Theoretical and scientific foundations of nursing

WK.5.RESPONSE.docx

NURS - 8114C

Theoretical and Scientific Foundations of Nursing

DISCUSSION

Respond to at least two colleagues, with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts.

PEER #1

Brytnee Barbara Frances Lolli

Brytnee Barbara Frances Lolli

Each individual in the healthcare field strives to provide the best care possible. However, there can be a disconnection between what is known in theory and the treatments used in practice. This divide is best mended through evidence-based practices and science translation. Guiding research into updating daily practice is achieved through multiple translation theories and frameworks that consider multiple factors, internal and external, of an organization and allow for the best outcome (White et al., 2019). Therefore, the purpose of this discussion is to assess one framework concerning the practice issue of addiction or substance abuse and treatment options.

Translation Framework Outlined

When attempting to produce treatments or understand addiction or substance abuse, healthcare professionals first must understand the individuals who suffer this affliction and the drives behind the abuse. For this practice issue, the Theory of Reasoned Action (TRA) best fits the production of evidence into practice. The TRA shares similarities with the Theory of Planned Behavior (TBP). However, TRA differs because it does not consider perceived behavioral control (PBC), which pertains to a person’s sense of control over behavior (Brown, n.d.). However, the TRA reports that purposeful behaviors arise from understanding values and morals that will lead to specific results (Cederbaum et al., 2021). Additionally, the article by Cederbaum et al. (2021) mentions that a significant element of a person’s behavior is the intention behind that action and the judgment from friends and family on the outcome of that behavior. Therefore, being judged by those important to them for a particular behavior and the individual’s perception and understanding of that action are chief driving factors on whether the person follows through with the behavior.

Translation Framework and Connection to Practice Issue

Gaining insight into why individuals may turn to substance abuse can prove beneficial in effectively managing associated symptoms and addressing the root causes of addiction. The TRA supports the practice issue of substance abuse because it allows the researcher to look past the outermost symptoms of substance abuse and creates an atmosphere to look deeper into the person and their beliefs and knowledge of their actions (Molloy et al., 2019). Enhancing addiction treatment requires a comprehensive understanding of the reasons behind addiction and the stimuli that trigger addictive conduct. By scrutinizing behavioral patterns, healthcare professionals can formulate individualized interventions catering to each patient. Additionally, the TRA usually overlooks socioeconomic and sociodemographic factors; however, incorporating these factors is crucial to obtain a more comprehensive understanding of individuals and their motivations (Hsiao et al., 2020; Lamiño Jaramillo et al., 2022).

Through utilizing the TRA, healthcare professionals can look into exploiting factors of individuals more susceptible to substance abuse. For example, should a connection be made to education and knowledge for those who are in a particular demographic, housing location, or with limited access to healthcare having a higher rate of substance abuse, interventions can be created that better serve these individuals, thereby increasing community health and decreasing the occurrence of substance abuse. Additionally, working in a field associated with law enforcement, interventions can be executed at this level with more training and resource availability through police encounters for those individuals on the street who abuse substances that healthcare professionals may not come into contact with and offer treatment options (del Pozo et al., 2021).

Conclusion

Understanding individuals and their motives is vital to the success of the TRA and the translation of theory into effective interventions for those suffering from substance abuse. The knowledge gathered by delving deeper into an individual, more than just their symptoms, allows for a comprehensive understanding and overview of a person, thereby allotting for more appropriate treatment options for each unique individual. Personal experiences, morals, and the impact of loved ones differ from person to person, and the TRA permits practitioners to provide more appropriate treatment avenues, creating a more holistic approach that includes more suitable surface symptom management opportunities.

Resources

Brown, A. (n.d.). Triad and the Theory of Reasoned Action/Theory of Planned Behavior. Models and mechanisms of Public Health. https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/triad-and-the-theory-of-reasoned-action-theory-of-planned-behavior/#:~:text=TRA%20does%20not%20account%20for,which%20then%20the%20behavior%20occurs.

