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

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

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.

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.

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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.

Despite advances in the science of cardiopulmonary resuscitation over the past several decades, the odds of

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

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 open6(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/

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 Quarterly33(1), 73–78. https://doi.org/10.1177/0894318419881807