Mohawk College Professional Development I PDF

Week 11 Professional Development I Module 11: Nursing Theories, Research, & Evidence-Based Practice  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and M...

Week 11 Professional Development I Module 11: Nursing Theories, Research, & Evidence-Based Practice  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and Mohawk College honours that union by recognizing the Six Nations of the Grand River and the Mississauga’s of the Credit First Nation. We acknowledge that the territories on which Mohawk College and its campuses are situated are governed by the Between the Lakes Treaty, the Dish with One Spoon Wampum Agreement, and the Upper Canada Treaty Agreement. These agreements are binding to this day and represent our mutual commitment to maintain healthy, reciprocal and respectful relationships with the many Indigenous nations and peoples of this area. We acknowledge this and iterate our dedication to inclusivity, to friendship and to valuing the ongoing contributions of Indigenous peoples and communities. Agenda 01 02 03 Housekeeping Learning Nursing Theory & Outcomes Research 04 05 06 Evidence-Based Coming Up Questions? Practice  0 Week 11 1 Housekeeping Questions Week 10?  0 Week 11 Learning 2 Outcomes Learning Outcomes 1 2 3 Define key terms Describe selected theories Identify the common related to nursing and conceptual frameworks components of nursing theories associated with nursing theories practice 4 5 6 Describe the Define introductory Understand what purpose of research research concepts and involvement in research in your professional terms & develop skills to means for the nursing nursing practice critique research profession Learning Outcomes 7 8 9 Explain the need for Describe the concepts of Describe various sources of evidence to inform evidence-based practice, evidence that are suitable for nurses’ decision- and nursing research, and nursing clinical practice making how this differs from quality improvement 10 11 Investigate a Review Best Practice question that you Guidelines that evaluate have regarding best research and suggest practice that can be what the best clinical answered using practice should be nursing research  0 Week 11 Nursing Theory & 3 Research Nursing Theory Terms 1. Concept: ○ An idea or notion 2. Conceptual Model: ○ A group of interrelated concepts described to suggest relationships among them 3. Framework: ○ A basic structure; the context in which theory is developed; the structure that permits theory to be understood 4. Metaparadigm: ○ Concept that identify the domain of a discipline (Astle & Duggleby, 2023) Nursing Theory Terms 5. Grand Theory: ○ A theory that covers a broad area of a discipline’s concerns 6. Metatheory: ○ Theory about theory development; theory about theory 7. Midrange Theory: ○ A focused theory for nursing that deals with a portion of nurses’ concerns or that is oriented to patient outcomes 8. Model: ○ A representation of interactions between and among concepts (Astle & Duggleby, 2023) Nursing Theory Terms 9. Nursing Theory: ○ A framework; a set of interrelated concepts that are testable; a way of seeing the factors that contribute to nursing practice and nursing thought 10. Worldview: ○ A perspective; a way of viewing, perceiving, and interpreting one’s experience Nursing Theory The aim of nursing theory is to organize knowledge about nursing to enable nurses to use it in a professional and accountable manner Useful because they provide a systematic way of explaining, predicting, and prescribing phenomena Provide nurses with a perspective from which to view patient situations, a way to organize data, and a method of analyzing and interpreting information (Astle & Duggleby, 2023) Nursing Theory Contemporary scholars consider Florence Nightingale work an early model for nursing Her theory provided nurses with a way to think about nursing practice in a frame of reference that focuses on patients and the environment Several major developments in nursing theory occurred in the late 1960’s ○ Health care system was expanding influenced by scientific discoveries ○ Focus of society shifted from attending to the sick towards curing and eradicating disease Nurses recognized the need to articulate how their role differed from that of other health care providers – this initiated nursing theories! (Astle & Duggleby, 2023) Nursing Theory Early theorists developed conceptual frameworks in which they organized nursing concepts and proposed relationships among these concepts Frameworks were “mental maps” to make sense of the information and decision process that nurses needed in their nursing practice Early theories sought to organize the knowledge about the practice of nursing, but these theories generally lacked ways of systematically explaining how nurses work with knowledge in new situations (Astle & Duggleby, 2023) The Nursing Process The nursing process resulted from the development of the problem-solving approach Process originally involved 