Cederbaum, J. A., Lee, W. J., Okine, L., Duan, L., & Lee, J. O. (2021). Using the Theory of Reasoned Action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers. Drug and Alcohol Dependence, 228, 109019. https://doi.org/10.1016/j.drugalcdep.2021.109019

del Pozo, B., Sightes, E., Goulka, J., Ray, B., Wood, C. A., Siddiqui, S., & Beletsky, L. A. (2021). Police discretion in encounters with people who use drugs: Operationalizing the Theory of Planned Behavior. Harm Reduction Journal, 18(1). https://doi.org/10.1186/s12954-021-00583-4

Hsiao, Y.-L., Lee, J.-J., Kuo, S.-F., Yeh, Y.-C., & Chen, I.-H. (2020). Intentions to use long-term care: Exploring the Y generation. International Journal of Healthcare Management, 13, 400–406. https://doi.org/10.1080/20479700.2018.1551952

Lamiño Jaramillo, P., Tábora-Sarmiento, S., Millares-Forno, C., & Boren-Alpízar, A. E. (2022). The theory of reasoned action as a predictor of environmental behavior: A cross-cultural comparison between college students from Texas, Louisiana, and Honduras. Journal of Human Behavior in the Social Environment, 33(4), 521–536. https://doi.org/10.1080/10911359.2022.2072040

Molloy, B. K., Stock, M. L., Dodge, T., & Aspelund, J. G. (2019). Predicting future academic willingness, intentions, and nonmedical prescription stimulant (NPS) use with the Theory of Reasoned Action and Prototype/Willingness Model. Substance Use & Misuse, 54(14), 2251–2263. https://doi.org/10.1080/10826084.2019.1645175

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.

PEER #2

Marjay Kelley

Introduction

As nurses practice overtime, they are expected to base their practices on rigorous evidence to improve their patients’ health outcomes and the quality of their patient’s health care. This is where best practice comes in and is implemented. The use of Evidence-based practice in our health practices, our interventions, our procedures and techniques yield positive outcomes for our patients. Evidence-based practice (EBP) requires nurses to incorporate the best research with clinical proficiency and patient values to achieve optimal health outcomes (Lehane et.al., 2018).

The Knowledge-to-Action Framework

Nurses are introduced and taught from the early stage of their education the importance of Evidence-based practice to the profession and to their practice. They are also expected to use and implement evidence based practices that are translated as best practice throughout their career. Oftentimes, barriers including lack of time, staff shortages, heavy patient loads, limited knowledge of EBP, as well as limited skills, typically seen in novice nurses prevent the use of EBP. During this period, called “knowledge-Gap", knowledge-translation happens. Knowledge translation is used to close the knowledge-practice gap and can be defined as translating clinical science, knowledge or evidence, which aims to enhance health outcomes (Grimshaw et. al.,2012). According to Graham and Tetro, the Knowledge -to-Action framework consists of two main components: Knowledge Creation and the Action Cycle. The Knowledge Creation process is divided into three phases: (1) knowledge inquiry, (2) knowledge synthesis and (3) knowledge tools and products (2012). This framework links evidence to action.

Why it is Relevant to My Practice Problem (CAUTI)

The knowledge-to-action framework is important to my practice problem because it provides a structured approach for making change. This structural approach at my work place included a seven phase action cycle that moves knowledge into practice, exactly what we needed as we tried to address the catheter-associated urinary tract infection(CAUTI) on our unit. Our UBQT worked hard to put together all the research and evidence-based practice information we could find on CAUTI. Of course we immediately identified the gap between knowledge and practice. We set up posters in common areas like break rooms, and fliers in bathrooms. Nursing staff and surgeons were loaded with the relevance of removing foley catheters immediately after surgery unless there were contraindications and specific orders not to remove them from surgeons. Surgeons were encouraged to incorporate in their post op orderset the removal of foley catheters from PACU. Gradually, we were able to monitor knowledge used, evaluate outcomes, and we have sustained the change obtained from use of knowledge from EBP (evidence-based practice). This has kept the cases of CAUTI in our hospital significantly lower and our patient healthier.

References

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., ... & Hegarty, J. (2018). Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine.

Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation science, 7(1), 1-17.

Graham, I.D. & Tetroe, J.M., 2010, ‘The knowledge to action framework’, in J. Rycroft-Malone & T. Bucknall (eds.), Models and frameworks for implementing evidence-based practice: Linking evidence to action, vol. 207, p. 222, Wiley-Blackwell, New York.

