Theoretical and scientific foundations of nursing

EXPLORINGEBPQUALITYIMPROVEMENT.docx

NURS - 8114C

Theoretical and Scientific Foundations of Nursing

EXPLORING EBP QUALITY IMPROVEMENT

Continue working on your Module 3 Assignment to complete this week. Keep in mind that the key requirements are to identify a hypothetical practice problem as the focus of an evidence-based quality improvement project; a hypothetical health care setting for the project based on investigating actual sites; stakeholders for project approval and implementation within health care settings; and a presentation outlining the basic steps of a specific framework/model for translating research and evidence to improved practice.

Although “hypothetical” is the watchword for this Assignment, the substantial effort you have invested and the information and insights obtained can pay real dividends as you begin your DNP project in earnest.

THE ASSIGNMENT

Part 1: Key Project Elements

Complete your paper of 6–8 pages, plus cover page and references page, explaining your investigation of three hypothetical practice sites for an EBP QI project.

Part 2: Implementation Science Presentation

Complete your PowerPoint presentation of 3–5 slides, plus cover and reference slides, to inform hypothetical stakeholders.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Handout-PreparingforanEBPQIPresentationtoStakeholdersatPracticeSite_to_Build1.docx

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NURS 8114: Theoretical and Scientific Foundations of Nursing

Preparing for an EBP QI Presentation to Stakeholders at a Practice Site

Use these guidelines in preparing a presentation, keeping in mind that for your Module 3 Assignment, you are not completing all steps (follow the specific assignment instructions) and are not making an actual presentation. However, this process has wide applications and will support your future work in developing a DNP Project on evidence-based practice and quality improvement (EBP QI) for this doctoral program, as well as other change initiatives you will lead as a DNP.

· Identify key stakeholders in the practice site who are responsible for quality improvement/evidence-based practice.

· For stakeholder analysis—those who will be involved in, affected by, or influential in the change process; the role of each; their level of commitment and influence for or against the change. Review stakeholder assessment guidelines (White, Dudley-Brown, & Terhaar, 2019, pp. 218–221).

· Determine practice problem(s) of concern to stakeholders/nursing staff that are amenable to intervention.

· Conduct a needs assessment to further define the problem(s) identified and methods used to further describe the problem.

· Determine organizational readiness for change (can be assessed at the individual or supra-individual level, e.g., team, department).

· Change commitment reflects members’ shared resolve to implement a change.

· Change efficacy reflects members’ shared belief in their collective capability to implement a change.

· Conduct a literature search to find evidence of existing interventions, as well as perceived need for interventions to resolve the identified problem, as defined in current existing publications.

· Generate a proposal for addressing the problem based on findings in the literature.

· Present the proposal to the stakeholders and elicit their comments, suggestions, and support.

· Obtain written commitments from key partners that state what they will do to implement the innovation; this includes nurses and other health care providers whose support is needed.

In making a presentation, always lead with the motivating force of your DNP role as an advocate of positive social change. You will give power to your presentation!

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assignment

EXPLORING EBP QUALITY IMPROVEMENT

· PRACTICE ISSUE: BIPOLAR DISORDER

· REMEMBER TO USE APA: Writing, sentence structure.

· Please insert (intext citations) citations throughout the paper.

· Clearly state the specific theory/ apply theory to practice.

Your previous paper on this practice issue

Application of Middle Range Theories to the Care of Individuals with Bipolar

Bipolar disorder, initially referred to as manic depression, is a mental health illness whereby individuals exhibit extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). The condition can severely impact an individual’s daily life; however, the effects vary between individuals. The Nation Alliance of Mental Illness reported that over 10 million Americans have bipolar, accounting for 2.8% of the population (McIntyre et al., 2020).

Middle range theories play an instrumental role in nursing, improving practice and quality of life. Several middle range nursing theories can be applied to the care of individuals with bipola. The theories offer nurses a framework for understanding and addressing the complex needs of these individuals. The self-regulation model, developed by Pender, Murdaugh, And Parsons, is an effective theory. Also known as the health promotion model, the theory describes health as a state characterized by positive dynamics instead only the absence of illness (Younas & Quennell, 2019). The health promotion model aims to enhance the overall well-being of individuals, which is why it is effective in helping individuals manage bipolar. The model notes the multifaceted character of individuals as they interact with their environments to achieve health.

Pender's model is categorized into three factors: individual features and experiences, cognitions and behavior-related feelings, and behavioral consequences (Gorbani et al., 2020). According to the theory, every individual has different personal features and experiences that impact later behaviors. The set of behavior-specific knowledge and affect factors holds significant motivational value. Nursing activities can be employed to alter the variables. This model's end-point is to promote healthy behavior (Gorbani et al., 2020).

