Discussion: Analyzing a Health-Related Scenario

Discussion Week 1 Scenario 2

For this discussion, scenario two was chosen. The role that will be assumed in describing the phenomena, concepts, and frameworks is that of the nurse leader. As previous personal professional experience has been primarily in leadership roles this scenario is most relevant. Currently working as a nurse leader in a research setting there are additional considerations that come to mind in relation to concepts. In this scenario, the nurse educator has identified a problem; staff not performing proper hand hygiene upon entering patient rooms.

Theoretical Foundation

In order to develop the theoretical foundation, the nurse leader must explore the root cause. As concepts that are loosely related to the topic such as time management or competing priorities may alter the direction that the intervention takes, the initial step is to clearly define the issue. A review of current literature related to similar settings and problems is beneficial. Exploring best practices and success of other units or facilities may be significant, however, there should be caution in applying a solution until the root cause is exhausted. Bringing the nurses together or representatives from different disciplines (for example house keepers, physicians, mid-level providers, nurses, nursing assistants) is important in determining the most appropriate theories and concepts related to the issue in this setting.

Concepts

Related concepts such as workflow, perceived significance, and personal value should be evaluated. According to McEwen and Wills, concepts can be thought of on a continuum ranging from solid ideas to abstract thought (2019). The more abstract, the more difficult it may prove to develop an intervention to the problem that meets the needs of many. Conceptual relationships then will guide the framework or theory utilized. The relatedness between concepts formulates the trajectory of the subsequent research (Gray, Grove & Sutherland, 2017). For this scenario, conceptual relationship examples may include motivators to hand hygiene, infection control, attitudes, beliefs, and access to products.

Frameworks and Theories

In researching this topic, the Theoretical Domains Framework is mentioned in several publications. This framework was developed from the premise that behavior change is necessary in implementing new practices (Atkins et al, 2017). Jean Watson’s theory of Caring is an example of nursing theory that can be applied to this phenomenon in considering the patient needs and perceptions of their environment and care (Gonzalo, 2019). As human’s care for one another, and specifically nurses who are trusted to care for vulnerable persons, taking the individual needs into account at every interaction is essential in the nurse-patient relationship. This theory lends itself to the underpinnings of assurance of meeting basic human needs. These needs in a care setting would include protection from preventable infection and harm.

Graphic Models

Graphic models to consider with this problem could be incorporation of an adapted form of the five moments of hand hygiene graphic that is frequently used in healthcare settings produced by the Centers for Disease Control (CDC), combining components related to behavior change and concepts related to the trust of the care provider to patient (CDC, 2020). This representation may provide additional meaning to support the why we do what we do. The motivation to encourage the healthcare team to perform hand hygiene prior to entering a patient’s room can be supported by relevance to the team and setting; essentially how this impacts outcomes.

References

Atkins et al (2017). A guide to using the Theoretical Domains Framework of behavior change

to investigate implementation problems. Implementation Science. 12 (77). https//

doi: 10.1186/s13012-017-0605-9.

CDC (2020). Clean hands count campaign.

https://www.cdc.gov/handhygiene/campaign/index.html

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing

Research: Appraisal, synthesis, and generation of evidence. (8th ed). Saunders

Elsevier.

Gonzalo, A. (2019). Jean Watson theory of human caring. Theorists and theories.

McEwin, M., & Wills, E. M. (2019) Theoretical basis for nursing (5th ed.) Wolters Kluwer

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9 hours agoSusan Fowler WALDEN INSTRUCTOR MANAGER

RE: Brakefield Discussion 1 Scenario 2

COLLAPSE

Traci

You identified the problem as staff not performing hand hygiene upon entering patient rooms. Is the concept performance, compliance, or adherence?

There are different levels of abstraction of a concept. According to Walker and Avant (2019) the levels are 1) primitive – shared meaning, 2) concrete – time and space, observable, and 3) abstract – an example being temperature. These concepts and their level of abstraction classify our experiences. Would you suggest performance is concrete, since lack of performance can result in adverse events, which are experienced? Why? Can I observe performance – or do I observe its consequences?

You suggested other concepts to consider in relation to this lack of performance including workflow, perceived significance, and personal value. What do you hypothesize is the relationship between these three concepts and the main concept of performance? For example, is increased personal value related to increased performance of hand hygiene practices?

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction. Prentice Hill.