INITIAL.POST.docx

2

MY INITIAL PDISCUSSION POST

Translational Model for EBP QI Project

Translational Model for EBP QI Project

Evidence-based practice (EBP) refers to the application of research findings and knowledge in nursing practice, whereas translational science/research is the study of implementation interventions, factors, and contextual elments that influence knowledge uptake and application in nursing practice (Boehm et al., 2020). The objective of research is to discover practical approaches for practitioners to improve outcomes. Aligning with existing EBP efforts, translational science offers an effective strategy to attain this objective (Boehm et al., 2020). Nursing facilities should aim to align the enormous efforts being devoted in developing best practice standards with translational nursing research to speed up the translation of scientific findings from research into broader use in practice. Translational research studies the procedures and results of the implementation of evidence-based practices.

Translational science models can be applied to solve many nursing practice problems. One of the significant issues in my organization is healthcare-associated infections (HAIs). Also known as nosocomial infections, healthcare-acquired infections are infections patients get from healthcare facilities while being treated. HAIs can result in serious illness or death in some cases. Literature has constantly recognized the occurrence and undesirable complications from HAIs in the past few decades (Haque et al., 2018). HAIs cases continue to increase at an alarming rate, which is concerning. They threaten patient safety, not only in the US but also in other countries across the world. HAIs are usually linked to surgical or medical procedures where practitioners use devices such as catheters and ventilators. According to research, 1 in 25 patients in the US is affected by an HAI daily (Magill et al., 2018).

As a nurse, it is essential to develop evidence-based practice quality improvement project that aims to reduce HAIs. One of the evidence-based strategies that solves this problem is hand hygiene. Nurses and other healthcare providers need to clean their hands with soap or alcohol-based hand rubs when caring for patients. Hand washing should be done before and after caring for every patient. At our facility, we need to implement and enforce strict hand hygiene protocols for healthcare workers to ensure the efficiency of this evidence-based practice. Furthermore, healthcare staff must be educated on proper hand hygiene strategies and the significance of compliance. Another EBP is using catheters only when necessary and removing them as soon as they are no longer needed. Healthcare professionals should adhere to strict aseptic strategies during central line insertion and maintenance to prevent Central Line-Associated Bloodstream Infection (CLABSI) (Haque et al., 2018). According to Magill et al. (2018), 22% of all HAIs are surgical infections; therefore, healthcare professionals at my facility should administer appropriate preoperative antibiotics within the proper timeframe. They should also ensure that they prepare the skin properly before surgery and maintain sterile conditions during surgical procedures. Another EBP is to always wear hair covers, masks, gowns, and gloves when appropriate.

Translational science models facilitate the uptake of research findings and evidence-based practices into routine healthcare. For my proposed EBP QI project, I would select the Knowledge-to-Action (KTA) model. The model is perfect for my proposal because it would help me select appropriate implementation strategies. The model is unique because it begins with research evidence and the need to synthesize and translate it (White et al., 2019). It is well-situated to situations where one has a practice change they want to make and recommendations outlining how things should be done differently.

The first step of KTA is the identification of the problem. At this stage, I clearly define the issue of HAIs in my facility, giving an overview of the prevalence and populations most affected. The second step is knowledge creation, which involves reviewing existing research, clinical guidelines, and best practices aiding the prevention of HAIs. The third step is the adaptation of knowledge. At this step, I would customize the evidence-based approaches to my healthcare facility, taking into account resources and the challenges we face. The next step is assessing barriers and facilitators. At this step, I would identify the factors contributing to HAIs and those that can aid prevention. Barriers can be inadequate resources or non-compliance to infection control protocols. After identifying barriers and facilitators, the next step is developing interventions based on them. The succeeding steps are implementation, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use. These comprehensive steps outlined by the KTA framework provide nurses looking to implement EBPs with a practical, systematic implementation strategy (White et al., 2019).

References

Boehm, L. M., Stolldorf, D. P., & Jeffery, A. D. (2020). Implementation science training and resources for nurses and nurse scientists. Journal of Nursing Scholarship, 52(1), 47-54.

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 2321-2333.

Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L., Dumyati, G., Nadle, J., ... & Edwards, J. R. (2018). Changes in prevalence of health care–associated infections in US hospitals. New England Journal of Medicine, 379(18), 1732-1744.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare. Springer Publishing Company.