The self-regulation model stresses the significance of promoting and maintaining health. Following the model, nurses can develop strategies significant in helping individuals with bipolar manage mood swings, follow recommended medications, and adopt a healthy lifestyle supporting mood stability. According to the self-regulation model, people are more likely to embrace health-promoting behaviors when significant others direct their behavior and offer the necessary assistance and support to facilitate the behavior (Younas & Quennell, 2019). Nurses are considered significant in health care provision and can effectively promote positive and health-promoting behavior among people with bipolar disorder. Besides, another theoretical statement deduced from the self-regulation model, which provides a foundation for investigative work on health behaviors, is that families, friends, and healthcare providers are significant interpersonal influences that can either enhance or limit engagement in behaviors that promote health (Younas & Quennell, 2019). The statement implies that through proper interventions, nurses can help promote healthy behaviors among these individuals. Nurses can work closely with family members of bipolar individuals to enhance the achievement of positive outcomes.

The self-regulation model highlights the roles of self-efficacy in promoting health behaviors. Nurses can improve bipolar individuals’ self-efficacy in managing the condition by closely working with them. Enhancing self-efficacy can involve teaching the individuals how to cope with the condition, providing education about the condition, and helping individuals set realistic goals necessary in managing their mental health.

Another model that nurses can apply to bipolar care is the Chronic Care Model. The theory emphasizes the significance of individual-centered care, self-management support, and healthcare team collaboration in managing chronic conditions like bipolar (Ortiz, 2021). The model was developed by a group of researchers led by Ed Wagner. Self-management support, a component of the model, posits that nurses should empower and prepare individuals to manage their health. According to self-management support, nurses should recognize that individuals play a central role in managing their health. While treating bipolar individuals, nurses need to involve individuals in the care and tailor treatment plans to their preferences. It implies considering individual goals of individuals in managing the condition.

Besides, nurses need to employ effective self-management support approaches, including goal-setting, action planning, and follow-up. Through self-management support, nurses can provide bipolar individuals with the resources and support necessary to manage their conditions. It includes educating individuals on mood monitoring, medication management, and coping strategies. Another critical component of the Chronic Care Model is using scientific evidence to support decisions (Ortiz, 2021). While developing appropriate interventions for individuals with bipolar, nurses base their decisions on evidence-based guidelines.

References

Gorbani, F., Mahmoodi, H., Sarbakhsh, P., & Shaghaghi, A. (2020). Predictive performance of pender’s health promotion model for hypertension control in iranian individuals. Vascular health and risk management, 299-305.

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.

Ortiz, M. R. (2021). Best Practices in Individual-Centered Care: Nursing Theory Reflections. Nursing Science Quarterly, 34(3), 322-327.

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian journal of caring sciences, 33(3), 540-555.

ImplementationScienceasaLeadership.pdf

491The Journal of Continuing Education in Nursing · Vol 50, No 11, 2019

leadership and development

In a recent conversation with a col- league who interviewed individu- als for a leadership position, she

noted that each candidate described their leadership style as transforma- tional. When asked to give an example of a transformation they had led— and its impact at the organizational level—few could cite a substantive transformational change at an organi- zational level. My colleague lamented that many see themselves as transfor- mative leaders, but few actually are. Is the ability to actually move an orga- nization in the direction of a desired change—given its culture, people with diverse backgrounds and educa- tional levels, and other complexities—

far more rare than commonplace? Yet, health care organizations need to respond to change more than ever, making implementation science—the science of change—a requisite compe- tency.

Dr. Dean Fixsen (2019), articu- lated three developmental levels on the journey to implementation sci- ence. The first level, letting it happen (change) aligns with the diffusion the- ory of change popularized by Everett Rogers who studied how innovations (change) spread through an organi- zation, simplified here by describing change as a domino effect. Fixsen described the second level as helping it (change) happen, equated with dis- semination science. Professional de- velopment educators know the power of education in advancing change, such that when groups are armed with education on a topic, an added stimu- lus to change occurs. Yet, education— as essential as it is as a stimulus for change—does not always equate to behavioral modification, individually or collectively. This leads to the third level of change mastery and imple- mentation science. Implementation science is necessary because it is the science of making nonoptional things happen. Leaders must guide organi- zational change, ensuring compliance and uniformity of actions, safeguard-

ing the quality and safety of patients, and managing resources.

IMPLEMENTATION SCIENCE DEFINED

Bauer, Damschroder, Hagendorn, Smith, and Kilbourne (2015) offered a useful and concise definition of im- plementation science. They defined implementation science as “the sci- entific study of methods to promote the systematic uptake of research find- ings and other EBPs [evidence-based practices] into routine practice, and, hence, it improves the quality and ef- fectiveness of health services” (p. 1). In the definition are salient key points— namely, that leaders should use evi- dence and research when available to drive change. A second point is that the leader/change agent should make the client group (those affected by the expected change) keenly aware of what is at stake with regard to quality and effectiveness. The third point is that there is a science to implementa- tion. The science comprises methods to drive the systematic uptake of re- search and evidence-based practices in practice settings, one of the outcomes now associated with the Doctor of Nursing Practice degree and an expec- tation of leaders in all clinical settings.

