Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example

The quality improvement project aims to determine if implementing the hospital-based advocacy intervention would impact reported intimate partner violence (IPV) cases and reinjury rates among IPV victims. The hospital-based advocacy intervention is an IPV program that involves the hospital working closely with survivors and community-based services that seek to offer support and link victims to hospital and community-based resources addressing IPV. Associated services include linking victims with independent domestic violence advisors, comprehensive follow-up and case management, crisis and counseling support, and robust trauma-related screening. It is anticipated that positive outcomes, including reduced IPV cases, reinjury rates, abuse cessation, and increased hospital survivors or increased IPV identification, can be achieved when hospitals work closely with survivors, community-based services, and other resources addressing IPV and domestic violence. This paper discusses the theoretical foundation and evidence-based change model selected to guide the quality improvement project.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Theoretical Foundations

Theoretical foundations are theories or models that help explain the issue driving the quality improvement project (Bethel et al., 2022). The theoretical framework will act as the structure that guides this practice project, identifying and linking key concepts and variables of concern to the practice project. The selected nursing theory will guide the implementation of the proposed intervention.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Peplau’s Theory Of Interpersonal Relations

The theoretical framework for the DNP is the theory of interpersonal relations, developed by Hildegard Peplau in 1952. According to Peplau’s concept, nursing is a therapeutic interpersonal process that happens when professionals who have received nursing-specific training interact with patients who require medical attention. Per this theory, successful nurse-patient relationships must go through the following stages: (a) orientation, (b) working, and (c) termination (Hagerty et al., 2019). Patients recognize their need for assistance during the brief orientation phase and try to acclimate to their present (and frequently novel) circumstances. Nurses encounter patients simultaneously and learn crucial details about them as individuals with particular needs and priorities (Hagerty et al., 2019).(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

The first character nurses play during the orientation phase is that of the stranger, one of several they play in their encounters with patients (Hagerty et al., 2019). Nurses should approach patients with the same decency and friendly attention that they would provide to a stranger. This phase is the shortest, and nurses must maintain politeness and respect throughout the three phases. In the DNP project, nurses will be involved in implementing the hospital-based advocacy intervention, which requires working closely with the victims and at-risk individuals. Therefore, the first step, orientation, will be critical in understanding their needs and priorities. Nurses will adopt the theory’s principles to develop a positive rapport to ensure victims feel heard, valued, safe, and comfortable to open up.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

The working period comes next, during which nurses spend most of their time with patients. In this stage, nurses conduct patient assessments to be used in teaching and as a part of the interdisciplinary care plan (Hagerty et al., 2019). Patients start to accept nurses’ roles as health educators, resource people, counselors, and care providers as they progress through the working phase. Nurses assist patients in clarifying their views by giving them reflective, nonjudgmental feedback through this therapeutic communication (Hagerty et al., 2019). This step will be critical in implementing hospital-based advocacy intervention. In this phase, nurses will assess IPV victims and at-risk individuals, serving as educators, resource people, counselors, and care providers. Nurses will work in an interdisciplinary team to develop a comprehensive assessment of the victims. (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

 The termination phase, often called discharge planning, is the last stage. How successfully nurses and patients handled the orientation and working phases will determine how well the termination phase goes. Teaching patients how to control their symptoms and recuperate at home is crucial to the termination phase (Hagerty et al., 2019). When implementing the hospital-based advocacy intervention during this phase, nurses will work with victims, educating them on how to identify risk factors of IPV, handle abusive cases, address the emotional and physical injuries due to IPV, and utilize healthcare and legal services when they experience IPV. This phase intends to give victims control and empower them to promote safety. (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            Clinical Question

To what degree does the implementation of hospital-based advocacy intervention impact reported IPV cases and reinjury rates compared to current practice among IPV victims in a community-based hospital in Arizona?

Implementing the hospital-based advocacy intervention requires working closely with IPV victims. This population is highly vulnerable and sensitive during interactions with other people, hence the need for good interpersonal relations. The interpersonal relations theory will guide the nurse interaction process with IPV victims by informing them what they should and should not do to promote a therapeutic relationship with the IPV victims.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            Synthesis of Theory

