Nursing Theories & Evidence-Based Practice

Week 11: Professional Development I

• Module 11 covers Nursing Theories, Research, and Evidence-Based Practice
• Mohawk College, named after the Mohawk Nation, recognizes the Six Nations of the Grand River and the Mississauga's of the Credit First Nation by incorporating the Between the Lakes Treaty, the Dish with One Spoon Wampum Agreement, and the Upper Canada Treaty Agreement
• Agreements govern lands on which the College is situated, maintaining healthy, reciprocal, and respectful relationships with Indigenous nations and peoples
• The ongoing contributions of Indigenous peoples and communities are valued

Agenda

• Housekeeping
• Learning Outcomes
• Nursing Theory & Research
• Evidence-Based Practice
• Coming Up
• Questions?

Learning Outcomes

• Define key terms related to nursing theories
• Describe selected theories and conceptual frameworks associated with nursing practice
• Identify common components of nursing theories
• Describe the purpose of research in professional nursing practice
• Define introductory research concepts and terms
• Develop skills in critiquing research
• Explain the need for evidence to inform nurses' decision-making
• Describe the concepts of evidence-based practice and nursing research
• Describe various sources of evidence suitable for nursing clinical practice
• Investigate a question regarding best practice that can be answered using nursing research
• Review Best Practice Guidelines that evaluate research
• Suggest what the best clinical practice should be

Nursing Theory Terms

• Concept: An idea or notion
• Conceptual Model: A set of interrelated concepts that describe relationships among them
• Framework: A basic structure in which theory is developed
• Metaparadigm: Concepts that identify the domain of a discipline
• Grand Theory: A broad theory covering a discipline's concerns
• Metatheory: Theory about theory development
• Midrange Theory: A focused theory for nursing concerned with patient outcomes
• Model: A representation of interactions between concepts
• Nursing Theory: A framework of testable concepts contributing to nursing thought and practice
• Worldview: A perspective for viewing, perceiving, and interpreting one's experience

Nursing Theory

• The aim of nursing theory is to organize knowledge to enable nurses to use it professionally and accountably
• It provides a systematic way to explain, predict, and prescribe phenomena
• It gives nurses a perspective to view patient situations, organize data, and analyze and interpret information
• Florence Nightingale's work is considered an early model for nursing
• Major developments in nursing theory occurred in the late 1960s as a response to health care system expansion, and the focus on curing disease
• Nurses needed to articulate how their roles differed from other health care providers, hence the beginnings of nursing theories
• Early theories organized knowledge of nursing but lacked systematic explanation of how nurses apply knowledge
• The nursing process resulted from the problem-solving approach, involving four steps: assessment, planning, intervention, and evaluation
• Each step allows nursing knowledge to be applied to nurse-patient situations
• The nursing process now includes Diagnosis as a step (ADPIE) and uses the term clinical judgment, highlighting critical thinking and multiple ways of knowing

Conceptual Frameworks

• Nursing theorists used frameworks to organize concepts and their relationships
• These frameworks work as "mental maps" to help make sense of information
• Theorists sought to depict theoretical structures of nursing practice to help nurses grasp clinical situations with a broader context.

Metaparadigm Concepts

• Conceptual frameworks defined nursing by identifying key bodies of knowledge to understand situations
• The collective body of knowledge is called metaparadigm concepts (Person, Environment, Health, Nursing Care)

Major Theoretical Models

• Grand theories are global frameworks for insight into abstract phenomena. They help with structures for broad ideas in nursing
• Middle-range theories address specific concepts and reflect nursing practice; they are less abstract
• Descriptive theories explain phenomena by detailing causes and consequences
• Prescriptive theories focus on nursing interventions by analyzing their consequences and guiding research
• Practice-Based: Covers models like Florence Nightingale.
• Needs-Based: Focus on understanding and meeting patient needs, examples include Maslows, Henderson and Orem.
• Interactionist: Explains the relationship between nurses and patients, e.g. Hildegard Peplau.
• Systems Theories: Encompass the understanding of overall systems, e.g. Dorothy Johnson, Betty Neuman
• Simultaneity Theories: Give unique perspectives on articulating and understanding patient care, e.g. Martha Rogers, Rosemarie Parse, and Jean Watson

Evidence Based Practice

• Canadian Nurses Association mandates all nurses to use evidence in decision making.
• This practice improves quality of care for clients.
• Nurses use factors like expertise, client preferences and other resources beyond evidence in their decision making process.
• Multiple methods describe Evidence-based practice (e.g. Evidence-Informed Decision Making, Evidence-Informed Practice)
• Evidence-based practice encompasses research evidence, clinical expertise and patients’ preferences.
• Steps include defining the clinical problem, searching for best evidence, critically appraising, integrating evidence and outcomes, and determining outcomes to modify procedures.
• The 6S Pyramid is used to quickly locate relevant research evidence, e.g. Systems, Summaries, Synopses of Synthesis.
• The CRAAP test helps to assess the quality of literature by looking at: Currency, Relevance, Authority, Accuracy, and Purpose.

Upcoming Work

• Complete 1-hour asynchronous work in Module 11
• Prepare for Module 12 (including reviewing module objectives, relevant readings and activities)
• Part C Assignment: Group Presentation (due December 6th). Refer to Canvas for instructions
• Final Exam (Monday, December 9th, at IAHS, 4:30 PM, 90 minutes). Worth 25% and covers Modules 9-13. Arrive early and have Mohawk OneCard