Implementation science drives nonoptional change, standardizes high-risk and high-stakes clinical in- terventions, and advances innovations within an organization. The science itself addresses the knowledge gap that exists between interventions that research has shown to be effective and its translation into practice in varying clinical settings. Increasingly, inter-

abstract Leaders must distinguish be-

tween diffusion as a change strat- egy, education as a stimulus for change, and implementation strat- egies associated with implementa- tion science. This article provides an operational definition for implemen- tation science, the distinguishing characteristics in leading transfor- mational change, and the degrees of implementation. [J Contin Educ Nurs. 2019;50(11):491-492.]

Dr. Bleich is Senior Professor and Director, Virginia Commonwealth University School of Nursing, Langston Center for Innovation in Quality and Safety, and President and Chief Executive Officer, NursDynamics, Ballwin, Missouri.

The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN, Senior Professor

and Director, Virginia Commonwealth University School of Nursing, Langston Center for Innovation in Quality and Safety, and President and Chief Executive Officer, NursDynamics, 221 Jasmin Park Court, Ballwin, MO 63021; e-mail: [email protected].

doi:10.3928/00220124-20191015-03

Implementation Science as a Leadership and Doctor of Nursing Practice Competency

Associate Editors: Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN Jan Jones-Schenk, DHSc, RN, NE-BC, FAAN

Author: Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN

vention researchers must build into their studies a science-based imple- mentation strategy, as well as philan- thropic organizations, to ensure that their efforts reach the point of intend- ed impact (Easterling & Metz, 2016).

DEGREES OF IMPLEMENTATION A highly recommended resource

for professional development educa- tors is the work of Fixsen, Naoom, Blase, Friedman, and Wallace (2005), which provided a useful synthesis of implementation science research. Their summary reflects that imple- mentation takes place with differ- ing levels of engagement, similarly to the letting it change, helping it change, and making it happen levels mentioned earlier. Paper implementa- tion—often required by regulators— refers to changes that result from the adoption of policies and procedures, where a needed paper trail documents change. Organizational leaders should be competent in preparing policies, procedures, algorithms, and protocols to give direction and insight into prac- tice.

Process implementation advances paper implementation. Educators play a pivotal role as leaders who pro- vide training as the backdrop for spec- ifying the rationale for change, the expectations linked to innovations, and simulation or competency expec- tations to ensure that the client system affected by the change is able to per- form, without the guarantee that they will perform or change their practice. Process implementation eliminates the variable relating to knowing what to do, as it has been measured and evaluated.

The third level of implementa- tion is where the change is actually implemented and takes hold in the organization, known as performance implementation. This is where the consolidated framework for imple- mentation research model developed by Damschroder et al. (2009) is a use- ful reference for educators and leaders. This model depicts the variables at play during the implementation of innova- tions with supportive evidence being generated by implementation scien- tists. Implementation is influenced by (a) intervention characteristics, which vary in factors such as adaptability, ad- vantage, and complexity; (b) the outer settings, with factors such as patient ex- perience and expectations, incentives, and pressure from peer organizations; (c) the inner setting, with its unique structural characteristics and networks; (d) the characteristics of the individuals involved, such as their knowledge and identification with the organization; and (e) the process of implementation, such as how it was planned, executed, and other factors. When taken com- pletely, it immediately becomes clear that multiple and often confound- ing variables are required for effective change management, offering a par- tial explanation for the often dismally slow uptake of innovations in health care settings. As the Doctor of Nurs- ing Practice enters the workforce in expanding roles, it should be with the ability to discern and lead innovations and change, from paper to practice.

SUMMARY The professional development

educator, whether in the practice or academic setting, who is teach-

ing implementation science content should move beyond the comfort zone of the process implementation described above. Yes, education at the process level is key to the implementa- tion of innovations—it can incentiv- ize and motivate learners to take heed of answering the “what” and “why” of change needed. However, widespread change that takes hold organization- wide is the skill and competency set needed by leaders. Novice leaders may not possess awareness of all the vari- ables to consider in driving change that must happen. Offering leaders training in the models and resources presented in this article is a starting point for advancing their competence in implementation science.

REFERENCES Bauer, M.S., Damschroder, L., Hagendorn, H.,

Smith, J., & Kilbourne, A.M. (2015). An introduction to implementation science for the non-specialist. Retrieved from https:// bmcpsychology.biomedcentral.com/track/ pdf/10.1186/s40359-015-0089-9

Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A., & Lowery, J.C. (2009). Fostering implementation of health services research findings into prac- tice: A consolidated framework for advanc- ing implementation science. Implementation Science, 4(50).

Easterling, D., & Metz, A. (2016). Getting real with strategy: Insights from implementation science. The Foundation Review, 8, 97-115.

Fixsen, D. (2019, February 4). The science of im- plementation—Dr. Dean Fixsen—episode 11 [Video file]. Retrieved from https://www. youtube.com/watch?v=t4k8pk9Bgps

Fixsen, D.L., Naoom, S.F., Blase, K.A., Fried- man, R.M., & Wallace, F. (2005). Imple- mentation research: A synthesis of the litera- ture. Retrieved from https://nirn.fpg.unc. edu/sites/nirn.fpg.unc.edu/files/resources/ NIRN-MonographFull-01-2005.pdf

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EXPLORINGEBPQUALITYIMPROVEMENT.docx

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