Connecting Nursing Theory and Evidence-based Change Models Essay

Connecting Nursing Theory and Evidence-based Change Models Essay

Theoretical foundations

Theoretical foundations underpin the role of theory in influencing nursing practice, particularly regarding evidence-based practice. Nursing theory provides a template for nursing practice by establishing conceptual premises that guide nursing practice. The significance of nursing theory lies in its reciprocal relationship with nursing practice. Whereas practice is the basis of theory formulation, theories must be validated by practice.

Nursing Theory: Johnson’s Nursing Theory

Johnson’s nursing theory advocates nurturing effective and efficient behavioral functioning among patients to prevent illness. It reiterates the essence of research-based knowledge on the effect of nursing care on patients. The theory is the brainchild of Dorothy E. Johnson. The theory affirms that humans have two major behavioral and biological systems. The theory emphasizes that individuals are a behavioral system involving seven subsystems: the sexual, achievement, ingestive, attachment-affiliative, eliminative, aggressive protective, and dependency subsystems (Aşkar et al., 2022). The subsystems connect with other subsystems and the environment and particular structural functions and elements that assist in upholding the behavioral system’s integrity.

Clinical question

To what degree does the implementation of positive behavioral interventions impact the prevention of lifestyle diseases like high blood pressure, obesity, and diabetes among adult patients in the United States?

Synthesis of theory

Johnson’s nursing theory is reasonable in practice since it enables healthcare workers to provide physical and psychological assistance to patients. It also helps health professionals inhibit inappropriate behavior emanating from different aspects. Johnson’s nursing theory is used to design and implement nursing care programs. For example, Rahmani et al. (2020) used a nursing care program relating to Johnson’s nursing theory to enhance the stability of the heart failure patient’s behavioral system. Under this role, the theory helps design and implement effective care programs. Johnson’s nursing theory is applicable as a universal framework in healthcare settings to diagnose and assess issues and plans a care program (Karkhah et al., 2018). This is based on its central principle of behavioral functioning as a benchmark for disease prevention. Connecting Nursing Theory and Evidence-based Change Models Essay

Summary

Johnson’s nursing theory provides a theoretical foundation for the improvement project aimed at preventing lifestyle diseases among adults in the United States. Through this theory, health professionals will provide psychological support that leads to behavioral change addressing lifestyle diseases.

Evidence-based Change Model

The Stetler model emphasizes research utilization, where practitioners evaluate how research discoveries and other applicable evidence are applicable to practice. The model emphasizes the role of research in influencing practice by considering specific dimensions of research findings in actual clinical practice (National Collaborating Centre for Methods and Tools, 2022). The role of research in influencing clinical practice is based on evidence-based practice, which underscores proven ideas and approaches applied in clinical practice. The Stetler model acknowledges that nursing research investigates several ideas, dimensions, and intervention and their applicability. As a result, research findings contain vital insights into various nursing issues and can be used to address problems. Therefore, the Stetler model provides a procedure or foundation for identifying specific research findings in clinical or nursing practice. Such evidence must apply to a prevailing or particular health condition. This model can transform nursing research findings into nursing or clinical interventions promoting enhanced patient outcomes.

The Stetler model

The Stetler model of evidence-based practice and how evidence is drawn from research can be used to generate formal change within firms. The model also exemplifies how individual practitioners can apply research informally as part of reflective practice and critical thinking. The model connects the use of research as the primary step in evidence-informed practice (National Collaborating Centre for Methods and Tools, 2022). The Stetler model establishes a framework for considering the connection between research usage and evidence-informed practice. Since the two concepts are different, the model focuses on integrating both to improve the general application of research. Connecting Nursing Theory and Evidence-based Change Models Essay

The Stetler model comprises five phases: preparation, validation, decision-making/comparative evaluation, application/translation, and evaluation (Indra, 2018). Each step enables critical thinking on the practical use of research findings, applies evidence in routine nursing practice, and mitigates human errors in decision-making. Preparation is the first phase of this model that involves identifying the purpose of seeking evidence, recognizing the need to evaluate vital contextual factors for implementation, and acknowledging the rationale for applying evidence for measurable outcomes. This underscores the first step in which nursing research is conducted for a specific purpose in nursing care. Validation is the second phase of the Stetler model that evaluates the source of evidence and determines its credibility, relevance, and applicability to a nursing problem. This helps ensure that the research evidence is relevant, credible, and valuable in nursing practice. The third phase of this model is a comparative evaluation or decision making, which involves organizing and summarizing evidence to determine its feasibility or desirability in nursing care. At this point, decisions are made based on this evidence in nursing care.

