DNP 815 Define the process of theory building

DNP 815 Define the process of theory building

DNP 815 Define the process of theory building

As with other practice professions, nursing requires a knowledge foundation that is based on theory and derived from systematic research. The first nursing theorist, Florence Nightingale, created detailed reports of both medical and nursing matters as chief nurse for the British in the Crimean War in the mid-1850s. (Stolley, et al 2000) Nightingale noted that apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion”. As a result, Nightingale’s conceptualization of nursing included the need to have an understanding of the laws of nature, the prevention of disease, and the use of personal power. She viewed persons as both physical and spiritual beings, emphasizing the importance of the environment and the need to care for the patient, not the disease. With her emphasis on the environment, changes in nutrition, hydration, and sanitation resulted, and mortality rates dropped drastically during the Crimean War.

Modernity has brought significant advances, which have strained the qualification of nurses’ being and doing; the insertion of new care and teaching technologies has been widely implemented. In this direction, Florence’s teachings have left their mark, influencing the nursing routine, as it has always emphasized the importance of nurses’ commitment to care, as well as learning based on practice (Reigel, et al ,2021). Currently, nurses are being challenged to boost Florence’s ideals through critical thinking, aiming to provide humane and competent care based on the best scientific evidence against the backdrop of unprecedented changes. Like Florence, it is worth highlighting other nursing theorists, such as Watson, Horta, King and Leninger, who impacted society by considering not only the physical aspects of a human being, but also the interconnection between each individual’s body, mind and spirit.

As a DNP learner this impacts and shapes how, we can interact with our patients. ,it prepares us to be able to use critical thinking and holistic thinking in clinical settings and decision making in diverse ,complex patient situations .

References

Riegel, F., Crossetti, M., Martini, J. G., & Nes, A. (2021). Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing. Revista brasileira de enfermagem, 74(2), e20200139. https://doi.org/10.1590/0034-7167-2020-0139

Stolley, J. M., Buckwalter, K. C., & Garand, L. (2000). The Evolution of Nursing Research. Journal of the neuromusculoskeletal system: JNMS : a journal of the American Chiropractic Association, Inc, 8(1), 10–15.

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Nursing theories have helped me understand my own transition into practice and become a better preceptor. In particular the: Novice to Expert from Benner. This Stages that are included in this model include novice, advanced beginner, competent, proficient, and expert (Murray et at., 2019). As a new graduate this theory helped me understand that what I was feeling the first few years in nursing was completely normal.  It explains expertise is developed within time, no matter how intelligent you might be. With the assistance of education and different experiences he or she learns the “how” (Murray et at., 2019). A perfect example Murray et at., (2019) provided in a research study where they assessed new nurses in practice included how in early stages new graduates identified a good day as not having tasks while the more experienced may struggle with patients’ safety and time management. This is important to remember to understand limitations students and or we might have as processionals.

References:

Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchscher’s theory: Providing the framework for understanding new graduate nurses’ transition to practice. Nurse Education in Practice, 34, 199–203. https://doi.org/10.1016/j.nepr.2018.12.003

The Theories can be useful to nurse-researchers as guides for conducting research. A theory offers a set of concepts and propositions that can be applied consistently and examined systematically across studies of clinical problems. When appropriate, researchers can use theories as guides across phases of research. When researchers communicate clearly about how they have applied a theory in their studies, others can synthesize evidence more readily across studies where the same theory was used. If scholars understand the conceptual dimensions, antecedents, and consequences of their clinical problems, then they are likely to select theories and methods that are aligned well with their clinical problems. Grounded theory is a research approach that appeals to nurses for several reasons. Grounded theory helps nurses to understand, develop, and utilize real-world knowledge about health concerns.

Initiating and sustaining effective change in healthcare is a continuing challenge, with even the most successful improvements often being difficult to sustain or replicate in other contexts. According to Breckenridge (2019), Key figures in improvement science have emphasized the importance of learning from the psychological, social and structural processes influencing the implementation and maintenance of practice innovations. They have called for researchers to look into the ‘black box’ of quality improvement to learn lessons from both successes and failures. Motivating Change conceptualizes the psychosocial-structural conditions for large-scale, sustained change. By narrowing the gap between extrinsic and intrinsic motivators, and equipping staff with the capacity and opportunity to act on these motivations, it is possible to create self-improving organizations with a systems structure that welcomes change as a means to improvement. The theory adds to and extends the existing evidence base on how to create large-scale sustained change and promotes the shared expertise of those individuals already actively doing improvement work on the ground.

