DNP 815 Select a nursing model or theory from the Philosophies and Theories for Advanced Nursing textbook to use for your DNP Project

For my DNP project, I selected the theory of Crosby on his attention to transforming the quality culture in the field of quality management. Crosby’s theory emphasized the importance of systems knowledge and improvement, failure of inspection, and the importance of statistical quality control with four basic absolutes or concepts of a quality improvement process (Butts & Rich, 2018).

The first absolute is “the definition of quality is conformance to requirements” where management has the basic tasks of establishing the requirements (Butts & Rich, 2018). The direct practice improvement that I’m working on is the prevention of central venous catheter (CVC) infection for patients receiving hemodialysis patients. The second absolute is “the system of quality is prevention” where prevention is successful when key processes are understood (Butts & Rich, 2018). Central Line-Associated Blood Stream Infections (CLABSI) is a highly prevalent problem that only through established protocol adherence, and best practices can reduce infections.

The third absolute is that “the performance standard is zero defect” (Butts & Rich, 2018). One of the clinical measures of The End-Stage Renal Disease (ESRD) Quality Improvement Program (QIP) is zero infection. This metric can be preventable with surveillance, proper aseptic technique, and management strategies. Mitigating risks and brainstorming solutions establish a culture of safety. The fourth absolute is “the measurement of quality is the price of nonconformance” (Butts & Rich, 2018). The Centers for Medicare & Medicaid Services (CMS) administers ESRD QIP to promote high-quality services in renal dialysis facilities and reduce payments for those who do not meet or exceed performance standards.

Quality management is a key element allowing operational performance improvement, product quality, and organizational performance (Negron, 2020). As doctoral-prepared nurses in dynamic roles, we are poised to interface and simultaneously lead within our professional sphere.

References

Butts, J.B., & Rich, K.L. (2018). Philosophies and theories for advanced nursing practice (3rd ed.) Jones & Barlett Learning.

Negron, L.A. (2020). Relationship between quality management practices, performance and maturity quality management, a contingency approach. Quality Management Journal, 27 (4), 215-228.

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https://doi.org/10.1080/10686967.2020.1809582

Nursing theory is ultimately the product of nursing practice. It is used to guide practice and close knowledge gaps. The theory that I will use from the Philosophies and Theories for Advanced Nursing textbook that I will use for my DNP project is Virginia Henderson’s Needs Theory. Butts (2018), does a great job discussing this theory. I loved when she proclaimed that Virginia Henderson believed that the beauty of nursing is the combination of your heart, your head and your hands and where you separate them, you diminish them. Some of the other key elements of this theory are defined within 14 components set up by the theorist.

Below the 14 components are broken down by its component category. The 14 components are built with the Maslowes Hierichy of needs in mind. Gonzalo (2022), does an amazing job placing them in their correct component category.

Physiological Components

1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying environment
8. Keep the body clean and well-groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others

Psychological Aspects of Communicating and Learning

10. Communicate with others in expressing emotions, needs, fears, or opinions.
14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

Spiritual and Moral

11. Worship according to one’s faith

Sociologically Oriented to Occupation and Recreation

12. Work in such a way that there is a sense of accomplishment
13. Play or participate in various forms of recreation

Henderson’s Needs Theory can be applied to nursing practice as a way for nurses to set goals based on Henderson’s 14 components. Meeting the goal of achieving the 14 needs of the client can be a great basis to further improve one’s performance towards nursing care. In nursing research, each of her 14 fundamental concepts can serve as a basis for research, they can assist with meeting your patients needs throughout their care.

DNP 815 Select a nursing model or theory from the Philosophies and Theories for Advanced Nursing textbook to use for your DNP Project

Despite advances in the science of cardiopulmonary resuscitation over the past several decades, the odds of neurologically intact survival from in-hospital cardiac arrest remain low. When cardiac arrest occurs, a patient’s survival depends on both the immediate recognition of the event (as each minute delay from the time of cardiac arrest to the initiation of cardiopulmonary resuscitation (CPR) corresponds to a 10% decrease in the likelihood of survival), as well as aggressive resuscitation in the form of CPR, mechanical ventilation, administration of cardioactive medications and electrical defibrillation. I see the needs theory applies to this as it helps us to understand the basic fundamental needs of the patient to stay alive. According to Clark (2016), facilities tend to overlook fundamental aspects of the preparedness gap to accurately apprehend the true nature of cardiac arrest teams. Hospitals aspire to the model of ‘high reliability teams’ in which team members have a high degree of familiarity with each other and with their individual roles, and in which the leadership structure is mutually understood. They need to understand basic principles and the needs of their patients pre code to avoid codes themselves.

