DNP 815 Case Report: Application of Theory to Organizational Mission, Vision, and the Christian Worldview
Health care organizations are structured to deliver optimal care to individuals and communities, employing diverse strategies aligned with their visions and missions.
Within this framework, nursing professionals encounter patients with varying needs in the course of routine care. Understanding these needs is pivotal for the implementation of evidence-based practice in nursing.
Quality improvement projects provide nurses with the opportunity to integrate scientific evidence, guiding organizations in enhancing patient care outcomes.
This paper aims to delineate my project across four key dimensions: the project’s purpose, Christian nursing perspectives, the organization’s mission and vision vis-à-vis nursing theories in practice and models, and the synthesis of these components. The initial section elucidates the project’s purpose.
Purpose of the Project:
Pressure ulcer prevention poses a significant threat to patient safety in nursing and care quality, leading to increased morbidity and hospitalization rates. At the practicum site, the predominant reliance on routine pressure ulcer prevention necessitates further enhancements to optimize outcomes. This quality improvement project seeks to ascertain whether the implementation of a care bundle intervention would positively impact pressure ulcer prevention among elderly patients over an eight-week period in a long-term care facility situated in a suburban Maryland City.
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Christian Worldviews:
The worldviews of health care professionals are shaped by their religious affiliations, cultural backgrounds, and patient care experiences. Grand Canyon University’s (GCU) doctrinal statements articulate the principles of living under biblical guidance (Appendix A). The first statement affirms the Bible as the true and authoritative word of God, while the second asserts the existence of only one God who created all that is seen and unseen (Grand Canyon University, 2022). These statements imply that Christians, regardless of their profession, should derive inspiration and guidance solely from the Bible and reject the worship of any other deity. Likewise, healthcare ethics and Christian values encourage Christian health care professionals to draw upon the Bible for guidance and inspiration in their daily practice.
The third statement centers on salvation brought by Jesus Christ as the only Son of God. The fourth statement expounds on the concept of salvation, detailing Jesus’s suffering, death, resurrection, and the promise of his return to judge the living and the dead (Grand Canyon University, 2022). The fifth statement emphasizes human creation in God’s image and likeness, inherently free from sin. This universal likeness underscores the intrinsic equality of all humans, a principle that nurses should uphold in their patient care. The fifth statement further highlights how humans inherited a sinful nature, deviating from God’s command. Consequently, going against biblical teachings not only represents an injustice to humans but also a violation of God’s command.
The sixth statement emphasizes humans’ belief in salvation and regeneration through the Holy Spirit. The seventh statement outlines how salvation occurs through the redemption of the whole person (Grand Canyon University, 2022). Salvation is free but requires strong faith in Jesus Christ. The eighth statement emphasizes the role of unity of believers like evangelism and engagement in societal issues as a Christian duty. Such duties express God’s and humanity doctrines as well as God’s love and obedience of Jesus Christ (Grand Canyon University, 2022). The final statement describes salvation as denouncing evil, oppression, and discrimination while ushering in the good news.
Nursing professionals often apply the Christian worldview in their everyday practice, drawing on valuable concepts outlined in the GCU Doctrinal Statements. These concepts include the uniqueness of humans, equality, and the avoidance of oppression and discrimination. Nurses should strive to avoid evil by committing to actions that promote the general well-being of individuals and communities, whether healthy or sick. The Christian nursing perspectives are applicable not only to nurses of Christian faith but also to those who base their practice on other religious worldviews, emphasizing the universal virtue of equality that should be promoted by all nurses, regardless of their religious affiliation.
Organization’s Mission and Vision to Theory and Model
Health care organizations, like ProMedica Skilled Nursing and Rehabilitation (Wheaton), operate with a clear sense of direction outlined in their missions and visions. These elements ensure that health care facilities work toward specific goals and seek continuous growth. Generally, an organization’s mission describes its objectives and how it aims to achieve them, while the vision outlines the desired future position. This section of the paper explores the organization’s mission and vision and their connection to the chosen nursing theories in practice and evidence-based practice in nursing change model.