WK.5.RESPONSE.docx

NURS - 8114C

Theoretical and Scientific Foundations of Nursing

DISCUSSION

Respond to at least two colleagues, with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts.

PEER #1

Brytnee Barbara Frances Lolli

Brytnee Barbara Frances Lolli

Each individual in the healthcare field strives to provide the best care possible. However, there can be a disconnection between what is known in theory and the treatments used in practice. This divide is best mended through evidence-based practices and science translation. Guiding research into updating daily practice is achieved through multiple translation theories and frameworks that consider multiple factors, internal and external, of an organization and allow for the best outcome (White et al., 2019). Therefore, the purpose of this discussion is to assess one framework concerning the practice issue of addiction or substance abuse and treatment options.

Translation Framework Outlined

When attempting to produce treatments or understand addiction or substance abuse, healthcare professionals first must understand the individuals who suffer this affliction and the drives behind the abuse. For this practice issue, the Theory of Reasoned Action (TRA) best fits the production of evidence into practice. The TRA shares similarities with the Theory of Planned Behavior (TBP). However, TRA differs because it does not consider perceived behavioral control (PBC), which pertains to a person’s sense of control over behavior (Brown, n.d.). However, the TRA reports that purposeful behaviors arise from understanding values and morals that will lead to specific results (Cederbaum et al., 2021). Additionally, the article by Cederbaum et al. (2021) mentions that a significant element of a person’s behavior is the intention behind that action and the judgment from friends and family on the outcome of that behavior. Therefore, being judged by those important to them for a particular behavior and the individual’s perception and understanding of that action are chief driving factors on whether the person follows through with the behavior.

Translation Framework and Connection to Practice Issue

Gaining insight into why individuals may turn to substance abuse can prove beneficial in effectively managing associated symptoms and addressing the root causes of addiction. The TRA supports the practice issue of substance abuse because it allows the researcher to look past the outermost symptoms of substance abuse and creates an atmosphere to look deeper into the person and their beliefs and knowledge of their actions (Molloy et al., 2019). Enhancing addiction treatment requires a comprehensive understanding of the reasons behind addiction and the stimuli that trigger addictive conduct. By scrutinizing behavioral patterns, healthcare professionals can formulate individualized interventions catering to each patient. Additionally, the TRA usually overlooks socioeconomic and sociodemographic factors; however, incorporating these factors is crucial to obtain a more comprehensive understanding of individuals and their motivations (Hsiao et al., 2020; Lamiño Jaramillo et al., 2022).

Through utilizing the TRA, healthcare professionals can look into exploiting factors of individuals more susceptible to substance abuse. For example, should a connection be made to education and knowledge for those who are in a particular demographic, housing location, or with limited access to healthcare having a higher rate of substance abuse, interventions can be created that better serve these individuals, thereby increasing community health and decreasing the occurrence of substance abuse. Additionally, working in a field associated with law enforcement, interventions can be executed at this level with more training and resource availability through police encounters for those individuals on the street who abuse substances that healthcare professionals may not come into contact with and offer treatment options (del Pozo et al., 2021).

Conclusion

Understanding individuals and their motives is vital to the success of the TRA and the translation of theory into effective interventions for those suffering from substance abuse. The knowledge gathered by delving deeper into an individual, more than just their symptoms, allows for a comprehensive understanding and overview of a person, thereby allotting for more appropriate treatment options for each unique individual. Personal experiences, morals, and the impact of loved ones differ from person to person, and the TRA permits practitioners to provide more appropriate treatment avenues, creating a more holistic approach that includes more suitable surface symptom management opportunities.

Resources

Brown, A. (n.d.). Triad and the Theory of Reasoned Action/Theory of Planned Behavior. Models and mechanisms of Public Health. https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/triad-and-the-theory-of-reasoned-action-theory-of-planned-behavior/#:~:text=TRA%20does%20not%20account%20for,which%20then%20the%20behavior%20occurs.