Butts, J. B., & Rich, K. L. (Eds.). (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett. ISBN-13: 9781284112245

Clarke, S., Carolina Apesoa-Varano, E., & Barton, J. (2016). Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest. BMJ open, 6(1), e009259. https://doi.org/10.1136/bmjopen-2015-009259

Gonzalo, A. (2022). Virginia Henderson: Nursing Needs Theory. Nurselabs. https://nurseslabs.com/virginia-hendersons-need-theory/

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The Theory of Human Caring is the Nursing theory selected. Jean Watson formulated it in 1979 (Murali, 2020). It guides enrichment in relationships to create a safe environment for individuals. Comfort is essential for the future of the direct practice improvement (DPI) due to the topic’s sensitivity, which includes end-of-life conversations. The DPI intends to use the Five Wishes to assist families and patients making decisions about care before death. The project expects to change waiting to speak about end-of-life measures before an acute event occurs with implementation in the primary care setting. This approach intends to deliver the opportunity to provide personal values and beliefs to influence decisions. The intervention gives the opportunity for care to be specific to the persons wishes. Advanced directives also assist in helping families and clinicians make determinations about resuscitation choices and alleviate the feeling of guilt or burden.

The ten critical concepts included in this theory were called carative and later evolved to caritas, which means cherish, love, appreciate, and attention (Gunawan et al., 2022). Gunawan et al. (2022) explain that caring is vital in creating an influential culture and environment for those involved. This process follows: embrace, inspire, trust, nature, forgive, deepen, balance, co-create, minister, and open. The factor of embracing focuses on treating others with respect. Murali (2020) explains that this can occur by providing respect and communication with patients in their end-of-life decisions. Providing presence, openness, and honesty in inspiring competency can assist decision-making. For the trust factor, it is essential to be sensitive and provide consistency. In the fourth and fifth curative nature, Murali (2020) discusses forming a trusting relationship and preserving dignity and humanity. The sixth factor provides a thorough review of all elements in the clinical situation, which may include scientific details and are not limited to clinical situations. In the educational factor, the idea is to provide patients and families with research findings and guide end-of-life care preferences from an honest perspective. In co- create, the ability to provide facilities, technologies, and infrastructures is important. The last two focus on fulfilling physical and spiritual needs, which can be done by understanding cultural beliefs and respecting thoughts about the environment chosen at the end of life.

References:

Gunawan, J., Aungsuroch, Y., Watson, J., & Marzilli, C. (2022). Nursing Administration: Watson’s Theory of Human Caring. Nursing Science Quarterly, 35(2), 235–243. https://doi.org/10.1177/08943184211070582

Murali, K. P. (2020). End of Life Decision-Making: Watson’s Theory of Human Caring. Nursing Science Quarterly, 33(1), 73–78. https://doi.org/10.1177/0894318419881807

I really enjoyed your post. It is true that this topic can be quite challenging to approach in the clinical setting for not only the family and clients but also the staff and providers. But you are absolutely right in the fact that not only does this conversation need to happen, but it needs to happen before something critical occurs. Oftentimes, this conversation is taking place as a client is crashing and with this situation, we see the family under immense pressure to make a choice that can and does greatly impact the life of the client. It is better to have this conversation with the client and the family when pressure is not a part of the environment and the client can comfortably and fully express his or her wishes when it comes to the end of life. According to Cott in 2022, there are four main parts to a successful and holistic conversation with clients regarding DNR/DNI. First, it is important to have a supportive and pressure-free environment and conversation regarding the topic. Then, clinicians need to clarify any questions that may arise regarding this topic or that. Then the conversation and decisions need to be documented and saved. Finally, and most importantly, clinicians and family need to take the appropriate steps to respect the wishes of the client with the appropriate treatment plans (Cotts, 2022).

References

Cott, M. (2022). Do not resuscitate – 4 keys to effective patient communication. Do Not Resuscitate – 4 Keys to Effective Patient Communication. Retrieved July 20, 2022, from https://go.myhomecarebiz.com/blog/home-health-do-not-resuscitate-agreement

The model which is selected is care, cure, and core nursing theory by Lydia Hall. This model is also known as the three Cs of the Lady Hall. In this model “core’’ is the patient receiving help and care from the nurse. The core has many goals set by her or himself rather than by other people. They behave according to their values and feelings. The cure is the attentiongiven by the medical staff and professions to the patients. TChinyama, J., Chipungu, J., Rudd, C., Mwale, M., Verstraete, L., Sikamo, C., Mutale, W., Chilengi, R., & Sharma, A. (2019). Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC public health to the patients. The three circles in this theory present a particular nursing aspect like cure, care, and core. The patient in the hospital is considered as a body or a person. During patient care, the nurse develops an interpersonal relationship and acts as an advocate to the cure of his condition.