Application or translation is the fourth phase of the Stetler model that involves transforming research findings or evidence into action plans for change. Under this phase, research findings are used to generate specific strategies and approaches for change that are implemented in nursing practice (National Collaborating Centre for Methods and Tools, 2022). This makes research evidence part of nursing care by developing and implementing change and action plans. The final phase of this model is evaluation. It involves clarifying anticipated outcomes, conducting cost-benefit, distinguishing information, and informal assessments, and using research to improve assessment data’s reliability. Through evaluation, the role of research findings in clinical practice is assessed to determine successes and failures. This helps determine whether the expected outcomes were achieved or not. It sets the gerund for further research use in clinical practice.

Clinical Question

To what degree does applying research findings on positive behavioral interventions impact the prevention of lifestyle diseases like high blood pressure, obesity, and diabetes among adult patients in the United States? Connecting Nursing Theory and Evidence-based Change Models Essay

Synthesis of Evidence-based Change Model

The Stetler evidence-based practice model provides a template for applying research findings about behavioral interventions in preventing diseases. This model helps identify specific research findings on behavioral interventions to prevent lifestyle diseases. For instance, adopting physical exercise is effective in preventing obesity. This indicates that applying research findings in clinical practice helps prevent illnesses and guarantees positive patient outcomes. The Stetler Model is used to emphasize critical thinking that is practitioner-oriented (Indra, 2018). This implies that research findings influence the approach to nursing care through critical thinking. Such practices enhance nursing care outcomes through research integration. The model is also used in implementing formal organizational change (Indra, 2018). This occurs when practitioners use research findings to model and implement change that enhances efficiency and care outcomes.

Stetler’s evidence-based practice model is useful in guiding project implementation (Amoako-Attah, 2022). When a project involving research evidence in clinical practice is developed, the Stetler model guides implementation. This is based on the systematic approaches that help implement projects phase by phase. The Stetler model designs implementation schedules for evidence-based practice in nursing care. The model’s five steps are standard guidelines for implementing intervention among selected patients (Preach et al., 2018). The model facilitates the systematic implementation of evidence-based interventions through the five steps.

Summary

The Stetler model of evidence-based practice effectively launches interventions for preventing lifestyle diseases. This involves applying specific research findings in clinical practice. Through the systematic steps involved, this model facilitates the design and implementation of care programs based on research evidence.

Linking Nursing Theory, Change, Model, to the Direct Practice Improvement Project

The growing prevalence of lifestyle diseases undermines overall well-being and causes early death. The number of people affected by lifestyle diseases indicates the expanding nature of the problem. A sedentary lifestyle has increased people’s vulnerability to obesity, hypertension, and diabetes across the US. Therefore, this project aimed to determine if implementing behavioral change interventions would impact lifestyle disease prevalence compared to current practice among adult Americans in primary care clinics in New York State over six weeks. Evaluating the role of behavioral interventions in addressing lifestyle diseases in the US is vital since it contributes to enhanced well-being. Furthermore, behavioral interventions are the best models for managing lifestyle diseases since most of these conditions are caused by harmful behaviors or lifestyles. As a result, examining whether behavioral interventions are effective in changing the course of lifestyle diseases among American adults in New York State was the primary goal of this project.

