DNP 815 Connecting Nursing Theory and Evidence-Based Change Models

DNP 815 Connecting Nursing Theory and Evidence-Based Change Models

DNP 815 Connecting Nursing Theory and Evidence-Based Change Models

Routinely, nurses encounter patients with varying needs, concerns, and attitudes to care. Despite the impacts of these variables on patient care, nurses must continually identify opportunities for change and address issues appropriately. Quality improvement projects utilize different nursing theories and frameworks. The current project seeks to improve outcomes among the elderly and debilitated patients using a preventive bundle to reduce pressure ulcers. Accordingly, the purpose of this paper is to describe the theoretical foundations, evidence-based change model, and the connection between the theory, change model and the direct practice improvement project. The section that follows describes the theoretical foundations.

Theoretical Foundations

Nurses borrow ideas of improving care quality from nursing theories. Grand and middle-range nursing theories are widely applied in direct practice improvement project. This section outlines the selected theory, clinical question, and how the theory has been applied in other practice areas.

Nursing Theory

A nursing theory is an organized body of knowledge that defines what nursing entails. Given this, nursing theories describe why nurses practice nursing and how they should approach different situations. According to Smith (2019), nursing theories provide baseline knowledge of care concepts that explain what nursing professionals should do for patients and the rationale for their actions. Such an approach to care is crucial in the ever-evolving practice since nurses should articulate evidence that validates their practice methodologies.

Imogene King Goal Attainment Theory:

broadly, Imogene King’s goal attainment theory is established on the principle that nurses and patients should set mutual goals and the care process should be transactional. As Butts and Rich (2021) explained, the goal attainment theory recognizes the importance of identifying a problem through effective nurse-patient communication and setting goals that must be achieved reciprocally. The implication is that the care process is not one-sided; thus, nurses and patients must be active partners. Butts and Rich (2021) further explained that nurses use their experience and skills to initiate action, reaction, and appropriate interactions between them and care recipients. To achieve the desired outcomes, nurses must share essential information about their perceptions of the situations and care processed to enable both parties to recognize specific goals and implement mechanisms to achieve them with a clear purpose. In summary, the care process through the goal attainment theory involves five concepts/steps: identifying a problem, mutual goal setting, shared roles to attain the goal, agreeing on how to accomplish the goals, and transaction/goal attainment.

The current project involves implementing a pressure preventive bundle to reduce pressure injury incidence among elderly and debilitated patients. The first concept of the goal attainment theory is problem identification through actions and interactions. The problem is clear, and both nurses and patients understand its implications. The second concept is mutual goal setting. The patients must be involved in setting goals to ensure they understand the projected benefits of the preventive bundle and their role in making the project a success. For instance, they can set reminders for repositioning to ensure they are awake as repositioning occurs. Seeking ways to achieve the goal should also be a joint exercise since patients must understand why and when each activity occurs. Mutual goal setting will ensure the nurse and patient’s goals align.

Clinical Question:

to what degree does the implementation of a pressure preventive bundle impacts pressure injury incidence when compared to routine care among elderly and debilitated patients in a long-term care facility in suburban Maryland City?

Implementing the pressure preventive bundle is expected to reduce pressure injury incidence in the long-term care facility. The nurse and patients should set mutual goals and identify measures to achieve these goals as the goal attainment theory recommends. Failing to engage the patients implies that the process will not be transactional, and the projected goals will not be achieved.

Synthesis of Theory

Imogene King’s goal attainment theory has been widely applied to set patient goals and optimize care outcomes in

DNP 815 Connecting Nursing Theory and Evidence-Based Change Models
DNP 815 Connecting Nursing Theory and Evidence-Based Change Models

nursing research and evidence-based practice. Araújo et al. (2018) evaluated the effectiveness of nursing interventions based on goal attainment theory on patient care outcomes among diabetic people. In this quasi-experimental study, sixty patients were divided into intervention and control groups. In the experimental group, health goals were formulated based on King’s theory and measures to enhance adherence to treatment identified mutually between nurses and patients. The control group did not receive nursing consultations. The primary finding was high adherence to treatment in the intervention group since patients felt co-responsible for the treatment and with high decisive power (Araujo et al., 2018). Nursing consultations that improved interactions further improved adherence.

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In a different study, Payamani et al. (2022) explored the impacts of applying the nursing process guided by the goal attainment theory’s concepts on patients with multiple sclerosis. In this study, the authors examined the impacts of the nursing process on patients’ quality of life (QOL) and activities of daily living (ADL) when the nursing process is based on the theory of goal attainment. Seventy patients were divided into the intervention and control groups, and the concepts of goal attainment theory were implemented in the intervention group. Payamani et al. (2022) found that the intervention group achieved a higher number of prioritized goals than the control group and reported higher QOL and instrumental ADL. The positive results underscored the effectiveness of goal attainment theory in promoting goal attainment, QOL, and instrumental ADL for patients.

King’s theory of goal attainment can also improve relationships if implemented effectively. Relationship building is pivotal in enhancing cooperation, adherence, and positivity in general and specialized care. To understand these connections, Adib-Hajbaghery and Tahmouresi (2018) assessed the use of King’s goal attainment theory in the nurse-patient relationship. For nurses to achieve optimal care, processes must be based on the tenet that nursing is enabling healthy interactions and building relationships to attain health and improve well-being. Such an understanding allows nurses to perceive patient care as a process whose ultimate goal is to attain health. Viewing care as an interactive process builds healthy nurse-patient relationships since nurses incorporate patients in goal setting and support them to interact positively with the immediate environment.