Cederbaum, J. A., Lee, W. J., Okine, L., Duan, L., & Lee, J. O. (2021). Using the Theory of Reasoned Action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers. Drug and Alcohol Dependence, 228, 109019. https://doi.org/10.1016/j.drugalcdep.2021.109019

del Pozo, B., Sightes, E., Goulka, J., Ray, B., Wood, C. A., Siddiqui, S., & Beletsky, L. A. (2021). Police discretion in encounters with people who use drugs: Operationalizing the Theory of Planned Behavior. Harm Reduction Journal, 18(1). https://doi.org/10.1186/s12954-021-00583-4

Hsiao, Y.-L., Lee, J.-J., Kuo, S.-F., Yeh, Y.-C., & Chen, I.-H. (2020). Intentions to use long-term care: Exploring the Y generation. International Journal of Healthcare Management, 13, 400–406. https://doi.org/10.1080/20479700.2018.1551952

Lamiño Jaramillo, P., Tábora-Sarmiento, S., Millares-Forno, C., & Boren-Alpízar, A. E. (2022). The theory of reasoned action as a predictor of environmental behavior: A cross-cultural comparison between college students from Texas, Louisiana, and Honduras. Journal of Human Behavior in the Social Environment, 33(4), 521–536. https://doi.org/10.1080/10911359.2022.2072040

Molloy, B. K., Stock, M. L., Dodge, T., & Aspelund, J. G. (2019). Predicting future academic willingness, intentions, and nonmedical prescription stimulant (NPS) use with the Theory of Reasoned Action and Prototype/Willingness Model. Substance Use & Misuse, 54(14), 2251–2263. https://doi.org/10.1080/10826084.2019.1645175

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.

PEER #2

Marjay Kelley

Introduction

As nurses practice overtime, they are expected to base their practices on rigorous evidence to improve their patients’ health outcomes and the quality of their patient’s health care. This is where best practice comes in and is implemented. The use of Evidence-based practice in our health practices, our interventions, our procedures and techniques yield positive outcomes for our patients. Evidence-based practice (EBP) requires nurses to incorporate the best research with clinical proficiency and patient values to achieve optimal health outcomes (Lehane et.al., 2018).

The Knowledge-to-Action Framework

Nurses are introduced and taught from the early stage of their education the importance of Evidence-based practice to the profession and to their practice. They are also expected to use and implement evidence based practices that are translated as best practice throughout their career. Oftentimes, barriers including lack of time, staff shortages, heavy patient loads, limited knowledge of EBP, as well as limited skills, typically seen in novice nurses prevent the use of EBP. During this period, called “knowledge-Gap", knowledge-translation happens. Knowledge translation is used to close the knowledge-practice gap and can be defined as translating clinical science, knowledge or evidence, which aims to enhance health outcomes (Grimshaw et. al.,2012). According to Graham and Tetro, the Knowledge -to-Action framework consists of two main components: Knowledge Creation and the Action Cycle. The Knowledge Creation process is divided into three phases: (1) knowledge inquiry, (2) knowledge synthesis and (3) knowledge tools and products (2012). This framework links evidence to action.

Why it is Relevant to My Practice Problem (CAUTI)

The knowledge-to-action framework is important to my practice problem because it provides a structured approach for making change. This structural approach at my work place included a seven phase action cycle that moves knowledge into practice, exactly what we needed as we tried to address the catheter-associated urinary tract infection(CAUTI) on our unit. Our UBQT worked hard to put together all the research and evidence-based practice information we could find on CAUTI. Of course we immediately identified the gap between knowledge and practice. We set up posters in common areas like break rooms, and fliers in bathrooms. Nursing staff and surgeons were loaded with the relevance of removing foley catheters immediately after surgery unless there were contraindications and specific orders not to remove them from surgeons. Surgeons were encouraged to incorporate in their post op orderset the removal of foley catheters from PACU. Gradually, we were able to monitor knowledge used, evaluate outcomes, and we have sustained the change obtained from use of knowledge from EBP (evidence-based practice). This has kept the cases of CAUTI in our hospital significantly lower and our patient healthier.

References

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., ... & Hegarty, J. (2018). Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine.

Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation science, 7(1), 1-17.

Graham, I.D. & Tetroe, J.M., 2010, ‘The knowledge to action framework’, in J. Rycroft-Malone & T. Bucknall (eds.), Models and frameworks for implementing evidence-based practice: Linking evidence to action, vol. 207, p. 222, Wiley-Blackwell, New York.

