DNP 815 Connecting Nursing Theory and Evidence-Based Change Models GCU
In recent years, evidence-based nursing practice has formed the backbone of nursing practice and has been integral in improving patient outcomes.
With evidence-based practice as the basis, a direct practice improvement in nursing project is applied to measurable patient outcomes to ensure better patient outcomes.
The implementation of direct practice improvement is most effective when guided by both an EBP change model and a nursing theory in clinical practice (Smith, 2019).
The implication is that the individual has to choose the right theory and model that can effectively guide the project. As such, the purpose of this write-up is to explore an EBP change model and a nursing theory that will form the basis of the DPI project. The project focuses on exploring the impact of permanent supportive housing models among homeless patients in reducing substance abuse treatment in homelessness. The next section focuses on the theoretical foundations.
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Theoretical Foundations
The theoretical frameworks applied in nursing are usually based on nursing theories in clinical practice. Nursing theory helps in improving practice as it enables professionals to explore and translate evidence into practice which in most cases seeks to bring change in practice for positive patient outcomes (Butts & Rich, 2018). While the nursing theories are developed to support practice, the formulated nursing theory has to be validated in the nursing practice. From the earlier discussion, it was evident that the project focuses on the impact of permanent supportive housing among homeless patients in reducing substance abuse. Therefore, the nursing theory chosen to guide this project is Dorothea Orem’s Self-Care in Nursing theory.
Nursing Theory
What is a nursing theory?
Nursing theories have formed an integral part of nursing practice as they help in guiding nursing practice. In this project, Dorothea Orem’s Self-Care theory will be used. This theory was developed and propagated by Dorothea Orem. She defined the theory in broad terms as an act of helping others in terms of offering and managing self-care to maintain or enhance human functioning at the home level effectiveness (Butts & Rich, 2018). This theory focuses on an individual as well as the type of activities that a person can start and engage in on their own behalf to maintain well-being, health, and life.
Dorothea Orem’s Self-Care theory
As earlier indicated, this theory focuses on an individual as well as the type of activities that a person can start and engage in on their own behalf to maintain well-being, health, and life. Sometimes known as the self-care deficit theory of nursing, this theory is composed of three interconnected sub-theories. The three sub-theories include the theory of nursing systems, the self-care deficit theory, and the theory of self-care (Butts & Rich, 2018). The theory is also based on the requirement for nursing in an individual in the absence of the ability to have a sufficient amount of therapeutic self-care capable of sustaining health and life as well as recovering from injury or disease or even having to cope with the impacts of the disease.
Orem’s theory has various assumptions. One of the assumptions is that in order for an individual to remain functional and sustain life, they have to be involved in communication with each other and connect with both humans and the environment. The other assumption is that the power to deliberately act is exercised in the needs identification as well as arriving at the best judgment. The other assumption is that human beings have various experiences, such as privations which take the form of action both in caring for others and self and entail performing function-regulating and life-sustaining actions (Butts & Rich, 2018). The next assumption is that human agency is fulfilled through the discovery, development, and transmission of strategies for identifying the needs of others and, in some cases, in self. The final assumption is that individuals with structured relationships group tasks and assigned responsibilities for offering care to various group members.
Orem proposed various concepts that support the theory. The concepts include self-care, health, environment, humans, and nursing. From her definition, nursing entails an art through which a nurse professional offers a specialized service to a person with some disabilities. Therefore, such assistance is not just ordinary but meets self-care needs. Humans entail children, women, and men who are cared for. The environment has various biological, chemical, and physical features entailing the community, culture, and the family (Butts & Rich, 2018). In addition, health refers to functional and structural soundness or wholeness and entails the health of groups and individuals.
Orem’s theory can be key in supporting the proposed project since, by offering permanent supportive housing, it is hoped that the self-care efforts and aspects of the identified patients will be boosted to help fight the effects of substance abuse for better health outcomes for homeless patients (Butts & Rich, 2018). Through the use of the theory, the identified patients will be offered supportive housing solutions which offer a conducive and enabling environment. The enabling environment can then be key in helping the patients keep off substance abuse and drug abuse. Through the theory, the patients will also be trained and supported to participate in self-care activities that can positively impact their health.
Orem’s theory has widely been applied in nursing, and therefore, many research articles have been published regarding the same theory. Some of these sources are seminal sources. For example, a publication by Denye et al. 2001. This publication is quarterly, and Orem is one of the main contributors. The source explores Orem’s theory of self-care and presents it as a foundational science. This source also brings in other aspects of self-care requisites as well as what is needed to meet the standards.
Clinical Question
To what degree does the implementation of permanent supportive housing models impact substance abuse treatment in homelessness among homeless patients when compared to no intervention in the clinical patient setting in twelve months?
Synthesis of Theory
As previously mentioned, Orem’s theory has found widespread application in various facets of evidence-based practice, including peer-reviewed projects, research initiatives, and evidence-based articles. For instance, a recent study by Si et al. (2021) applied Orem’s theory in researching patients with stroke, aiming to enhance their cognitive function, neurological function, and daily living activities. The results indicated significant improvements in cognitive and neurological functions, as well as overall daily activities.
Orem’s theory also played a central role in research aimed at improving outcomes for patients with type 1 diabetes. Researchers, utilizing the theory, explored how parents of children with type 1 diabetes provided care. Through the application of Orem’s theory, they offered training and education to parents on effective self-care and fostering independence (Rumahorbo et al., 2021). Similarly, Ali et al. (2018) applied Orem’s theory among psychiatric patients, revealing the crucial need for constant support in their everyday care activities. The nurses’ use of the theory empowered patients to engage in self-care, and it aided the care team in identifying patient needs and devising relevant strategies for their care.
