outcomes. As conceptualized by Covell (2008), nurse staffing and employer support for nurse professional advancement promotes nursing human capital which when combined with nursing structural capital produces desirable patient outcomes, as well as organizational outcomes.

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Figure : Components of the nursing intellectual capital theory (Covell, 2008)

Borrowed Theory: Social Exchange Theory

From a theoretical perspective, the issue of medical errors has a significant relationship with nursing knowledge and the social aspect of nurses. This implies that exchange of social resources within the clinical setting can address the problem of medical errors; primarily in nursing practice where nurses’ interactions and collaboration with other healthcare providers underpins delivery of evidence based nursing care. Therefore, it is apparent that the social exchange theory is appropriate for solving medical errors.

In principle, social exchange theory presents a sociological approach to negotiated exchanges involved in social change and stability. This theory shares a close relationship to structuralism and rational choice theory. The basic concepts of the social exchange theory revolve around cost and rewards. According to Lambe, Wittmann and Spekman (2001), exchange, as conceptualized in the social exchange theory, is a social behavior that exhibits social and economic outcomes. As such, it is presumed that social exchange generates satisfaction in situations where costs are covered by fair returns. In this case, relationship decisions are based on costs and rewards. As explained by the social exchange theory, costs can be defined as elements of rational life with undesirable consequences to an individual, whereas rewards are the positive returns from a relationship. Overall, this theory has several assumptions related to human nature and relationship. One of these assumptions is that humans are rational beings. The second assumption is that humans avoid punishments and seek rewards. Third, it is assumed that humans use diverse standards in evaluating rewards and costs. Finally, it is postulated that rational life occurs as a process and that relationships are interdependent (West & Turner, 2007).

Additionally, there are several theoretical prepositions that structure human behaviors in the context of rewards and costs. The first preposition holds that behaviors that generate appreciable outcomes tend to be repeated. Second, it is stated that rewarding an individual’s behavior promotes its execution. Third, it is postulated that the value of reward diminishes upon subsequent repetition (Cook & Rice, 2013). Concisely, the social exchange theory holds that individuals minimize costs by pursuing rewards.



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Title: Integration of Nursing Intellectual Capital Theory and Social Exchange Theory in Reducing Medical Errors in Hospitals