INITIAL.POST.docx

2

MY INITIAL PDISCUSSION POST

Translational Model for EBP QI Project

Translational Model for EBP QI Project

Evidence-based practice (EBP) refers to the application of research findings and knowledge in nursing practice, whereas translational science/research is the study of implementation interventions, factors, and contextual elments that influence knowledge uptake and application in nursing practice (Boehm et al., 2020). The objective of research is to discover practical approaches for practitioners to improve outcomes. Aligning with existing EBP efforts, translational science offers an effective strategy to attain this objective (Boehm et al., 2020). Nursing facilities should aim to align the enormous efforts being devoted in developing best practice standards with translational nursing research to speed up the translation of scientific findings from research into broader use in practice. Translational research studies the procedures and results of the implementation of evidence-based practices.

Translational science models can be applied to solve many nursing practice problems. One of the significant issues in my organization is healthcare-associated infections (HAIs). Also known as nosocomial infections, healthcare-acquired infections are infections patients get from healthcare facilities while being treated. HAIs can result in serious illness or death in some cases. Literature has constantly recognized the occurrence and undesirable complications from HAIs in the past few decades (Haque et al., 2018). HAIs cases continue to increase at an alarming rate, which is concerning. They threaten patient safety, not only in the US but also in other countries across the world. HAIs are usually linked to surgical or medical procedures where practitioners use devices such as catheters and ventilators. According to research, 1 in 25 patients in the US is affected by an HAI daily (Magill et al., 2018).

As a nurse, it is essential to develop evidence-based practice quality improvement project that aims to reduce HAIs. One of the evidence-based strategies that solves this problem is hand hygiene. Nurses and other healthcare providers need to clean their hands with soap or alcohol-based hand rubs when caring for patients. Hand washing should be done before and after caring for every patient. At our facility, we need to implement and enforce strict hand hygiene protocols for healthcare workers to ensure the efficiency of this evidence-based practice. Furthermore, healthcare staff must be educated on proper hand hygiene strategies and the significance of compliance. Another EBP is using catheters only when necessary and removing them as soon as they are no longer needed. Healthcare professionals should adhere to strict aseptic strategies during central line insertion and maintenance to prevent Central Line-Associated Bloodstream Infection (CLABSI) (Haque et al., 2018). According to Magill et al. (2018), 22% of all HAIs are surgical infections; therefore, healthcare professionals at my facility should administer appropriate preoperative antibiotics within the proper timeframe. They should also ensure that they prepare the skin properly before surgery and maintain sterile conditions during surgical procedures. Another EBP is to always wear hair covers, masks, gowns, and gloves when appropriate.

Translational science models facilitate the uptake of research findings and evidence-based practices into routine healthcare. For my proposed EBP QI project, I would select the Knowledge-to-Action (KTA) model. The model is perfect for my proposal because it would help me select appropriate implementation strategies. The model is unique because it begins with research evidence and the need to synthesize and translate it (White et al., 2019). It is well-situated to situations where one has a practice change they want to make and recommendations outlining how things should be done differently.

The first step of KTA is the identification of the problem. At this stage, I clearly define the issue of HAIs in my facility, giving an overview of the prevalence and populations most affected. The second step is knowledge creation, which involves reviewing existing research, clinical guidelines, and best practices aiding the prevention of HAIs. The third step is the adaptation of knowledge. At this step, I would customize the evidence-based approaches to my healthcare facility, taking into account resources and the challenges we face. The next step is assessing barriers and facilitators. At this step, I would identify the factors contributing to HAIs and those that can aid prevention. Barriers can be inadequate resources or non-compliance to infection control protocols. After identifying barriers and facilitators, the next step is developing interventions based on them. The succeeding steps are implementation, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use. These comprehensive steps outlined by the KTA framework provide nurses looking to implement EBPs with a practical, systematic implementation strategy (White et al., 2019).

References

Boehm, L. M., Stolldorf, D. P., & Jeffery, A. D. (2020). Implementation science training and resources for nurses and nurse scientists. Journal of Nursing Scholarship, 52(1), 47-54.

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 2321-2333.

Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L., Dumyati, G., Nadle, J., ... & Edwards, J. R. (2018). Changes in prevalence of health care–associated infections in US hospitals. New England Journal of Medicine, 379(18), 1732-1744.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare. Springer Publishing Company.