Breckenridge JP, Gray N, Toma M, et al. Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK. BMJ Open Quality 2019;8:e000553. doi:10.1136/ bmjoq-2018-000553

Singh, S., & Estefan, A. (2018). Selecting a Grounded Theory Approach for Nursing Research. Global Qualitative Nursing Research. https://doi.org/10.1177/2333393618799571

Different nursing theories ventured to shape the practices of clinical nurses and patient care. Florence Nightingale’s Environmental Theory in the 19th century presented as the foundation for the present-day application of the 21st-century nursing practice of Infection Control. Her environmental theory from her experiences in the Crimean War of infection, diseases, and death was the start of a lifetime’s nursing practice that continues to evolve through this day. Florence Nightingale believed that the cleanliness of the environment aligned with holistic patient care as fundamental to promoting healing which placed her theory into practice and provides strong evidence.

Environmental Theory known as infection control today is now an essential component of nursing practice worldwide that creates a safe environment to promote healing and excellent quality care for patient outcomes (Gilbert, 2020). The concept of basic infection control practices such as hand washing is an integral part of nursing practice. Nurses are responsible for the safety of the patients as hospital-acquired infections are still active today and unfortunately, come from primary health care clinicians due to non-adherence to hand hygiene. Guidelines were established, and standard precautions were developed as a basic strategy for infection control.

It is important to understand the origins of our current nursing practices for nurses to be well-prepared to embrace technological advances and emerging technologies as well as to be more receptive and compassionate to patient-centered care. Modern healthcare organizations have acquired much knowledge from Florence Nightingale’s expertise and insights. As we prepare for DNP practice, we will still be facing a new set of challenges for the influx of patients with different illnesses and to plan for a better hospital design for the future. We need to be grounded in the practice of caring and be role models to create a caring culture and create a healing environment for patients.

References

Gilbert, H. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27 (6), 626-633.

Gunawan, J., Aungsuroch, Y., Watson, J., & Marzilli, C. (2022). Nursing administration: Watson’s theory of human caring. Nursing Science Quarterly, 35 (2), 235-243.

A significant impact on the evolution of nursing theory began in the 1960-1970s. Several historical events contributed to these developments. One was the clinical situations nurses confronted during World War II and the introduction of antibiotics, which declined infectious disease but increased chronic disease as the leading cause of mortality and morbidity (Tobbell, 2018). Health care then focused on caring for these clinical problems and advancing care with surgical procedures. This state-of-the-art surgical care surfaced new issues, such as post-surgical complications (Tobbell, 2018). Medical technology was also implemented to care for these patients; thus, nurses had to provide more complex care than ever before. Nurses soon enough realized that they were left with making difficult decisions for the patients and the need for safe and effective care. With their experience, they developed frameworks and theories to improve patient outcomes. During this time, the nurses who received training in research and doctoral through the Division of Nursing grants, fellowships, and the Nurse Scientist Graduate Training Program during 1950- 1960 developed a new generation of fantastic theorists.

The current system faces several problems that include but are not limited to financial burden, high cost of care, lack of coverage, nursing/physician shortage, and increasing co-morbidity. Due to this complexity of care in patients that continue to occur, a new approach to meet current population needs is emerging. Reimbursement models are now changing from fee of service to value-based care. Insurance companies will provide incentives for those who demonstrate improved patient clinical outcomes and reduced health care costs. The approach focuses primarily on prevention and health promotion versus the number of patients seen. A theory that relates to preparing the doctoral nurse practitioner for changes occurring that focus on valued based care is the Penders Health Promotional Model. This theory was established in the 80s and promoted healthy aging (Barreto et al., 2022). Its fundamentals surround holistic nursing, social psychology, and learning theory (Barreto et al., 2022). The three main points include experiences, knowledge, feelings about the goal, and desired health promotion behaviors (Barreto et al., 2022). This structured approach is an instrument to guide the nurse practitioner in the multidisciplinary direction to improve clinical outcomes when aging, thus reducing health care costs. Most importantly, this approach promotes increasing dignity and the opportunity to maintain independence in the elderly.