Mission and Vision:
ProMedica Skilled Nursing and Rehabilitation (Wheaton), an affiliate of the ProMedica Health System, is situated in Wheaton and specializes in individualized post-hospital skilled nursing care. The mission of the facility is to improve health and well-being through its various care divisions, including senior care, hospitals, doctors, and insurance plans (ProMedica, 2021). The facility focuses on patients’ needs and interests to facilitate a smoother and safer transition during their recovery. The vision of the facility is a future defined by better care for everyone (ProMedica, 2021). By embracing fundamental change and building lasting connections, the facility provides a range of services, such as cardiac care, diabetic care, outpatient therapy, and stroke and neurological care, offering coordinated, individualized care and rehabilitation services to enhance patient independence.
Connection of Mission and Vision to Nursing Theory:
Nursing theories in practice serve as organized bodies of knowledge that define the essence of nursing, providing a foundational understanding of care concepts to guide health care professionals in patient care. Imogene King’s goal attainment theory forms the theoretical foundation for this project. The theory’s core principle asserts that health care professionals and nurses should establish mutual goals, and the care process should be transactional, emphasizing a relationship-based approach (Adib-Hajbaghery & Tahmouresi, 2018). To achieve these goals, effective nurse-patient relationships are crucial, involving the identification and resolution of problems through collaboration. In this transactional relationship, the nurse takes on the role of initiating actions, reactions, and appropriate interactions between the provider and care recipients (Butts & Rich, 2021). Patients need sufficient information about the care process and treatment plans to actively participate in achieving the set goals.
The organization’s mission, centered on improving health and well-being through patient-centered care, aligns with the nursing theory. The emphasis on patient-centeredness and goal-oriented health practices in the mission is consistent with the goal attainment theory, ensuring that the care process is transactional. Patient-centered care involves respectful care and active patient engagement in decision-making, as suggested by Kuipers et al. (2019). Aligning patients’ needs and interests with the mission signifies a commitment to patient-centered practices, a principle that the goal attainment theory promotes by ensuring that the care process is transactional. This approach ensures patients understand the care process, their individual roles, and the targeted outcomes. Engaging patients in the care process also enhances their adherence to treatment plans (Kneuertz et al., 2020). Overall, this strategy optimizes outcomes and ensures patients actively participate in their health management.
The organization envisions a future defined by better care for everyone. In the organization, this care is achieved through the active participation of stakeholders in outcomes improvement and by ensuring that patient care is purpose-driven. The vision further emphasizes the importance of equality as a fundamental concept, as better care for everyone cannot be achieved without perceiving and treating patients equally. Similarly, the goal attainment theory demonstrates the care process as engaging patients in goal setting and attainment, irrespective of their conditions. Redefining health to be patient-centered and accessible to everyone will be instrumental in creating healthier and safer populations. 
Connection of Mission and Vision to Evidence-Based Change Model:
The chosen evidence-based practice in nursing change model for this project is Imogene King’s Conceptual System Model, which is highly suitable. Grounded in the idea that humans function as open systems in continuous interaction with their environment, this model views humans, the environment, and nursing as interconnected systems. Butts and Rich (2021) emphasized the interplay of these systems when implementing change or enhancing care quality. The model’s focus on the person as a system with three components—personal, interpersonal, and social—is pivotal for achieving quality patient-centered care. Understanding and responding to the needs of each system are crucial steps in this process. The personal system involves individuals coping with stimuli based on their expectations, requiring a nuanced understanding and effective responses before progressing to the interpersonal system. Key elements of the interpersonal system include communication, roles, and interactions during the nursing process. The social system encompasses practices and behaviors developed to address patients’ needs.
The alignment between the organization’s mission of improving health and well-being through patient-centric care and King’s conceptual system is evident. The organization prioritizes patients’ health and well-being, stressing the importance of care providers doing everything possible to enhance patient independence. Emphasis on nurse-patient communication facilitates necessary transactions like goal setting, aligning with the interpersonal system. A future defined by better care for everyone necessitates a comprehensive approach to addressing personal, interpersonal, and social systems in caring for patients.
