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Week 3: Use of Nursing Theory to Guide DNP Projects
Conduct a literature search in one or more of the nursing databases on the potential topic or problem of interest to you for your eventual DNP Project (Health Acquired Infections is the problem of interest- SEE PROBLEM STATEMENT ATTACHED). Select one article or paper and discuss how a particular nursing theory or model (SEE THE LESSON ATTACHED ON NURSING MODELS) was used as a framework for the research study or DNP project. What insights has reading this article provided you in considering and firming up, supporting the problem statements that you have formatted in Weeks 1 and 2?
Hint: If searching the Proquest Dissertations and Theses database, use the search words: DNP (as author) and Nursing Theory (contained in abstract).
1 PAGE, 2 REFERENCES, APA.
NOTE:
I have chosen the article below for you:
The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research
Focusing on the Impact of Healthcare Environments
Zborowsky, Terri, PhD, EDAC. HERD : Health Environments Research & Design Journal; London Vol. 7, Iss. 4, (Summer 2014): 19-34.
The part of the question in bold is the only part you are working on based on the article named above.
Week 3: Use of Nursing Theory to Guide DNP Projects
Conduct a literature search in one or more of the nursing databases on the potential topic or problem of interest to you for your eventual DNP Project (Health Acquired Infections is the problem of interest- SEE PROBLEM STATEMENT ATTACHED). Select one article or paper and discuss how a particular nursing theory or model (SEE THE LESSON ATTACHED ON NURSING MODELS) was used as a framework for the research study or DNP project. What insights has reading this article provided you in considering and firming up, supporting the problem statements that you have formatted in Weeks 1 and 2?
Hint: If searching the Proquest Dissertations and Theses database, use the search words: DNP (as author) and Nursing Theory (contained in abstract).
1 PAGE, 2 REFERENCES, APA.
NOTE:
I have chosen the article below for you:
The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research
Focusing on the Impact of Healthcare Environments
Zborowsky, Terri, PhD, EDAC. HERD : Health Environments Research & Design Journal; London Vol. 7, Iss. 4, (Summer 2014): 19-34.
The part of the question in bold is the only part you are working on based on the article named above.
Theoretical and Conceptual Models Contributions to Advanced Nursing Practice
Overview
Our lesson for Week 2 reviewed Nursing’s Ways of Knowing and Theories of Knowledge. All nursing study and knowledge development occurs within the context of nursing’s four phenomena of interest: (a) person, (b) environment, (c) health, and (d) nursing. These 4
Concepts, taken together, form Nursing’s Metaparadigm. The historical influences that have shaped the development of nursing’s meta paradigm Theory and Parse’s paradigmatic classifications of nursing theory (Parse, 1987) are introduced this week.
Nursing’s Phenomena of Interest
Just as in other disciplines, there are unique phenomena of interest to nursing. Consider for a moment the study of business. One might describe the phenomena of interest to business as being administration, finance, leadership, marketing, management, and the like. Similarly, there are four phenomena of interest to our discipline: person, environment, health, and nursing. Collectively, these phenomena of interest form nursing’s metaparadigm. You can think of a paradigm as a worldview, one way of looking at a subject of interest. You can think of a metaparadigm as an overarching worldview, much like an umbrella under which exist nursing’s phenomena of interest and within which knowledge development and undersanding occur.
Nursing Metaparadigm
Nursing Metaparadigm
Nursing Metaparadigm (Links to an external site.)Links to an external site.
Can you identify which elements belong in the nursing Metaparadigm
Transcript (Links to an external site.)
Week 2: Nursing Metaparadigm
Can you identify which elements belong in the nursing metaparadigm?
· P
erson
· Pharmacology
· E
nvironment
· H
ealth
· T
heory
· Practice
· S
cience
· Pathophysiology
· N
ursing
· Physical Assessment
Answer:
Person, Environment, Health and Nursing
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Nursing’s Metaparadigm and Related Paradigmatic Perspectives
To better understand how the phenomena of person, environment, health, and nursing form the metaparadigm of nursing, it is helpful to examine some important historical contributions to theory development in nursing. At the doctoral level, most nurses recognize the many contributions Florence
Nightingale
made to the development of modern nursing. Similarly, there are additional important events that have contributed either directly or indirectly to the development of nursing knowledge. Two reports by Flexner, a social scientist, made a long-term impact on the development of nursing (Flexner, 1910; 1915).
The first focused on the need for medical-education reform and was published the same year that Nightingale passed away (1910). The second was a follow-up report that focused on requisite criteria for a profession such as social work. The outcome of these reports was that certain practice disciplines such as social work and nursing fell short of meeting the criteria of a profession due to their reliance on borrowed theory from liberal arts and sciences. Flexner’s reasoning was that a profession should function autonomously according to a codified set of laws, deliver an indispensable service to better society, have the ability to retain and continually educate its members, demonstrate unique language, and require a university-based level of education that engaged the scientific method (research) to build its unique knowledge base.
