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 .
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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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
Change is such a huge component of medicine and nursing. But making a change is not enough. We must also find a
way to ensure that this change lasts through the years. In an article done by Lennox et al. in 2020, it was illustrated that there are many methods to ensure the sustainability of a change and it is our job as doctorally-prepared RNs to understand how to do so (Lennox et al., 2020). In many projects, one of the key questions is how to ensure that the project makes an overall impact and difference in the current practice. With our projects, something we are going to have to think of is how we incorporate our projects, improve patient care, but also keep it going long after we are done. This is why it is important for us to have buy-in from the representatives at the hospital. Though they are not offering any incentive for the project, they are still investing in us in a kind way. If our projects go well, the facility in question may take on the project and incorporate it into practice.
Lennox, L., Linwood-Amor, A., Maher, L., & Reed, J. (2020). Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review. Health Res Policy Sys, 18. Retrieved from https://doi.org/10.1186/s12961-020-00601-0.
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.
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.