4 steps 1. Assessment 2. Planning 3. Intervention 4. Evaluation Each step represents a distinct way general nursing knowledge could be applied to nurse-patient situations (Astle & Duggleby, 2023) The Nursing Process 1. Assessment Phase: ○ Gather information (biological, environmental, psychological…etc.) ○ Organize data (interpret major issues or concerns) ○ Produce a nursing diagnosis (nurses prospective of the patient issues) 2. Planning Phase: ○ Prioritize the nursing issues from the assessment ○ Identify which issues could be supported with nursing interventions ○ Create a plan of care (Astle & Duggleby, 2023) The Nursing Process 3. Intervention Phase: ○ The plan of care is carried out here 4. Evaluation Phase: ○ Plans success or failure would be judged here ○ Determine whether the intended outcomes had been achieved ○ Do any nursing interventions need revision? ○ Evaluate whether you need to repeat the cycle (Astle & Duggleby, 2023) The Nursing Process Today *Now added “Diagnosis” formally (Acronym: ADPIE) The Nursing Process The nursing process was widely accepted by nurses because it was a logical way to describe basic problem-solving Quickly adopted by all nurses because it represented a continuous, rapid cycling of information through each of the phases Very useful for organizing and applying knowledge to nursing practice Current practice; we now use terms such as “clinical judgement” as opposed to nursing process as this highlights critical thinking and multiple ways of knowing “Clinical Judgement” implies the systematic use of the nursing process to invoke intuitive and conscious thinking strategies that are part of decision making (Astle & Duggleby, 2023) Conceptual Frameworks Following the late 1960’s conceptual framework builders now use the term nursing theorists The building of nursing models was an attempt to theorize how all nurses might be taught to organize and synthesize knowledge about nursing Theorists who developed framework models sought to depict theoretical structures that would allow nurses to grasp clinical situations with broader context (Astle & Duggleby, 2023) Metaparadigm Concepts Conceptual frameworks attempted to define nursing by creating definition for the substance and structure of the key bodies of knowledge to understand situations The collective body of knowledge was then called metaparadigm concepts ○ Person ○ Environment ○ Health Care ○ Nursing Care (Astle & Duggleby, 2023) Metaparadigm Concepts Metaparadigm Concepts 1. Person: ○ Can be either person, client, patient, or community member ○ An entity with biological, psychological, social, and spiritual dimensions 2. Environment: ○ The person is part of and interacts with the complex environmental system ○ Environment may involve family, , social ties, community, health care system, physical environment (Astle & Duggleby, 2023) Metaparadigm Concepts Metaparadigm Concepts 3. Health: ○ More than the absence of disease but rather a state of overall well-being ○ Nurses help patients reach their optimal level of health 4. Nursing: ○ Guided nurses to think systematically ○ Implementation process caused the emphasis to shift towards individualized nursing (Astle & Duggleby, 2023) Metaparadigm Concepts Major Theoretical Models Types of Theories Grand Theories ○ Global conceptual framework that provides insight into abstract phenomena, such as human behaviour or nursing science ○ Intended not to provide guidance for specific nursing interventions but rather to provide structural frameworks for broad ideas about nursing Middle-Range Theories ○ Less abstract and address specific concepts and reflect practice ○ Cross different nursing fields and reflect different nursing situations (Astle & Duggleby, 2023) Major Theoretical Models Types of Theories Descriptive Theories ○ Describe phenomena and why it occurs along with consequences ○ Can explain, relate, and predict nursing situations Prescriptive Theories ○ Addresses nursing interventions and consequences ○ Action oriented and guide nursing research and assist in develop interventions (Astle & Duggleby, 2023) Major Theoretical Models Types of Theories 1. Practice-Based Theories 2. Needs Theories 3. Interactionist Theories 4. Systems Theories 5. Simultaneity Theories (Astle & Duggleby, 2023) Major Theoretical Models 1. Practice-Based Theories ○ Designed to guide and shape practice Florence Nightingale Model The McGill Model 2. Needs theories ○ Conceptualizing the patient as representing a collection of needs ○ Studying the nature of people (Maslow’s Hierarchy of Needs) Virginia Henderson Model Dorthea Orem Self Care Theory (Astle & Duggleby, 2023) Major Theoretical Models 3. Interactionist Theories ○ Focus on relationships between nurses and their patients Hildegard Paplau Joyce Travelbee Evelyn Adam 4. Systems Theories ○ Accounts for the whole of the entity (the system) and the parts (subsystem) as well as complex interactions of the parts Dorothy Johnson Betty Neuman Sister Callista Roy (Astle & Duggleby, 