Summary

The above section on theoretical foundations explores the chosen nursing theory and its application in other nursing areas. As discussed in detail, Imogene King’s fundamental concepts include nurses and patients engaging in a transactional process to set mutual goals and identify ways of achieving them. The clinical question aligns with the goal attainment theory since nurses and patients should set mutual goals and engage in a transactional process to reduce the incidence of pressure ulcers. The next section analyzes the evidence-based change model.

Evidence-Based Change Model

Implementing evidence-based practice (EBP) requires health care professionals to combine scientific evidence, clinical expertise, and patients’ values and preferences to improve patient care outcomes. EBP models provide concepts and frameworks for implementing scientific evidence to make positive changes in patient care (Duff et al., 2020). If differently stated, EBP change models help change leaders to demystify the process of research translation into clinical practice.

Imogene King’s Conceptual System Model

The conceptual system is established on the principle that human beings are open systems interacting continuously with the environment. According to Butts and Rich (2021), King’s model reflects humans, the environment, health, and nursing as systems. The concept of a person is the most critical and contains three systems: personal, interpersonal, and social. Butts and Rich (2021) further explained that the personal system includes people (patients) who respond and cope with stimuli based on their expectations. The interpersonal system includes roles, communication, and interaction that transpire during the nursing process. The social system includes the roles, practices, and behaviors developed to address the needs of patients. In the project, patients are perceived as a combination of systems whose fundamental principles must be implemented to reduce the incidence of pressure injuries in the long-term care facility. Much emphasis is on the interpersonal system where nurse-patient communication will enable nurses and patients to make the essential transactions such as goal setting and identify the strategies for attaining those goals to maintain their health.

Clinical Question

Perceptions shape how people interact between themselves and person-to-environment transactions. However, without effective communication, nurses cannot model the desired nurse-patient interactions. Using the interpersonal system principles, communication will be fundamental in enabling nurses and patients set mutual goals, choose common strategies, and work together to implement the preventive bundle to reduce pressure injury incidence. The implication is that the goal attainment theory will be successfully implemented through transactions and helping patients perceive the process positively through continuous communication and engagement.

Synthesis of Evidence-Based Change Model

Imogene King’s conceptual system model has been widely used in current and past research. Park (2021) studied the impacts of nurse-led intervention programs based on the personal and interpersonal systems that Imogene King proposed in the conceptual system model. The model was utilized by categorizing the study’s dependent variables into personal and interpersonal systems. Adib-Hajbaghery and Tahmouresi (2018) also conceptualized the influence of personal and interpersonal systems on nurse-patient interactions. They conjectured that the nurse-patient interaction could not be effective without the nurse and patient understanding each other. Adib-Hajbaghery and Tahmouresi (2018) further mentioned that nurse-patient relationships exemplify the interpersonal system of the King’s conceptual system. In another study, Joseph et al. (2019) analyzed how King’s conceptual system and a transactional process provide a framework for effective and efficient case management. They argued that perceiving patients as interpersonal systems leads to mutual satisfaction for patients, physicians, and families.

Summary

Change models provide frameworks for implementing scientific evidence in nursing practice. Imogene King’s conceptual system model outlines how to implement goal attainment theory’s fundamental principles. The above section illustrates the change model and how it has been applied in other articles. The next section links the nursing theory and change model to the project.

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

Pressure injuries are a significant threat to patient outcomes since they threaten patient safety and care quality and increase morbidity and hospitalization. Addressing the problem will reduce the incidence of pressure injuries in the site that primarily relies on standard care practices. Therefore the purpose of this quantitative quasi-experimental project was to determine to what degree the implementation of a pressure preventive bundle would impact pressure injury incidence when compared to current practice among elderly and debilitated patients in a long-term care facility in Maryland within 60 days.

Conclusion

Imogene King’s theory of goal attainment theory presumes that nurses and patients set goals that must be achieved reciprocally. The transaction process enables the two crucial parties of the nursing process to set goals and navigate situations while communicating with a clear purpose. King’s conceptual system model provides a framework for implementing the goal attainment theory. Its interpersonal system principles will be instrumental in implementing the DPI project by ensuring the nurse-patient relationship is transactional, and each understands the other. The nurse theory supports the change model by establishing patient care as a transaction. The model supports the theory by affirming the importance of a transactional relationship and provides a framework for implementing the theory’s basic concepts. The theory and the model support the purpose of the project since nurse-patient communication, and mutual goal setting will be instrumental in the project’s success.

 

 

References

Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies7(3), 141-144. doi: 10.4103/2322-1488.235636

Araújo, E. S. S., Silva, L. D. F. D., Moreira, T. M. M., Almeida, P. C. D., Freitas, M. C. D., & Guedes, M. V. C. (2018). Nursing care to patients with diabetes based on King’s Theory. Revista Brasileira De Enfermagem71, 1092-1098. https://doi.org/10.1590/0034-7167-2016-0268

Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: An interpretive description. Implementation Science Communications1(1), 1-9. https://doi.org/10.1186/s43058-020-00070-0

Joseph, S. S., George, R. A., Jose, R., & Sebastian, B (2021). Application of a nursing care protocol based on King’s Theory of Goal Attainment: A pre-experimental study. PJMHS, 15(12), 3481-3484. https://doi.org/10.53350/pjmhs2115123481

Park, B. M. (2021). Effects of nurse-led intervention programs based on goal attainment theory: a systematic review and meta-analysis. Healthcare 2021, 9, 699. https://doi.org/10.3390/

Payamani, F., Khatiban, M., Soltanian, A., Ghiasian, M., & Borzou, S. R. (2022). The effect of applying the nursing process based on the Theory of Goal Attainment on activities of daily living and quality of life in persons with multiple sclerosis during COVID-19 pandemic: A clinical trial. Irish Journal of Medical Science (1971-),1-9. https://doi.org/10.1007/s11845-022-03104-9

Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.