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[ANSWERED] Directions: Identify an outcome of nursing practice in your area of practice that can be improved.  For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. 

Assignment Prompt

Summary: A theory can be used to guide practice.  This assignment is an exercise in supporting a clinical practice with theory and evidence.

Directions: Identify an outcome of nursing practice in your area of practice that can be improved.  For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent.  You may be able to use the problem that inspired the theory concepts that you developed in week two.

Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.

Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.

This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.

Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.

If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).

Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.

Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion.

Present your outcome in an APA formatted paper that meets the University’s standards for a written assignment.

Expert Answer and Explanation

Development of Theoretical Framework

Every research project, especially in nursing is often guided by a theoretical framework. Theories are developed to predict, explain, understand an event or phenomenon and to challenge and improve knowledge of existing arguments (Swanson & Chermack, 2013). A theoretical framework is used by researchers to introduce and describe a theoretical perspective that explains why the current research project is being undertaken. A theoretical framework brings concepts together, defines them making it easy for researchers to support the concepts with relevant evidence-based literature (Swanson & Chermack, 2013). Having a theory in a research project can direct the researcher to answer the questions of how and why. Lastly, theories also help the researcher identify the generalization limits to a concept (Abend, 2008). The purpose of this assignment is to identify a nursing problem, create a clinical theory based on the problem, and match it to a middle-range theory and conceptual model the clinical theory represents.

The Problem

The problem-focused in this assignment is falls among adults in geriatric departments. Falls is one of the serious problems among older adults in the geriatric department. Dykeman et al. (2018) note that falls can increase the cost of care by prolonging the number of days patients stay in hospital beds. The problem also increases costs by prolonging recovery (Elliott & Leland, 2018). For instance, if a patient was to be discharged within one week, the incidence of falls can be prolonged the discharge period to more than a month. As a result, the patients will have to pay for extra hospital stays falls-related injuries. Another negative impact of falls on patients is that it can prevent them from achieving the patient outcome (Elliott & Leland, 2018). One of the patients’ outcomes is to recover completely and faster from the medical problem that took them to the hospital. However, incidences of falls prevent them from achieving this outcome. The problem can also cause low satisfaction among patients and make them lose trust in their healthcare professionals. Hospital facilities can also suffer from falls. Dykeman et al. (2018) note that some patients can sue their healthcare facilities for not protecting them from falling while they are receiving care in their hands.

The Clinical Theory

The clinical theory that can guide a research project to solve the problem identified above is; educating geriatric patients about falls prevention practices reduces the incidences of falls in the geriatric department.

Conceptual Model the Clinical Theory Represents

The concepts in the theory above have been analyzed using Walker & Avant’s approach (Yazdani et al., 2016). The first step is to select the concepts. The clinical theory represents two concepts. They include patient education and low falls incidences in the geriatric department. The conceptual framework in the diagram below shows the concepts and how they are related. The purpose of this conceptual analysis is to identify the concepts, define them, and identify how the concepts could be measured in a research project. The outcome measure in this theory is incidences of falls. This outcome measure can be measured using surveys and document analysis. The survey will focus on the satisfaction rate and document analysis record the incidences of falls recorded. Patient education is the independent variable and incidences of falls is the dependent variable. Concept A is required to impact concept B.

Concept A: Patient Education 

Patient education is the process of improving the patient’s knowledge about a specific health issue or problem to influence their behavior and improve and maintain their health. Patient education can also be defined as the process of providing patients with the information they need to improve their general health and influences them to adopt healthy behaviors (Seeman, 2019). In this case, patients are educated and provided knowledge about falls prevention practices they can apply to prevent them from experiencing the incidences of falls. Nurses are best suited to provide patient education because they interact with patients daily when performing their roles. Cerio (2017) notes that nurses build trusting relationships with patients and this provides opportunities for them to reinforce and encourage patients to practice healthy behaviors. The authors conclude that patient education is a significant component of nurse training.

Patient education is often done for many reasons. The primary use of patient education is to improve patients’ knowledge and skills about various health concerns (Seeman, 2019). In this case, patient education will be used to improve the patient’s knowledge about falls prevention practices. Another use of patient education is to improve patients’ satisfaction with their care. Patient education activities often make patients attracted to their health providers and improve their satisfaction with them. Patient education also helps nurses to provide patient-centered care and improves patients’ adherence to treatments and medications. The patient can take more control of their health through patient education, and this can improve patient outcomes. Patient education can also lead to cost-effective and efficient care delivery because it increases patients’ compliance with treatment services (Grabeel et al., 2018).

Patient education can also be used to reduce complications related to treatment provision. For instance, older patients who have visited the hospital to get heart treatment can develop complications if they experience falls in the process of receiving care. Patient education is often used to prevent such complications. Patient education also allows the staff to focus on other tasks that are of priority. For instance, fall prevention patient education might reduce incidences of falls, hence allowing patients to focus on the health of the patient. Lastly, patient education can be used to reduce confusion among patients regarding various health problems or concerns. The attribute of this concept is that it demonstrates the determination of readiness to change. Patient education aims to equip patients with the knowledge they can use to tackle various health problems. Abbasi et al. (2018) note that patients with knowledge about fall prevention practices avoiding incidences of falls because they knew how to prevent the problem from happening.

Concept B: Incidences of Falls 

The clinical theory represents incidences of falls. Falls is one of the outcome measures used to measure the quality and safety of care received by patients. Marques et al. (2017) note that falls occurring in healthcare facilities are regarded as negligence on the part of the hospital. If the hospital reports a high number of falls in various departments, then the quality of health services provided by the hospital is of low quality and threatens the safety of the patients. Other factors associated with incidences of falls in hospital settings include readmission rates, high cost of care, and low patient satisfaction.