2023) Major Theoretical Models 5. Simultaneity Theories ○ Represent a distinct approach to articulating an understanding of the client of nursing as well as nursing’s role in relation to the client Martha Rogers Rosemarie Parse Jean Watson (Astle & Duggleby, 2023) Break Time… Please enjoy a 5-minute break  0 Week 11 4 Evidence-Based Practice Library Presentation Welcome Laura Riggs! Laura is our Mohawk College librarian and resident expert in EIDM/EIP & searching through databases. Laura was kind enough to be here today with us to speak about Evidence Informed Practice or Evidence-Informed Decision Making and how we can use the CRAAP tool to assist us in recognizing appropriate literature. Laura’s presentation will be about 45- minutes Evidence-Based Practice Canadian Nurses Association (CNA) states that all nurses MUST use Evidence- Informed Decision Making (EIDM) or Evidence-Informed Practice (EIP) Nurses must critically appraise scientific evidence and integrate it into their practice This improves quality of care for clients and enhances the healthcare system Multiple terms are used to describe Evidence-Based Practice ○ Evidence-Informed Decision Making ○ Evidence-Informed Practice (Astle & Duggleby, 2023) Evidence-Based Practice Evidence-Based Practice Evidence-Informed Decision Making: ○ Involves use of evidence as part of the decision-making process, along with other factors beyond evidence, such as resources, or cultural values and beliefs Evidence-Informed Practice: ○ An ongoing process that incorporates evidence from research findings, clinical expertise, client preferences, and other resources to inform decisions nurses make about clients (Astle & Duggleby, 2023) Steps for Evidence-Informed Practice 1. Ask a question that clearly presents the clinical problem 2. Search for and collect the most relevant best evidence 3. Critically appraise the evidence 4. Integrate all evidence with clinical expertise, patient preferences, and patient values to make a practice decision change 5. Evaluate the outcome of the practice decision or change and modify if necessary 6. Determine the outcomes of the decision or change (Astle & Duggleby, 2023) Researching the Evidence 1. Asking the Clinical Question: Clinical questions come from our nursing practice and represent problems that we wonder about or things that do not make sense Examples: ○ What is the best cleaner to use when I provide mouth care to a patient ○ How can you reduce falls on a post-op unit (Astle & Duggleby, 2023) Researching the Evidence Clinical questions that arise from your nursing practice should be first addressed by looking to see if the answer is readily available ○ Practice Guidelines from professional associations ○ RNAO has 50 published Best Practice Guidelines When consulting empirical literature (databases/journal articles) you will want to read the most informative 4-6 articles available to address your knowledge gap Therefore, you will want to have a well-developed research question to ensure you are receiving the best results (Astle & Duggleby, 2023) Researching the Evidence The PICO Question: (Quantitative) Using a P-I-C-O format to create your question will help to ensure you have a focused, researchable, question that will produce the best quality resources ○ P: Population (age, gender, ethnicity…etc. of the patients) ○ I: Intervention (what intervention or health strategy is being considered?) ○ C: Comparison (what is the ususal standard of care/practice?) ○ O: Outcome (what is the result or change you want to achieve?) (Astle & Duggleby, 2023) Researching the Evidence PICO Question Example: In adult hospitalized medical-surgical patients, does an evidence-based falls prevention program that includes comprehensive assessment and individual interventions based on patient-specific risks decrease fall rate? ○ P – adult hospitalized medical-surgical patients ○ I – Evidence-based falls prevention program that includes comprehensive assessment ○ C – Usual Care ○ O – Decrease rate of falls Researching the Evidence The PS Question: (Qualitative) Using a P-S format is use for questions that are looking for answers around context or experiences ○ P: Population (age, gender, ethnicity…etc. of the patients) ○ S: Situation (what circumstance do you want to know about?) (Astle & Duggleby, 2023) Researching the Evidence PS Question Example: What is the physical and emotional experience of the postpartum period like for women over the age 50? ○ P – Postpartum women over the age of 50 ○ S – Physical and emotional experience of the postpartum period Researching the Evidence 2. Collect the Best Evidence Once you have a clear and concise PICO or PS question you are ready to search You can find the evidence you need in a variety or sources; agency policies, practice guidelines, databases…etc. Databases contain published empirical studies, including peer-reviewed research ○ What does ”peer reviewed” mean? Best databases for nursing literature are MEDLINE and CINAHL (Astle & Duggleby, 