Conclusion

Johnson’s nursing theory and the Stetler model of evidence-based practice support the purpose of this project. The goal of the project is to determine if implementing a behavior change intervention is effective in addressing or preventing lifestyle diseases. Johnson’s nursing theory supports the project’s purpose since it emphasizes nurturing effective and efficient behavioral functioning among patients to prevent disease. The theory emphasizes the role of behavioral interventions in addressing illnesses. In this case, the theory applies to the project’s goal of developing a behavior change intervention to address the growing prevalence of lifestyle diseases. The Stetler evidence-based practice model supports the project since it provides a template for applying research findings or evidence in clinical practice. The model emphasizes the role of research findings in influencing clinical practice. It supports the project’s purpose by emphasizing the role of research findings or evidence in preventing lifestyle diseases through behavior change interventions. Therefore, the theory and the model support developing and implementing a behavioral change model to address lifestyle diseases. Johnson’s nursing theory supports the Stetler evidence-based practice model by highlighting the significance of efficient behavioral functioning among patients to prevent diseases. This provides research findings or evidence that effective behavioral functioning among patients helps prevent illnesses. Therefore the theory provides a foundation for applying research evidence in clinical practice to prevent diseases. The Stetler evidence-based practice model supports Johnson’s nursing theory by acknowledging the role of research evidence in nursing practice. This makes it possible to apply evidence obtained from research to nursing practice for preventing diseases and enhancing healthcare outcomes. Connecting Nursing Theory and Evidence-based Change Models Essay

References

Amoako-Attah, I. (2022). Increasing patient participation with colorectal cancer screening in primary care: An evidence-based improvement initiative. https://hdl.handle.net/11274/13760

Aşkar, S. E., & Ovayolu, Özlem. (2022). Nursing care based on Dorothy Johnson’s Behavioral System Model in coronary artery disease: A case report. Medical Science and Discovery, 9(2), 138–142. https://doi.org/10.36472/msd.v9i2.671

Indra, V. (2018). A review on models of evidence-based practice. Asian J. Nursing Education and Research. 8(4):549-552 https://ajner.com/HTML_Papers/Asian%20Journal%20of%20Nursing%20Education%20and%20Research__PID__2018-8-4-24.html

Karkhah, S., Ghazanfari, M. J., Norouzi, M., Khaleghdoust, T., Dahka, S. M., Taheri, G., Ghanbari, A. (2018). Designing a nursing care plan based on Johnson’s behavioral model in patients with wrist joint hematoma: A case study. Research Square. https://doi.org/10.21203/rs.3.rs-34306/v1

National Collaborating Centre for Methods and Tools. (2022). Stetler model of evidence-based practice. https://www.nccmt.ca/knowledge-repositories/search/83

Parach A, Sadeghi-Ghahroudi M, Saeid Y, Ebadi A. (2018). The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty. ARYA Atheroscler, 14(6), 237-241. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527151/

Rahmani, B., Aghebati, N., Esmaily, H., & Florczak, K. L. (2020). Nurse-led care program with patients with heart failure using Johnson’s Behavioral System Model: A randomized controlled trial. Nursing Science Quarterly, 33(3), 204–214. https://doi.org/10.1177/0894318420932102

New regulations have been put in place to regulate the prescription of Opioids such as Oxycodone and Percocet. Consequently, this has necessitated stricter regulations prescribing such forms of medication. Pharmaceutical companies have prescribed many opioids to their patients leading to the widespread misuse of prescription and non-prescription opioids (Purcell, 2005, pp.740-741). This led the United States Department of Health to declare a public health emergency. Hospitals and other healthcare institutions must meet the regulations outlined by the Center for Disease Control and Prevention. This paper aims to create a Clinical Decision Support System (CDSS) that involves adopting a Computerized Provider Entry System to assist physicians in the dispensation of opioids based on regulations outlined by the CDC.

The Computerized Physician Order Entry System uses the regulations set by the Federal Agency for Healthcare Research and Quality on Patient Safety Networks (El-Sappagh & El-Masri, 2014, pp.69-78). The CPOE will have an order section where the clinician will determine the most appropriate medication, dose, and frequency. The patient can refill their medication from a registered pharmacist. If the patient’s ailment persists, they must return to their physician for a new prescription. Consequently, the CPOE will only dispense medication prescribed by a certified healthcare practitioner (Purcell, 2005, pp.740-741). This is crucial as it prevents any medication errors from arising.  Additionally, it will allow pharmacists to determine whether patients are likely to suffer from allergic reactions to the prescribed medications. This stage is more likely to have errors as pharmacists may unwillingly prescribe drugs that may cause patients to suffer from allergic reactions, and medication errors may cause unintended consequences to a patient. Finally, CPOE will also facilitate the administration activities to ensure that the dosage of medications given to patients is correct (Purcell, 2005, pp.740-741). Ordering through order sets, patient-centered decision support, patient safety features, an intuitive human interface, regulatory compliance and security features, billing, and access through wireless PCs or tablet computers are some of the features offered for a CPOE. The CPOE will provide the patient data necessary for the CDSS to decide on the patient prescription of opioids. Connecting Nursing Theory and Evidence-based Change Models Essay