Following Nightingale’s death, a number of events and wars greatly changed nursing. In the decades that followed 1910 through 1950, there were many grand dames of nursing who sought to demonstrate that nursing as a practice discipline indeed measured up to the criteria of a profession that Flexner had proposed. During those years, the American
Nurse
s Association was established (1911), State Boards of Nursing implemented codified laws, and nursing developed its Code of Ethics (1950). At the same time, many nurse theorists sought to introduce unique terminology into the practice of nursing by building on prior theoretical works (Tourville & Ingalls, 2003). Many of the early nursing theories can be classified according to their roots in other theories such as general systems theory (Bertalanffy, 1950), developmental theories of Erikson (1950) and Kohlberg (1981), change theory (Lewin, 1951), and interactional theories. In addition, many societal changes resulting from women’s suffrage (1920) and the civil rights movement (1955-1968) additionally served to pave the way for nursing to emerge as a profession.
Technological changes further contributed to the development of nursing as a profession. In Nightingale’s era, there was no such thing as critical care and triage. Most soldiers injured on the field died on the field. With the advent of the machine gun, some of the world’s bloodiest wars were fought during the years of World War I (1914-1918) and World War II (1939-1945). These wars precipitated the need for more sophisticated nursing intervention. However, the development of critical care technology in the midst of the Vietnam War (1955-1975) brought about a paradigm shift from healthcare’s previous focus on quantity of life to quality of life. Triage from the battlefield could now offer life support capable of artificially maintaining life, resulting in new questions regarding the prior definition of health as absence of disease.By 1970, a new definition of a profession had emerged.
Another social scientist, Kuhn (1970), suggested that perhaps a discipline emerges as a profession when it is able to support more than one worldview. In the years since the close of the Vietnam War, while nursing continued to debate whether or not it had emerged as a profession, nursing theorists continued to define and refine nursing theory. One nursing theorist, Parse (1987), noted that the many nursing theories that emerged over the years since Nightingale each addressed common phenomena of interest regarding person, environment, health, and nursing. As she further examined these nursing theories, she noted that there existed common definitions of these phenomena of interest in two baskets that she classified as totality and simultaneity (Rose, 1999). The table below summarizes Parse’s classifications of theory by phenomena of interest and paradigmatic perspective.
Phenomena of Interest
Totality Paradigm
Perspective
Simultaneity Paradigm Perspective
Person
The sum of its parts (a biopsychosociospiritual being)
More than and different than the sum of its parts
Environment
That which is manipulated by the nurse to achieve health
A composite of internal and external forces that influence health
Health
The absence of disease
A continuum of wellness and/or well-being
Nursing
Holistic
Holistic
Supporting Concepts
Roots
1870s
1970s
Primary Theorist
Rogers
Focus
Quantity of Life
Quality of Life
Locus of Control
Patient
Scientific Orientation
Physical Sciences
Behavioral Sciences
Level of Scientific Inquiry
Quantitative
Qualitative
According to Happell (2009), “The theory-practice gap is a familiar concept in nursing and reflects the challenges faced by nursing in enhancing a symbiotic relationship between the theory and practice of nursing” (p. 166). In the years between the origin of the totality paradigm in the 1870s and the simultaneity paradigm in the 1970s, a theory-practice gap and a research-practice gap became evident. In more recent years, there has even emerged a theory-research gap! The aspects of theory, research, and practice are vital and inseparable to nursing. With the advent of evidence-based practice, the profession of nursing emerges at the intersection of nursing theory, nursing research, and evidence-based practice, as illustrated in the diagram below.
Theory Development
Consider for a moment a stairway of theory development ranging from the lowest level of abstraction to the highest. At the lowest level are the general Assumptions regarding the phenomena of interest to nursing that extend from nursing’s metaparadigm. Upon these assumptions exists the first landing or philosophical discourse of nursing. The philosophical level of discourse is the most foundational level of understanding.
From there, the building blocks of theory emerge at the theoretical level of discourse. The theoretical level of discourse is a higher level of understanding, in which the elements of theory such as concepts, Constructs, and frameworks have been examined.
Theory Development
Click each active letter below for a list of terms.
· A
· B
· C
· D
· E
· F
· G
· H
· I
· J
· K
· L
· M
· N
· O
· P
· Q
· R
· S
· T
· U
· V
· W
· X
· Y
· Z
Philosophy
Propositional Statements
Philosophy
A philosophy is a proposed understanding. broad view of phenomena of interest to a given discipline that exists at the philosophical level of discourse. Philosophies often precipitate new worldviews
Propositional Statements
Propositional statements relate two or more concepts from a principle in a way that guides further inquiry. The proposition moves concepts from the theoretical to the empirical level of discourse.