Peplau’s theory of interpersonal relations has been adopted in multiple research studies. Fletcher (2023) adopted the theory to inform aesthetic nursing. Nurses interact with patients, playing multiple roles during these interactions, including the stranger, the resource, the teacher, the counselor, and the surrogate roles. Therefore, nurses need to develop interpersonal techniques like skilled verbal interventions to help bolster nurse-patient relationships, problem resolution, and empower or build confidence in patients by comprehending and addressing their perceptions of the problem they are facing. Fletcher (2023) reports that about a third of all aesthetic patients had experienced significant life events like the death of a loved one or divorce a year before, approximately 50% of them were going for counseling from a mental health practitioner, and 25% were under a particular psychiatric medication. Therefore, most of these patients might be experiencing issues like insecurities, low self-esteem, anxieties, and other forms of dysphoria. Fletcher (2023) adopts the interpersonal relations theory to inform how nurses in cosmetic medicine can interact with patients to understand and address their clinical and emotional needs.    (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Another study by Arabacı (2019) adopts Peplau’s theory of interpersonal relations in caring for a juvenile delinquent. The study aimed to establish the role therapeutic interaction and communication have on a child delinquent, adopting Peplau’s concepts. Strong interpersonal relations are required when dealing with juveniles to influence positive behavior change. The steps of the interpersonal relations theory were adopted to establish a patient-nurse relationship to help the 15-year-old child delinquent in addressing suicidality, lack of impulse control, ineffective coping, impaired social interaction, low self-respect, ineffective health management, and hopelessness. The patient was discharged after committing to be more responsible in his life.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Hagerty et al. (2019) employed Peplau’s theory of interpersonal relations to explore nursing’s wide contribution to hospitalized patients’ experiences. The article discusses the importance of patients’ experiences in hospitals as vital indicators of the quality of care. Nurses are central to these experiences because they interact more with the patients. Hagerty et al. (2019) adopted the theory of interpersonal relations as a conceptual framework to extensively reflect on nurses’ contributions to the experiences of hospitalized patients.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Summary

Peplau’s theory of interpersonal relations describes the interpersonal and therapeutic process that occurs when healthcare professionals, particularly nurses, participate in therapeutic relationships with individuals in need of health services. Per the theory, the nurse-patient relationship undergoes three phases: 1) orientation, 2) working, and 3) termination. These concepts will be adopted to guide the implementation of the hospital-based advocacy intervention, which requires nurses to work closely with IPV victims to establish a safe, comforting, and respectful environment to encourage engagement. The theory has been adopted in multiple studies to guide the process of establishing a therapeutic relationship between nurses and patients, including by Fletcher (2023), Arabacı (2019), and Hagerty et al. (2019).   

Evidence-based Change Model

            Evidence-based practice (EBP) is an integral part of nursing practice, helping translate evidence into practice. Several evidence-based practice models exist to help implement EBP. These models aid in organizing and guiding the integration of the most recent research to establish the best patient care practices. EBP models also help enhance the success of implementing EBP projects and optimize healthcare resource utilization. The Ottawa Model of Research Use is selected to help implement the EBP change project (Tucker et al., 2019). The model is an interactive one that views research as a dynamic process with interlinked decisions made and actions performed by stakeholders involved.   (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Ottawa Model of Research Use

            Graham and Logan developed the Ottawa Model of Research Use (OMRU) to guide the successful implementation of interventions. It has been adopted in nursing practice and research to guide the implementation of evidence-based interventions. OMRU comprises three phases: assessing barriers and facilitators, monitoring intervention and use, and evaluating outcomes (Tucker et al., 2019). The theory also includes six primary elements subsumed under the three phases that must be considered during research integration into practice.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            The first step is assessing barriers and facilitators to implementing the evidence-based intervention. In this step, three primary elements include clearly identifying what the intervention is and what its implementation will entail (Tucker et al., 2019). The intervention recommended in the EBP project is hospital-based advocacy, adopted as an IPV program that will involve nurses and other providers working closely with IPV survivors and community-based services geared toward offering support and linking victims to hospital and community resources that address IPV. Specific services involved in the implementation include linking victims with independent domestic violence advisors, comprehensive follow-up and case management, crisis and counseling support, and robust trauma-related screening. The second element in this phase is identifying potential adopters and their characteristics that would influence adoption (Tucker et al., 2019). Adopters of the recommended project include hospitals, community services linked to IPV, and providers, including nurses and mental health practitioners. The third element is describing the practice environment by identifying formal and informal leaders who can inspire change and assessing the resources required to implement the intervention. Nurses are the facilitators of the project.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            The second phase involves monitoring the intervention and extent of use. This phase has two primary elements that include implementing the intervention by selecting appropriate strategies to bolster awareness of its implementation and offering needed education and training to support implementation (Tucker et al., 2019). Nurses and other involved stakeholders, including social workers, will receive education and training to help implement the hospital-based advocacy program. The second element is adopting the intervention and determining the extent of its adoption by the identified adopters. The third phase is evaluating outcomes. It comprises one key element that entails assessing the impact of the intervention on the patients, practitioners, and other involved stakeholders like the hospital. The nurses involved will evaluate the impact of the hospital-based advocacy in addressing IPV in the community.   (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            Clinical Question

To what degree does the implementation of hospital-based advocacy intervention impact reported IPV cases and reinjury rates when compared to current practice among IPV victims in a community-based hospital in Arizona?(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

The OMRU provides a step-wise process of integrating research into practice. The model is selected to help implement the hospital-based advocacy intervention through the three phases of assessing barriers and facilitators, monitoring intervention and use, and evaluating outcomes.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