Whatsoever, the central role of the nurse in all three circles is present but major focus is on the care circle. This is the place in the nursing theory, where a nurse can act as a role model while assisting patients and in providing quality care and helping them to attain their level of satisfaction and attaining a sense of balance. The selected theory based on the three elements of care, cure and core. Core is the patient, who is receiving care and has specific objectives. Cure is

the attention provided to patients by the physicians and act as interventions necessary for the actions to receive information about the illness of the patients. So nurses are central model in the whole process of taking care of the patients.

References:

Chinyama, J., Chipungu, J., Rudd, C., Mwale, M., Verstraete, L., Sikamo, C., Mutale, W., Chilengi, R., & Sharma, A. (2019). Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC public health, 19(1), 16. https://doi.org/10.1186/s12889-018-6360-2

Yip J. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE open nursing, 7, 23779608211011993. https://doi.org/10.1177/23779608211011993

Orem in her self-care deficit nursing theory defined self-care as the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being. (Hartweg & Metcalfe,2022) .Throughout five decades, Orem refined the description of nursing for this purpose to empower patients and their families to care for themselves .The self-care deficit nursing theory separates four key operations within professional practice which are diagnostic, prescriptive, treatment or regulatory, and case management (Yip ,2021) .Within the self-care deficit nursing theory, diagnostic operations refer to the diagnosis and prediction of self-care requisites, which must consider the effect of foundational capabilities and dispositions on the patient’s self-care ability and determine the practical actions required based on the patient’s state of health, manner of daily living, and environmental constraints, and health or other goals

This theory will be appropriate for my DPI project that is focused on fall preventive measures among hospitalized patient in a Skilled Rehabilitation Nursing Facility. As an ARPN I can offer help and advice in matters such as adjusting a patient’s environment in the facility and even at home when discharged and ensuring that they have the necessary knowledge and skills to accomplish the prescribed actions. Self-care deficit theory entails the initiation of self-care for patients who are hospitalized that cannot perform certain cares for themselves while in the hospital and after discharge , the incorporation of Orem’s theory on self-care deficit and ways to bridge the gap will empower patients and their families to care for themselves and these can be achieved through, patient education for those that lack the knowledge , assessments so as to know limitations and strength and plan of care with associated goals will be established to enable the initiation of activities on the patient thus promoting life, health and wellbeing .

Within the self-care deficit nursing theory, the role of the ARPN is to apply practical nursing knowledge by determining how a patient can best undertake self-care within the boundaries of their living arrangements and support facilities. These initiatives are called people centered care which provides a framework to empower and engage people in their healthcare to improve health and well-being. People centered care consciously adopts individual, careers, families’ and communities’ perspectives as participants in, and beneficiaries of, trusted health systems that respond to their needs and preferences in humane and holistic ways (Yip,2021). All these can be achieved by establishing an integrated partnership between the patient and all providers of care which will in return will encourage co-designing and delivery of personalized care in an efficient and effective way. The goal is better health and well-being outcomes across levels of care.

References

Hartweg, D. L., & Metcalfe, S. A. (2022). Orem’s Self-Care Deficit Nursing Theory: Relevance and Need for Refinement. Nursing Science Quarterly, 35(1), 70–76. https://doi.org/10.1177/08943184211051369

Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing. https://doi.org/10.1177/23779608211011993

Henderson’s “need-based theory” is one of the most successful attempts to determine the role of nurses and explain the significant aspects of nursing care that must be offered to a patient. Henderson defines this as the unique function of the nurse to assist the individual, sick or healthy, in the performance of the activities contributing to health or recovery, including peaceful death that a person would perform unaided if he had the necessary strength or knowledge; and to do this in such a way as to help him gain independence as rapidly as possible (Henderson, 1964). Research shows that the definition given by Henderson in the need theory was one of the most influential moments in nursing practice. She stated, “The unique function of the nurse is to assist the individual, sick or healthy, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. Furthermore, to do this in such a way as to help him gain independence as rapidly as possible” (Henderson, 1964). It created a global change in how nurses developed their services and improved patients’ health and wellbeing. Virginia Henderson used the scientific method, deductive reasoning, to develop the needs-based theory. According to Ahtisham, Y., & Jacoline (2015), Virginia Henderson’s utilized the physical, emotional, and mental (psychological components) to derive this theory related to Maslow’s theory. However, Henderson was unaware of the 14 sub-concepts that coincide with Maslow’s.