WK.5.RESPONSE.docx

NURS - 8114C

Theoretical and Scientific Foundations of Nursing

DISCUSSION

Respond to at least two colleagues, with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts.

PEER #1

Brytnee Barbara Frances Lolli

Brytnee Barbara Frances Lolli

Each individual in the healthcare field strives to provide the best care possible. However, there can be a disconnection between what is known in theory and the treatments used in practice. This divide is best mended through evidence-based practices and science translation. Guiding research into updating daily practice is achieved through multiple translation theories and frameworks that consider multiple factors, internal and external, of an organization and allow for the best outcome (White et al., 2019). Therefore, the purpose of this discussion is to assess one framework concerning the practice issue of addiction or substance abuse and treatment options.

Translation Framework Outlined

When attempting to produce treatments or understand addiction or substance abuse, healthcare professionals first must understand the individuals who suffer this affliction and the drives behind the abuse. For this practice issue, the Theory of Reasoned Action (TRA) best fits the production of evidence into practice. The TRA shares similarities with the Theory of Planned Behavior (TBP). However, TRA differs because it does not consider perceived behavioral control (PBC), which pertains to a person’s sense of control over behavior (Brown, n.d.). However, the TRA reports that purposeful behaviors arise from understanding values and morals that will lead to specific results (Cederbaum et al., 2021). Additionally, the article by Cederbaum et al. (2021) mentions that a significant element of a person’s behavior is the intention behind that action and the judgment from friends and family on the outcome of that behavior. Therefore, being judged by those important to them for a particular behavior and the individual’s perception and understanding of that action are chief driving factors on whether the person follows through with the behavior.

Translation Framework and Connection to Practice Issue

Gaining insight into why individuals may turn to substance abuse can prove beneficial in effectively managing associated symptoms and addressing the root causes of addiction. The TRA supports the practice issue of substance abuse because it allows the researcher to look past the outermost symptoms of substance abuse and creates an atmosphere to look deeper into the person and their beliefs and knowledge of their actions (Molloy et al., 2019). Enhancing addiction treatment requires a comprehensive understanding of the reasons behind addiction and the stimuli that trigger addictive conduct. By scrutinizing behavioral patterns, healthcare professionals can formulate individualized interventions catering to each patient. Additionally, the TRA usually overlooks socioeconomic and sociodemographic factors; however, incorporating these factors is crucial to obtain a more comprehensive understanding of individuals and their motivations (Hsiao et al., 2020; Lamiño Jaramillo et al., 2022).

Through utilizing the TRA, healthcare professionals can look into exploiting factors of individuals more susceptible to substance abuse. For example, should a connection be made to education and knowledge for those who are in a particular demographic, housing location, or with limited access to healthcare having a higher rate of substance abuse, interventions can be created that better serve these individuals, thereby increasing community health and decreasing the occurrence of substance abuse. Additionally, working in a field associated with law enforcement, interventions can be executed at this level with more training and resource availability through police encounters for those individuals on the street who abuse substances that healthcare professionals may not come into contact with and offer treatment options (del Pozo et al., 2021).

Conclusion

Understanding individuals and their motives is vital to the success of the TRA and the translation of theory into effective interventions for those suffering from substance abuse. The knowledge gathered by delving deeper into an individual, more than just their symptoms, allows for a comprehensive understanding and overview of a person, thereby allotting for more appropriate treatment options for each unique individual. Personal experiences, morals, and the impact of loved ones differ from person to person, and the TRA permits practitioners to provide more appropriate treatment avenues, creating a more holistic approach that includes more suitable surface symptom management opportunities.

Resources

Brown, A. (n.d.). Triad and the Theory of Reasoned Action/Theory of Planned Behavior. Models and mechanisms of Public Health. https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/triad-and-the-theory-of-reasoned-action-theory-of-planned-behavior/#:~:text=TRA%20does%20not%20account%20for,which%20then%20the%20behavior%20occurs.