            Synthesis of Evidence-based Change Model

The Ottawa Model of Research Use has been used in multiple research studies to guide the implementation of specific interventions. Gifford et al. (2019) used the OMRU as the implementation framework of a study that aimed to identify barriers and facilitators of EBP in Hunan, China.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example) The researchers adopted the model to comprehend the interrelationships and complex organizational dimensions of research or new knowledge translation into practice. The study also adopted the OMRU to understand factors influencing research evidence implementation into practice and barriers and facilitators at the different phases of implementation.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Another study by Prochnow et al. (2019) adopted the OMRU to implement an innovative teach-back toolkit to enhance patient and caregiver new medication education. The researchers employed the six primary elements of identifying and assessing the practice environment, evidence, and potential adopters, articulating the EBP project, identifying methodologies of strategies of implementation, designing and adopting the project, and measuring outcomes. Similarly, Tucker et al. (2019) selected the OMRU as one of the two models they used to implement a career development plan to promote nurse retention. The authors used the model to assess the practice environment, potential adopters of the recommended intervention, the EBP intervention, research translation strategies, intervention/evidence adoption, and nurse retention outcomes. Conclusively, the model is widely used to guide the implementation of EBP interventions.  (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Summary

            The Ottawa Model of Research Use has been selected to guide the implementation of the hospital-based advocacy intervention. The OMRU has three phases with six primary elements subsumed in these three phases, including identifying the intervention and what the implementation will entail, potential adopters, assessing the practice environment, identifying strategies to implement the intervention, adopting the intervention, and evaluating the intervention’s impact on the involved stakeholders. The model has been selected because it is easier to understand and use. (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Linking Nursing Theory, Change Model, to the Direct Practice Improvement Project

            The EBP project seeks to explore intimate partner violence and implement an intervention to reduce IPV cases and reduce reinjury rates. IPV victims tend to be underdiagnosed and undertreated because of the trauma associated with IPV, leading to underreporting and underdocumentation of the cases. Miscommunication or poor communication is implicated in the underrecognition, underdiagnosis, undertreatment, and underdocumentation of IPV cases at the community-based hospital. Therefore, the purpose of this quality improvement project is to determine if or to what degree the implementation of the hospital-based advocacy intervention would impact reported IPV cases and reinjury rates when compared to current practice among IPV victims in a community-based hospital in Arizona over 12 weeks.(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Conclusion

            The selected nursing theory is Peplau’s theory of interpersonal relations, and the selected evidence-based change model is the Ottawa Model of Research Use. The theory of interpersonal relations provides a process of developing a therapeutic relationship between nurses and patients, which is critical in this project as nurses will work closely with IPV victims (Hagerty et al., 2019). The OMRU is an easy-to-use model with three phases and six key elements that guide the translation of evidence to practice (Tucker et al., 2019).(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)The theory will aid with implementing the hospital-based advocacy intervention during the identifying adopters, strategies of adoption, adopting the intervention, and evaluating the outcomes phases of the OMRU. The OMRU will help understand the characteristics of nurses and patients, which will help in developing the therapeutic relationship needed per the theory of interpersonal relations to ensure the implementation is successful. The theory of interpersonal relations supports the project by guiding nurses in their interactions with IPV victims. The OMRU will support the project by providing steps that will help implement the hospital-based advocacy intervention. (Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

References

Arabacı, L. B. (2019). Effect of using a Peplau’s interpersonal relation nursing model in the care of a juvenile delinquent. Journal of Psychiatric Nursing. https://doi.org/10.14744/phd.2019.54366(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Bethel, C., Reed, P. G., Brewer, B. B., & Rainbow, J. G. (2022). Selecting a theoretical framework to guide research on the COVID-19 pandemic impacts on nursing care delivery and the critical care work system (using Reed’s Intermodern approach to theory critique). Applied nursing research: ANR, 63, 151513. https://doi.org/10.1016/j.apnr.2021.151513(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Fletcher, L. (2023). Peplau’s theory of interpersonal relations and its applications in aesthetic nursing. Journal of Aesthetic Nursing, 12(3), 145-148. https://doi.org/10.12968/joan.2023.12.3.145

Gifford, W., Zhang, Q., Chen, S., Davies, B., Xie, R., Wen, S., & Harvey, G. (2019). When east meets west: A qualitative study of barriers and facilitators to evidence-based practice in Hunan China. BMC Nursing, 17(1). https://doi.org/10.1186/s12912-018-0295-x(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2019). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data. Nursing Science Quarterly, 30(2), 160–167. https://doi.org/10.1177/0894318417693286(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Prochnow, J. A., Meiers, S. J., & Scheckel, M. M. (2019). Improving patient and caregiver new medication education using an innovative teach-back toolkit. Journal of Nursing Care Quality, 34(2), 101-106. https://doi.org/10.1097/ncq.0000000000000402(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

Tucker, S. J., Gallagher-Ford, L., Baker, M., & Vottero, B. A. (2019). Promoting Nurse Retention Through Career Development Planning. The American journal of nursing, 119(6), 62–66. https://doi.org/10.1097/01.NAJ.0000559823.73262.d2(Connecting Nursing Theory and Evidence-based Change Models Comprehensive Nursing Essay Example)

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