Conceptual and Theoretical Models
You will recall that Relational Statements can be derived from conceptual frameworks and grand theory. These relational statements are used to explain how concepts relate and explain phenomenon in which nurses are interested; concepts are put together in ways that form a new framework for understanding. To exist at a level of theoretical discourse, the unique concepts of a given model must additionally specify relationships among the concepts central to nursing. Once the relationships among the applicable concepts are explicated, a conceptual or theoretical model emerges at the theoretical level of discourse. In this way, a conceptual or theoretical model formalizes related concepts together to form a new perspective.
Regardless of how a theorist titles his or her theory, remember that the degree to which the classification of nursing theory meets the criteria for theory development is most instructive for where the theory might exist among the levels of discourse. Let’s explore some of these conceptual and theoretical models.
Johnson’s behavioral system model
(1959) was an early conceptual model that originally did not explicate assumptions about the environment. Over the next 20 years, Johnson fully addressed assumptions regarding the four phenomena of interest to nursing. However, one of Johnson’s most significant contributions to nursing theory development was the recognition that nursing theory development was foundational to the emergence of the discipline of nursing as a profession (1974).
King’s conceptual system model and theory of goal attainment (2007) are particularly challenging for the novice nursing theorist. Classification of King’s work is complex from the standpoint that she was one of the first nursing theorists to clearly explicate a middle-range theory, that of goal attainment. However, her work through the years was expanded and refined, resulting at the least in a conceptual framework or grand theory (Lane-Tillerson, 2007), although most nursing theorists since her death recognize her work as that of a conceptual model.
Levine’s conservation model
(1967, 1996) was another early conceptual work that focused on four conservation principles. However, Levine was one of the first nursing theorists to differentiate holistic from wholistic terminology. Although Levine’s work best fits the totality paradigm in terms of her assumptions of the phenomena of interest to nursing, she introduced holistic nursing from a perspective more commonly defined in the simultaneity paradigm.
Neuman’s systems model
(1995) is a fairly straightforward conceptual model that has consistently addressed the four phenomena of interest to nursing. Neuman’s assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm. Neuman’s work was one of the first to explicate the environment with both internal and external dimensions.
Orem’s self-care deficit nursing theory
(2001) is an extremely complex theoretical model that actually includes three theories: (a) self-care theory; (b) self-care deficit theory; and (c) nursing systems theory. Orem’s assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm. Orem’s work is one of the most tested theoretical models to date in nursing theory development (Biggs, 2008).
Roger’s theory of unitary human beings (1994) is also an extremely complex theoretical model. Roger’s assumptions regarding the phenomena of interest to nursing are very representative of the simultaneity paradigm. Roger’s work is another of the most tested theoretical models to date in nursing theory development (Wright, 2007).
Roy’s adaptation model
(1984, 1988) is another fairly straightforward conceptual model that has consistently addressed the four phenomena of interest to nursing. Roy’s assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm.
Further Reflection
In terms of similarities and differences among these conceptual and theoretical models, one can see that the various models presented explicate assumptions regarding the phenomena of interest to nursing: person, environment, health, and nursing. The degree to which each model offers assumptions that are more representative of the totality paradigm versus the simultaneity paradigm provides one basis upon which to assess their individual differences. In addition, each model offers unique definitions for further critical appraisal. Conceptual and theoretical models generate nursing theory as Propositional Statements. Propositional statements are “If . . . then . . .” statements that can be promulgated for further testing. If you were to compare and contrast conceptual and theoretical models, you would find that the majority fall under the totality paradigm, though some of the newer models that are humanistic in nature fit best under the simultaneity paradigm. See if you can correctly identify the paradigmatic perspective of these conceptual and theoretical models.
Conceptual and Theoretical Models
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Reset
Drag each of the terms below to the most appropriate column.
Totality Paradigm
King’s conceptual systems model of goal attainment
Levine’s conservation model
Johnson’s behavioral system model
Roy’s adaptation model
Neuman’s systems model
Orem’s self-care deficit nursing theory
NOTE:
One of the theorists that I would like you to include in my post is Faye Glenn Abdellah she formulated 21 nursing problem that guided nursing care.
Running head: HAND HYGIENE TO CONTROL INFECTIONS 1
HAND HYGIENE TO CONTROL INFECTIONS 6
Hand Hygiene to Control Infections
Name:
Institution:
Hand Hygiene to Control Infections
In most of the healthcare facilities throughout the country be it the doctors’ offices, hospitals, home health facilities and various skilled care facilities, there has been notable lack of hand hygiene not only among the patients but also among the healthcare workers. The problem of hand hygiene is not limited only to some facilities but its known worldwide. Most infectious diseases spread through the hands since being one of the most useful parts of the body. Therefore, hand hygiene in healthcare can be one of the most effective ways to reduce the spread of infectious diseases.