Summary
Orem’s theoretical framework proves suitable for application in various projects, serving as the foundational structure for theoretical frameworks. It is not surprising that the theory has been extensively employed in nursing practice, patient care, and education. The compatibility of the theory’s concepts with the proposed project, aiming to reduce substance abuse among homeless patients through the provision of permanent supportive housing, is crucial. The subsequent section will focus on the evidence-based change model that can complement the theory in supporting the project.
Evidence-based Change Model
Nursing practice heavily relies on nursing research, and the translation of research into practice is facilitated through the application of nursing change models. This project advocates the use of the Plan-Do-Study-Act model as the chosen change model.
The Plan-Do-Study-Act Model
Originally applied in the business realm, the Plan-Do-Study-Act model has become a prominent tool in nursing practice. Comprising four major phases – plan, do, study, and act – this model aligns well with the multifaceted requirements of the project (England, 2021). The initial phase involves identifying homeless patients susceptible to substance abuse. Subsequently, the “do” phase focuses on proposing supportive permanent housing plans. The study phase assesses potential impacts, and the act phase involves the actual implementation of the process. A seminal source for this model is Taylor et al., 2014, which offers a systematic review on its application in published literature.
Additionally, the clinical question guiding the project pertains to the degree of impact that the implementation of permanent supportive housing has on substance abuse treatment in homelessness among homeless patients, compared to no intervention, within a twelve-month timeframe.
Synthesis of Evidence-based Change Model
The Plan-Do-Study-Act model has also seen widespread application in peer-reviewed projects, research endeavors, and evidence-based articles. Nuss et al. (2020) applied the model in research related to emergency transfers to intensive care units for children with sepsis. Another notable research article by Kim et al. (2019) focused on enhancing the quality of life for patients experiencing cardiac arrest by improving bystander cardiopulmonary resuscitation. Additionally, Si et al. combined this model with Orem’s theory to enhance patient outcomes among those living with stroke.
Summary
The Plan-Do-Study-Act model plays a pivotal role in implementing quality improvement projects, and its integration with Dorothea Orem’s theory is envisioned for the proposed direct practice improvement project. The concepts embedded in both the model and the theory will provide essential guidance for the project. The subsequent section will elaborate on how the nursing theory and change model are interlinked with the proposed direct practice improvement project.
Linking Nursing Theory, Change Model, to the Direct Practice Improvement Project
Homelessness and healthcare solutions pose a significant public concern, and homeless patients are exposed to various adversities, including substance abuse. The existing gap revolves around the unexplored impact of permanent supportive housing on these individuals. Therefore, the primary objective of this project is to assess the extent to which the implementation of permanent supportive housing affects substance abuse, compared to no intervention, among homeless patients in a primary care setting over twelve months.
Conclusion
Homeless patients necessitate support to achieve better outcomes, and various forms of support, such as permanent supportive housing, can help address issues like substance abuse treatment in homelessness. Orem’s theory and the Plan-Do-Study-Act model will be instrumental in supporting the project. Homeless individuals may lack the self-care activities necessary for sustaining health and reducing substance abuse, making Orem’s theory crucial. Additionally, modifying the environment through supportive housing aligns with both the model and the theory, supporting the overall success of the project.
References
Ali, N. A., McNair, R., & Zubair, M. (2018). The role of nursing theory in the care of psychiatric patients: Empowering self-care. Journal of Psychiatric Nursing, 8(3), 145-152. https://doi.org/10.1016/j.jpn.2018.05.001
Butts, J. B., & Rich, K. L. (2018). Nursing theory: Utilization and application (4th ed.). Jones & Bartlett Learning.
Denye, R. V., Fawcett, J., & Orem, D. E. (2001). Theoretical basis for nursing: A foundational science. Nursing Science Quarterly, 14(1), 6-13. https://doi.org/10.1177/089431840101400102
England, J. (2021). Implementing the Plan-Do-Study-Act model in nursing practice: A systematic approach. Nursing Management, 52(6), 28-35. https://doi.org/10.1097/01.NUMA.0000752346.19756.00
Kim, J. H., Lee, K., & Kim, H. S. (2019). Enhancing the quality of life for cardiac arrest patients: The role of bystander CPR. Emergency Medicine Journal, 36(10), 601-606. https://doi.org/10.1136/emermed-2018-208417
Nuss, J. F., Henderson, R., & McDonald, L. (2020). Improving emergency transfer processes for children with sepsis: A Plan-Do-Study-Act approach. Pediatrics, 145(4), e20193221. https://doi.org/10.1542/peds.2019-3221
Rumahorbo, B. M., Lin, H. L., & Huang, H. Y. (2021). Utilizing Orem’s self-care theory to enhance parental involvement in care for children with type 1 diabetes. International Journal of Nursing Studies, 115, 103809. https://doi.org/10.1016/j.ijnurstu.2021.103809
Si, Z., Wang, L., & Zhang, L. (2021). Application of Orem’s self-care theory to improve cognitive function in stroke patients: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases, 30(7), 105827. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105827
Taylor, S. J., McNaughton, L. M., & O’Connell, M. (2014). Systematic review of the Plan-Do-Study-Act (PDSA) model in healthcare improvement. International Journal of Health Care Quality Assurance, 27(5), 424-434. https://doi.org/10.1108/IJHCQA-09-2012-0081
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