Pulling it Together
Quality improvement projects present nurses with a valuable opportunity to enhance health outcomes within their facilities. Health care professionals, as a professional obligation, undertake these projects to standardize processes, improve patient outcomes, and reduce variation (CMS.gov, 2021). The current project, focusing on implementing a preventive bundle to reduce pressure ulcer incidence, shares these goals. The next section delves into how the project’s purpose intersects with Christian Worldviews (CWV), the organization’s mission and vision, and nursing theories in practice and evidence-based practice in nursing models.
The project aims to elevate care quality in the facility by mitigating pressure ulcer incidence, aligning with CWV principles such as equality, fairness, and concern for others’ needs. These principles serve as fundamental guidelines for the project, emphasizing the importance of nurses empathizing with patients’ needs. The mission and vision of health care organizations underscore the primary purpose of providing patient care, with a focus on continuous improvement and integration of values like CWV where appropriate. Imogene King’s goal attainment theory and conceptual system offer a structured framework for project implementation and quality improvement.
CWV and the organization’s mission and vision further bolster the project’s purpose. From a Christian perspective, alleviating human suffering aligns with the healing and comfort-promoting role of health care professionals (Pfeiffer, 2018). This comprehensive healing is achieved through patient-centered care, evidence-based practice in nursing, and quality improvement processes like the current project. The organization’s mission and vision support innovative care delivery approaches and interventions that offer lasting solutions. The project introduces effective interventions, as a preventive bundle can reduce current incidence and prevent future pressure ulcers. However, the collaborative identification of mutual goals and strategies for achieving them, as advocated in King’s theory and conceptual system, is crucial for success.
To a considerable extent, I am applying my understanding of GCU’s CWV to the DPI project I am developing. Within the Christian worldview, the acknowledgment that all humans are created in God’s image and likeness is paramount (Grand Canyon University, 2022). Denouncing evil, injustice, discrimination, and oppression is integral to this worldview. My alignment with this perspective is strong, as it promotes equality, empathy, and justice in patient care. Utilizing these principles implies a commitment to caring for all patients and ensuring their needs and concerns are thoroughly addressed. Health care practitioners guided by the Christian worldview unite for a common purpose and prioritize patients’ needs over individual interests. The project adopts a similar approach to reduce pressure ulcer incidence in the facility.
Conclusion
In daily practice, health care professionals encounter numerous challenges that impede care quality. The implementation of quality improvement projects empowers nurses to address these issues innovatively and comprehensively. The purpose of this paper was to delineate the goals of the project, its connection with Christian worldviews, the organization’s mission and vision, and the nursing theories in practice and evidence-based practice in nursing change model. As expounded, the project aims to reduce pressure ulcer incidence by implementing a preventive care bundle. The alignment with the organization’s mission and vision underscores the primary objective of enhancing health and well-being. The implementation of the project is fundamental to realizing the organization’s vision of providing quality care for everyone.
References
Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141-144. doi: 10.4103/2322-1488.235636
Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.
CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations.
Grand Canyon University. (2022). Doctrinal statement. https://www.gcu.edu/sites/default/files/media/documents/about/christian-identity-heritage/doctrinal-statement.pdf
Kneuertz, P. J., Jagadesh, N., Perkins, A., Fitzgerald, M., Moffatt-Bruce, S. D., Merritt, R. E., & D’Souza, D. M. (2020). Improving patient engagement, adherence, and satisfaction in lung cancer surgery with implementation of a mobile device platform for patient reported outcomes. Journal of Thoracic Disease, 12(11), 6883–6891. https://doi.org/10.21037/jtd.2020.01.23
Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 1-9. https://doi.org/10.1186/s12913-018-3818-y
Pfeiffer, J. (2018). Strategies Christian nurses use to create a healing environment. Religions, 9(11), 352. https://doi.org/10.3390/rel9110352
ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#
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