This theory is appropriate to my future practice setting as an advanced practice nurse (APN) caring for patients with end-stage renal disease (ESRD) in an outpatient patient hemodialysis facility. This theory is applicable within my practice setting because “meeting patient needs of respiration, nutrition, elimination, body mechanics, rest, and sleep, keeping clean and well groomed, controlling the environment, communication, human relations, work, play, and worship (Butts & Rich, p. 614), are all advanced nursing care that I will need to provide for my patient’s basic needs. The common problems outlined by Virginia Henderson’s need-based theory include 14 components of fundamental nursing care and interventions that patients have or use as part of their independence and ADLs (Butts & Rich, p. 598). As a future APRN, the common resolved problems are 14 components that maintain the patient’s physical functions, safety, a sense of well-being, and finding oneself about where they see themselves in life (Butts & Rich, p. 615). As for advanced practice nursing fields, Virginia Henderson was a proponent for nurses to be independent practitioners Ahtisham, Y., & Jacoline (2015), as well as well-defined concepts and propositions that characterize any theory or nursing model, Henderson’s need theory. It is not enough for nurses to care for patients and educate them. Ndiok & Ncama (2018) specify that Henderson focused on individual care through the prism of 14 components that explain the nursing role and preferred actions to preserve health. The nursing need theory aims to introduce a unique focus on nursing and prove its appropriateness. A patient needs autonomy in personal care, and a nurse is a person for professional assistance (Fernandes et al., 2019). In terms of the chosen model, all the fourteen needs of patients may be divided into four groups, including biological or physiological, moral or spiritual, psychological, and social (Fernandes et al., 2019).

According to (Fernandes et al., 2019), there are seventeen assumptions of the Needs theory that were implicated in Henderson’s theory. Nurses must assist people with illnesses; nurses must collaborate within an interdisciplinary team and become independent professionally from the physician; 14 concepts of nursing describe patient needs and complete nursing functions; goals are achieved with a symbiotic relationship between patient and nurse with health promotion as the nurse’s primary goal; patient and family are one with mind and body being one within the person; assist patient with independence while the patient controls their physiological and psychological harmony; people function in health at all times and must maintain independence and relationships; people maintain health status with knowledge and awareness; illness effects environment conditions and nurses should maintain a safe environment; nurses must be culturally competent and must maintain best practice methods while relying on evidence-based research methods. These are all relevant elements to me as an APRN as these can be used to assess my patient’s independence level and to assess the patient’s assistance in obtaining or maintaining activities of daily living for basic needs (Fernandes et al., 2019). Being an APRN in the outpatient dialysis center, Virginia Henderson’s needs theory applies to my discipline of nursing and various practice scopes. Utilizing this theory and putting it into action within the practice is adaptable and allows one to reflect on their nursing competency when it involves maintaining a person’s health promotion and independence level. As stated by Durepos, P. et al. (2015), with Henderson’s philosophy of applying best practice methods that involve evidence-based research, advanced practice application of theory can be a foundation for the nursing process.

References

Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice; Virginia’s Henderson needs theory. International Journal of Caring Sciences, 8(2), 443-450.

Butts, J. B., & Rich, K. L. (Eds.). (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett. ISBN-13: 9781284112245

Durepos, P., Orr, E., Ploeg, J., & Kaasalainen, S. (2018). The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques. Journal of Advanced Nursing, 74(10), 2290-2300. Web.

Fernandes, B. K. C., Clares, J. W. B., Borges, C. L., da Nóbrega, M. M. L., & de Freitas, M. C. (2019). Nursing diagnoses for institutionalized elderly people based on Henderson’s theory. Revista Da Escola de Enfermagem Da USP, 53. Web.

Henderson, V. (1964). The nature of nursing. American Journal of Nursing, 64, 62–68. Web.

Masters, K. (2018). Models and theories focused on nursing goals and functions. In J. B. Butts &

Ndiok, A., & Ncama, B. (2018). Assessment of palliative care needs of patients/families living with cancer in a developing country. Scandinavian Journal of Caring Sciences. Web.

Vera, M. (2014). Virginia henderson’s nursing need theory. Retrieved July 17, 2022, from http://nurseslabs.com/virginia-hendersons-need-theory/

DNP 815 Select a nursing model or theory from the Philosophies and Theories for Advanced Nursing textbook to use for your DNP Project