2023) Researching the Evidence The 6S Pyramid Tool developed to help find the best available research evidence quickly and effectively (Astle & Duggleby, 2023) Researching the Evidence The 6S Pyramid Systems: Sophisticated electronic systems that link to patient records and prompt practitioners about guidelines for care Summaries: Synthesized sources of research evidence for a given health issue Synopsis of Syntheses: Summaries of the findings from systematic reviews Syntheses: Synthesis of primary studies by using systematic review methods to answer a focused research question Synopsis of Single Studies: A summary of the results and implications of single studies Studies: Single research studies related to a particular focused question (Astle & Duggleby, 2023) Researching the Evidence 3. Critique the Evidence Research literacy is an essential competency for evidence-informed practice It is the ability to locate, understand, and critically evaluate empirical literature for application in practice Critiquing evidence is essentially determining the value of the literature We can use the CRAAP test to help us determine literature quality (Astle & Duggleby, 2023) Researching the Evidence Researching the Evidence The CRAAP Test C: Currency (The timeliness of the information) ○ When was the information published or posted (should be within last 5 years) ○ Has the information been revised or updated? ○ Does your topic require current information, or is older information appropriate? ○ Are the links functional? (CSU, 2010) Researching the Evidence The CRAAP Test R: Relevance (The importance of the information for your needs) ○ Does the information relate to your topic or answer your question ○ Who is the intended audience? ○ Is the information at an appropriate level? ○ Have you looked at a variety of sources before determining this it the one you’ll use? ○ Would you be comfortable citing this source in your research paper? (CSU, 2010) Researching the Evidence The CRAAP Test A: Authority (The Source of the Information) ○ Who is the author/publisher/source/sponsor? ○ What are the author’s credentials or organizational affiliations? ○ Is the author qualified to write on the topic? ○ Is there contact information, such as a publisher or email address? ○ Does the URL reveal anything about the author or sourse.com/.edu/.gov/.org/.net (CSU, 2010) Researching the Evidence The CRAAP Test A: Accuracy (The reliability and correctness of the content) ○ Where does the information come from? ○ Is the information supported by evidence? ○ Has the information been reviewed or refereed? ○ Can you verify any of the information in another source or from personal knowledge? ○ Does the language or tone seem unbiased and free of emotion? ○ Are there spelling, grammar, or typographical errors? (CSU, 2010) Researching the Evidence The CRAAP Test P: Purpose (The reason the information exists) ○ What is the purpose of the information? Is it to inform, teach, sell, entertain, persuade? ○ Do the authors make their intentions clear? ○ Is the information fact, opinion, or propaganda? ○ Does the point of view appear objective and impartial? ○ Are there political, ideological, cultural, religious, institutional, or personal biases? (CSU, 2010) Researching the Evidence 4. Integrate the Evidence ○ Apply the research in your plan of care for the patient ○ Use the evidence you find as rationale for an intervention you plan to try 5. Evaluate the Outcome ○ How did the intervention work? ○ How effective was the clinical decision for your patient or practice setting? 6. Disseminate the Outcome ○ If the outcomes was positive, incorporate the decision on a larger scale ○ Get all nurses implementing this into their practice (Astle & Duggleby, 2023) References Astle, Duggleby, Potter, Perry, Stockert & Hall. (2023). Potter and Perry's Canadian Fundamentals of Nursing (7th edition). Toronto: Elsevier Canada Canadian Nurses Association. (2018). Evidence-informed decision making and nursing practice. https://hl-prod-ca-oc-download.s3-ca-central 1.amazonaws.com/CAN/2f975e7e-4a40-45ca-863c- 5ebf0a138d5e/UploadedImages/documents/Evidence_informed_Decision_making_and_ Nursing_Practice_position_statement_Dec_2018.pdf California State University. (2010). Evaluating information – Applying the CRAAP test. https://library.csuchico.edu/sites/default/files/craap-test.pdf  0 Week 11 5 Coming Up… Coming up… Ensure you have completed 1 hour of asynchronous work for Module 11 Prepare for Module 12 (Week 12) ○ Review module objectives ○ Begin required readings and activities and come prepared to engage in lecture Part C Assignment: Group Presentation ○ Refer to Canvas for Assignment Instructions ○ Due: December 6th Final Exam… Refer to Announcement for Information Refer to Module 14 Final Exam Information Monday December 9th at IAHS – No students writing at TW/WH 4:30pm 90 minute exam Covering Module 9-13 Worth 25% Arrive Early MUST have Mohawk OneCard NO belongings – please use lockers  0 Week 11 6 Questions