Healthcare-acquired infections (HAI) are infections that are acquired in hospitals after being established by patients within two days after there are admitted or some few days once they have a surgical operation and some few days after discharge. The nurse usually transfers HAI from one patient to another as they provide to them. Low Submission to hand hygiene is due to lack of training or qualification, work overload and lack of knowledge (Fox et al.., 2015).
Healthcare-acquired infections are transmitted to the victim via healthcare provider’s contaminated hands, and therefore the healthcare organization is financially obligated for the diagnostic testing and extended long stay of the patient (Huis et al. 2013). HAI also affected the number of nurses unavailing them for their duty in the process limiting the time they should spend on the patients (Landers, Abusalem, Coty & Bingham, 2012). Additionally, HAI causes a rise in the rate of mortality and morbidity among the patients. Considering the high numbers of deaths brought about by HAI, the world health organization set up guidelines stipulating when healthcare should wash their hands that is before a procedure, once they touch a patient’s environment, after a procedure, after touching a patient and before touching a patient.
HAI infects millions of patients every year, and approximately 1.8 million patients are infected by HAI where over 110,000 of them die (Mathur, 2011). This significantly increases healthcare system financial liability as the numbers keep on increasing. HAI is opposite to what the healthcare facilities are meant to do since instead of creating a safer environment, due to this condition many people suffer in these facilities. The nurse is the largest staff in hospitals and can, therefore, assist in decreasing the number of HAI most especially by practicing hand washing (CDC Foundation, 2017).
To find a solution, the first step would be to get all the doctors, supervisors and administrators involved. Being the leaders, they will find reasons why the staff members are not complying with the set guidelines. However, some reasons may include insufficiency of the hand washing equipment, work overload or general lack of knowledge. The moment the leasers know and understand the particular reasons, they will then have the chance to correct primary issues (Fox et al.., 2015). Additionally the doctors and the entire management can approach the issue of washing hands in their facilities is by following regulations and rules themselves.
Getting the staff and the nurses involved to find a solution has in the past yielded positive results by significantly reducing HIA and improving compliance. Putting in mind that the nurses are the staff who mostly get involved with the patients, they, therefore, have ideas and chance to find ways to control the issue. Allowing the nurses to make and form visual aid may allocate a more efficient reminder since they will feel they were involved in the problem analysis and implementation (Mathur, 2011).
Getting the patients involved is also another way of ensuring that HAI is addressed through hand hygiene. One way to address this is by educating the patients on ways to promote good hand hygiene and also letting them know they have a right to ask the healthcare provider if they have washed their hands before attending to them (Huis et al. 2013).This will alert the healthcare professionals always to wash their hands. Insisting on the compliance of washing hands is important and should be a must at all times.
Etiology of low hand hygiene in hospitals
Hand hygiene compliance rates have reduced due to some reasons, and as a result of hand hygiene being strikingly very low, there has been so many readmissions and too much uncoordinated care for patients. Some of the etiological causes of hand hygiene non-compliance are: the presence of broken sinks or dispensers in the hospitals thus the nurses and doctors avoid using them. Similarly, empty dispensers discourage the nurses from bothering to use whichever dispenser they come across in the hospital. There are also inconveniently positioned hand hygiene dispensers and sinks. Bearing in mind that they should be strategically positioned for any nurse going to attend to a patient and that would reduce readmission rates. Incorrect hygiene products in the dispenser is also a factor. Sometimes the nurses and doctors are too busy or get distracted, and they forget to clean their hands. Sometimes as they pass the sinks their hands are full thus not able to clean them (Chassin, Mayer & Nether, 2015). However, ignorance of nurses is also a cause of low hand hygiene that may be due to ineffective education and some assume that putting on gloves negate the need for hand hygiene.
References
CDC Foundation. (2017). Hand Washing: A Simple Step To Prevent Hospital Infections.
Chassin, M. R., Mayer, C., & Nether, K. (2015). Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), 4-12.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Jones, L., Bennett, Y. P., & . .. Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal Of Critical Care , 24 (3), 216-224.
Huis, A; et al. (2013). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial. International Journal of Nursing Studies . Philadelphia, Pennsylvania, 50, 4, 464-474.
Landers, T., Abusalem, S., Coty, M., & Bingham, J. (2012). Patient-centered hand hygiene: The next step in infection prevention. American Journal Of Infection Control , 40 (s1), S11-7.
Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian Journal Of Medical Research , 134 (5), 611-620.
by Dtf Rwgrwg
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Submission ID: 904 67 0195
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