Cederbaum, J. A., Lee, W. J., Okine, L., Duan, L., & Lee, J. O. (2021). Using the Theory of Reasoned Action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers. Drug and Alcohol Dependence, 228, 109019. https://doi.org/10.1016/j.drugalcdep.2021.109019

del Pozo, B., Sightes, E., Goulka, J., Ray, B., Wood, C. A., Siddiqui, S., & Beletsky, L. A. (2021). Police discretion in encounters with people who use drugs: Operationalizing the Theory of Planned Behavior. Harm Reduction Journal, 18(1). https://doi.org/10.1186/s12954-021-00583-4

Hsiao, Y.-L., Lee, J.-J., Kuo, S.-F., Yeh, Y.-C., & Chen, I.-H. (2020). Intentions to use long-term care: Exploring the Y generation. International Journal of Healthcare Management, 13, 400–406. https://doi.org/10.1080/20479700.2018.1551952

Lamiño Jaramillo, P., Tábora-Sarmiento, S., Millares-Forno, C., & Boren-Alpízar, A. E. (2022). The theory of reasoned action as a predictor of environmental behavior: A cross-cultural comparison between college students from Texas, Louisiana, and Honduras. Journal of Human Behavior in the Social Environment, 33(4), 521–536. https://doi.org/10.1080/10911359.2022.2072040

Molloy, B. K., Stock, M. L., Dodge, T., & Aspelund, J. G. (2019). Predicting future academic willingness, intentions, and nonmedical prescription stimulant (NPS) use with the Theory of Reasoned Action and Prototype/Willingness Model. Substance Use & Misuse, 54(14), 2251–2263. https://doi.org/10.1080/10826084.2019.1645175

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.

PEER #2

Marjay Kelley

Introduction

As nurses practice overtime, they are expected to base their practices on rigorous evidence to improve their patients’ health outcomes and the quality of their patient’s health care. This is where best practice comes in and is implemented. The use of Evidence-based practice in our health practices, our interventions, our procedures and techniques yield positive outcomes for our patients. Evidence-based practice (EBP) requires nurses to incorporate the best research with clinical proficiency and patient values to achieve optimal health outcomes (Lehane et.al., 2018).

The Knowledge-to-Action Framework

Nurses are introduced and taught from the early stage of their education the importance of Evidence-based practice to the profession and to their practice. They are also expected to use and implement evidence based practices that are translated as best practice throughout their career. Oftentimes, barriers including lack of time, staff shortages, heavy patient loads, limited knowledge of EBP, as well as limited skills, typically seen in novice nurses prevent the use of EBP. During this period, called “knowledge-Gap", knowledge-translation happens. Knowledge translation is used to close the knowledge-practice gap and can be defined as translating clinical science, knowledge or evidence, which aims to enhance health outcomes (Grimshaw et. al.,2012). According to Graham and Tetro, the Knowledge -to-Action framework consists of two main components: Knowledge Creation and the Action Cycle. The Knowledge Creation process is divided into three phases: (1) knowledge inquiry, (2) knowledge synthesis and (3) knowledge tools and products (2012). This framework links evidence to action.

Why it is Relevant to My Practice Problem (CAUTI)

The knowledge-to-action framework is important to my practice problem because it provides a structured approach for making change. This structural approach at my work place included a seven phase action cycle that moves knowledge into practice, exactly what we needed as we tried to address the catheter-associated urinary tract infection(CAUTI) on our unit. Our UBQT worked hard to put together all the research and evidence-based practice information we could find on CAUTI. Of course we immediately identified the gap between knowledge and practice. We set up posters in common areas like break rooms, and fliers in bathrooms. Nursing staff and surgeons were loaded with the relevance of removing foley catheters immediately after surgery unless there were contraindications and specific orders not to remove them from surgeons. Surgeons were encouraged to incorporate in their post op orderset the removal of foley catheters from PACU. Gradually, we were able to monitor knowledge used, evaluate outcomes, and we have sustained the change obtained from use of knowledge from EBP (evidence-based practice). This has kept the cases of CAUTI in our hospital significantly lower and our patient healthier.

References

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., ... & Hegarty, J. (2018). Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine.

Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation science, 7(1), 1-17.

Graham, I.D. & Tetroe, J.M., 2010, ‘The knowledge to action framework’, in J. Rycroft-Malone & T. Bucknall (eds.), Models and frameworks for implementing evidence-based practice: Linking evidence to action, vol. 207, p. 222, Wiley-Blackwell, New York.