References:

Barreto Cardoso, R., Pereira Caldas, C., Gomes Brandão, M. A., Alfradique de Souza, P., & Ferreira Santana, R. (2022). Healthy aging promotion model referenced in Nola Pender’s theory. Revista Brasileira de Enfermagem, 75(1), 1–9. https://doi-org.lopes.idm.oclc.org/10.1590/0034-7167-2020-0373

Tobbell, D. A. (2018). Nursing’s boundary work: theory development and the making of nursing science, ca. 1950–1980. Nursing Research, 67(2), 63–73. https://doi.org/10.1097/NNR.0000000000000251

Great post. I love how you began your statement reflecting on the social changes post WWII. As an African American, post WWII p Vietnam represents a significant change in perspective. The war increased mortality rates with the introduction of antibiotics and reduction of post surgical infections as stated in your post. I haven’t had the opportunity to watch the video posted by the professor however, after reading the philosophy or theories of nurse leaders in the past, I was surprised searching for one that included the basic needs of human rights. Luckily, the American Nursing Association posted a position statement in 2016 addressing the ethical responsibility of nurses to uphold the rights of our population (American Nursing Association, 2016). For me, it is the foundation of the care that Doctor of Nurses should focus their care(American Nursing Association, 2016) . For example, DNPs are advocates for practices that create and maintain an environment of professional practice, this includes the application of scientific underpinnings or research supported practice to our patients (American Nursing Association, 2016). As we watch the protest regarding Roe Vs Wade, George Floyd or the LGBTQ community the DNP program prepares us to apply the theory of care to our patients. Perhaps I will find a theorist in the Prizy presentation that speaks to the need for nurses to consider the rights of others and serve as advocates. If not my theory, perhaps it is our charge as future DNPs to develop theories of human rights, In this theory the consideration of the right to choose, be heard, and respected is the foundation of adequate care. This theory combines the environment that so many theorist speak about, for example the LGBTQ! community environment if considered as a theory would include special consideration for unique circumstances and how their personal experiences influence their outcomes. I am going to view the Prizy now.

American Nursing Association. (2016). The Nurse’s Role in Ethics and Human Rights: Protecting and Promoting Individual Worth, Dignity, and Human Rights in Practice Settings. ANA. https://www.nursingworld.org

The very foundation of theory building is scientific knowledge. A better understanding of scientific knowledge requires a proper grasp of philosophy of science, a way the world is seen. (Butts & Rich, 2017). In the nursing profession, the philosophy of science is the view point from which nurses act from in their encounter with patient and family. What readily comes to mind when talking about nursing is the image of performing certain clinical functions such as medication administration, attending to wounds, and listening to the sounds of pressure. According to Butts and Rich (2017, p.38), Nurses in the broad professional of registered nurses understand that there is more to nursing than the performance of the duties mentioned above. In discussions that revolve around the nursing profession, most of the focus is on what nurses do. Less attention is placed on the knowledge base that underpins the performance of those functions as well as other acts that are beyond the physical.

With the emergence of the nursing profession, a mental model or philosophy is developed that guides the belief structures of the prominent roles played by nurses in health care. Moving forward, this emergence necessitates the deployment of a paradigms or theories that define the extent and dimensions of the duties and responsibilities of nurses (Dewey. 2020). In a nutshell, these paradigms or theories would define and outline the specific roles of nurses, while helping them to navigate the unpredictable and high-pressure demands of hospital care. Prior to World War 11, before the nursing profession takes the center stage, the profession was relegated to professional facilitator assisting attending physicians in an emergency Units (Dewey, 2020). 

Informed by the knowledge that nurses routinely face situations that calls for several theoretical, nursing theory today requires that nurses choose a specific paradigm or a combination of paradigms that could best be deployed to respond to the situation that involves hospital care. As a doctoral-prepared nurse, I shall work with the theoretical model that adequately deal with what the situation calls for.

References

Butts, J. B., & Rich, K. L. (2017). Philosophies theories and for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.

Dewey, J. (2020). Nursing theory. Salem Press Encyclopedia of Health.