According to Elliott and Leland (2018), one of the causes of readmission rates in geriatric departments is incidences of falls. The authors note that many patients often experience falls after being discharged from the hospital. Some of the impacts of falls are severe and might warrant emergency care and even readmission. Elliott and Leland (2018) also argue that incidences of falls are related to the high cost of care. For instance, if patients get readmitted to health facilities, they will have to incur extra costs that they did not for or expected. Patients will be less satisfied with the care they receive if its cost is high and readmission rates are high.

Matching The Theory and Watson’s Caring

The concepts represented by the theory match some of the concepts in the theory by Watson. Concept A which is patient education matches three elements from the 10 Caritas Processes developed by Jean Watson in her theory of Human Caring (Pajnkihar et al., 2017). One of the elements that match patient education is balance. This element argues that nurses should engage in transpersonal learning and teaching within the perspective of a caring relationship. According to the theory, learning and teaching should be balanced to address readiness, individual needs, and learning styles (Rafael, 2000). This concept is focused on providing patient education to address falls in the geriatric department. Patient education will also make patients ready to handle risk factors associated with falls. If patients know fall prevention strategies, they will be ready to handle factors that might cause falls.

The concept is matched with trust. Educating patients about fall prevention strategies means that patients are trusted that they can adhere to what they have learned and spearhead falls prevention within the hospital facility. Educating patients is also a form of giving them hope and inspiring faith in them. The last aspect that matches concept A is deepen. Patient education has been scientifically proven to be an effective method to reduce incidences of falls in geriatric departments. Harper et al. (2017) conducted a study and found that brief patient education about falls prevention at emergency care reduced the incidences of falls among older patients. Another study by Dykeman et al. (2018) also reports that falls can be prevented by educating patients about falls prevention. Concept A also matches human beings which is one of the main concepts in Watson’s theory. In the theory, the human being is the patient and the concept in my theory is focused on the patient. Concept B matches the two concepts of the theory. The main concepts in Watson’s theory include nursing, environment, health, and human beings. Concept B matches nursing and health. According to Rafael (2000), nursing and health can be seen in terms of roles, functions, and goals. Concept B is the goal or the proposed outcome.

Conclusion

My theory is; educating geriatric patients about falls prevention practices reduces the incidences of falls in the geriatric department. The key concepts in the theory are patient education and incidences of falls. Studies show that patient education about falls prevention strategies can impact cases of falls in healthcare facilities by reducing the incidences of falls in the geriatric department. This finding is significant to the nursing profession. Nurses, especially those working in home health can apply this discovery in their respective environments and reduce the incidences of falls in their respective areas. Further studies should be done to find whether nurse education can also reduce incidences of falls in healthcare facilities. 

References

Abbasi, M., Rabiei, L., & Masoudi, R. (2018). Experience of nursing students about the barriers to patient education: a qualitative study in Iran. Korean journal of medical education, 30(4), 327–337. https://doi.org/10.3946/kjme.2018.107

Abend, G. (2008). The meaning of ‘theory’. Sociological theory, 26(2), 173-199.

Cerio, R. (2017). The importance of patient‐centred care to overcome barriers in the management of actinic keratosis. Journal of the European Academy of Dermatology and Venereology, 31, 17-20. https://doi.org/10.1111/jdv.14091

Dykeman, C. S., Markle-Reid, M. F., Boratto, L. J., Bowes, C., Gagné, H., McGugan, J. L., & Orr-Shaw, S. (2018). Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study. BMC geriatrics, 18(1), 34. https://link.springer.com/article/10.1186/s12877-018-0725-3

Elliott, S., & Leland, N. E. (2018). Occupational therapy fall prevention interventions for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72,7204190040. https://doi.org/10.5014/ajot.2018.030494

Grabeel, K. L., Russomanno, J., Oelschlegel, S., Tester, E., & Heidel, R. E. (2018). Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials. Journal of the Medical Library Association : JMLA, 106(1), 38–45. https://doi.org/10.5195/jmla.2018.262

Harper, K. J., Barton, A. D., Arendts, G., Edwards, D. G., Petta, A. C., & Celenza, A. (2017). Controlled clinical trial exploring the impact of a brief intervention for prevention of falls in an emergency department. Emergency Medicine Australasia, 29(5), 524-530. https://doi.org/10.1111/1742-6723.12804

Marques, P., Queirós, C., Apóstolo, J., & Cardoso, D. (2017). Effectiveness of bedrails in preventing falls among hospitalized older adults: a systematic review. JBI Evidence Synthesis, 15(10), 2527-2554. doi: 10.11124/JBISRIR-2017-003362

Pajnkihar, M., McKenna, H. P., Štiglic, G., & Vrbnjak, D. (2017). Fit for practice: analysis and evaluation of Watson’s theory of human caring. Nursing Science Quarterly, 30(3), 243-252. https://doi.org/10.1177%2F0894318417708409

Rafael, A. R. F. (2000). Watson’s philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. Advances in nursing science, 23(2), 34-49.

Seeman, K. (2019). The importance of quality perioperative patient education. Journal of Consumer Health on the Internet, 23(1), 94-101. https://doi.org/10.1080/15398285.2019.1574525

Swanson, R. A., & Chermack, T. J. (2013). Theory building in applied disciplines. Berrett-Koehler Publishers.

Yazdani, S., Hosseini, F., & Ahmady, S. (2016). System based practice: a concept analysis. Journal of Advances in Medical Education & Professionalism, 4(2), 45–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827756/

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