Most CDSS can be divided into two main types: those with knowledge bases and those without. A non-knowledge-based CDSS uses artificial intelligence (machine learning) to find patterns in clinical data. This system is currently outdated as there have been several changes made to the guidelines concerning prescribing opioids to patients. The adoption of a knowledge-based CDSS will use the rules and association of compiled data. These rules typically take the form of IF-THEN and are crucial in determining if a patient should be given a particular drug or not. The proposed CDSS Embedded in the Electronic Health Record System will use CDSS knowledge rules (Sutton et al., 2020, pp.1-10). The procedure will commence when the CDSS is activated to create some output. Subsequently, the output will be utilized as a parameter in the query building process. All the rules utilized in the decision will be retrieved using the rule retrieval tool. The process will use an IF-THEN statement which serves as a rule that will guide all the decisions made by the software.  For example, if drug X and drug Y are taken, the person cannot be prescribed medicine Z. The inference engine will use the knowledge base’s predefined rules in conjunction with patient data to allow clinicians to make choices. On the other hand, the communication mechanism will allow the system to display the results and accept human input.

When implementing this CDSS, four main factors need to be considered. These factors include setting, policy and law-related considerations, implementation guidance, and resources. The best setting for the implementation of CDSS, according to the CDC, is in the context of outpatient care (Wright et al., 2016, pp.1068-1076). Policy and law considerations are crucial since they serve as the basis for the systems’ algorithms. Regular updates are crucial since they ensure that the CDSS is in line with any changes to the prescription of opioids. There are various guides from different medical associations when it comes to guidance. An example of this is a toolkit from the American Medical Group Foundation. Resources will also affect the implementation of the CDSS. Despite this, many federal initiatives and agencies assist in financing CDSSs. The CDSS will be implemented by determining the best integration strategy for the workflow. This will involve consulting various IT experts to understand how the system can be integrated into the institution’s legacy applications and data sources. This will be followed by fine-tuning the CDSS to fit the institution’s needs (Wright et al., 2016, pp.1068-1076). The institution will need to work with IT experts to ensure that the features are adjusted to its specific requirements. The final step is training personnel to use the CDSS system, allowing for easy problem solving to be carried out, and it will assist with onboarding.

One of the challenges that might be experienced during the implementation of the CDSS is opposition from the various stakeholders in the healthcare institution. The system is complex, and much care must be taken to ensure that mistakes are minimized since errors can be detrimental to the execution of the system (Sutton et al., 2020, pp.1-10). The CDSS is connected to the CPOE, and hackers can use this as a loophole to access patient data. Biological systems are also very complicated, attributed to the fact that many data must be utilized. Some of the data utilized, such as family, patient, medical history, and genetics, play a huge role in determining factors that are crucial in the prescription of opioids (Lakshmanaprabu et al., 2019). The system might also be plagued by alerts that might be annoying to various personnel using the system. These problems can be fixed by educating stakeholders on the importance of the CDSS and how to utilize it properly.  Appropriate security measures must be instituted to prevent hacking, and regular checks should be implemented to ensure the system is up to date and that zero-day exploits are patched. Connecting Nursing Theory and Evidence-based Change Models Essay

The value of the CDSS will be demonstrated by its ability to improve clinical workflow or outcomes (Sutton et al., 2020, pp.1-10). Consistency is also another benchmark that can be used to evaluate the performance of the CDSS. Specifically, the CDSS should be consistent and accurate in its classification of ailments and its dispensation of opioids to patients. Finally, it should also reduce the number of errors while ensuring that the system is up to date with the regulations set by the CDC and the United States Department of Health. Connecting Nursing Theory and Evidence-based Change Models Essay