Nurse 250: Exam 2

A student nurse interacting with patients on a cardiac unit recognizes the four concepts of nursing theory that determine nursing practice. Of these four, which is the most important?

***A. Person B. Environment C. Nursing D. Health

Demographics

Between now and 2050 - number of individuals 65 years + will double (approximately 80 million between Canada and the US). Many will become dependent on the health care system as a result of chronic health problems: COPD, Cancer, Heart disease, Diabetes, Alzheimer's disease, HIV

Ambulatory Care Centers/Clinics

Deliver outpatient medical care. May be located in hospitals, may be freestanding service or may be managed by an APRN. May be located in convenient areas such as malls. Walk in services/non-traditional hours. Improved access to care for uninsured and other barriers to care. RNs - provide technical services (admin. Meds), provide education, assist with minor procedures. Urgent care centers - type of ambulatory care center. Provides walk in care for illness and minor trauma

Somebody's Got To Do Something

'Somebody' = nurses themselves Need to identify what needs accomplished and understand the political framework. Nurses can use their considerable power to make changes that will benefit both their patients and the profession. Professional organizations

What is the ultimate goal of expanding nursing knowledge through nursing research?

***A. Learn improved ways to improve and promote health B. Develop technology to provide hands on nursing care C. Apply knowledge to become independent practitioners D. Become full fledged partners with other health care providers

Palliative Care

-focus is on pain and symptom management -patient does not have to be terminal -may still be seeking aggressive treatment

Hospice Care

-focus is on pain and symptoms management -patient has a terminal diagnosis with life expectancy of less than six months -not seeking curative treatment In both hospice and palliative care, the focus is on quality of life of the patient. The goal for both types of care is to address any adjustment to illness or end-of-life issues.

Professional Nursing Roles

1) Majority of nurses practice in hospital settings, followed by community settings, ambulatory care, nursing homes/extended care settings 2) Offers expanded roles and different kinds of career opportunities 3)Take advantage of the different clinical practice/professional opportunities

Rsearcher

1) Participation/Conduct research to increase knowledge in nursing and improve patient care. 2) Typically nurse with advanced degree. 3) Began with Florence Nightingale: systematically collected objective data. 1855: described environmental factors that affected health and illness

Resercher Time Periods

1940's - Studies concerning nursing education. Weaknesses were found and spawned new research focused on: Nurses' functions, Roles, Attitudes, Acceptance, Interaction with client 1950's - Increasing number of advanced degree nurses. Center for nursing research formed at Walter Reed Army Institute of Research. Creation of the American Nurses' Foundation and journal Nursing. Research allowed publication of research findings giving a face and voice to the studies. 1960's - Phrases such as conceptual model, conceptual framework, and nursing process made their appearances in textbooks and other nursing literature. Many professional nursing organizations set priorities for research. 1980's - Continued growth of research trained, graduate school educated nurses. Introduction of computers Electronic databases (www) ANA created Center for Research for Nursing - serves as a source of national data for the profession. Applied Nursing Research - journal with the specific intention of providing research directed toward the practicing clinical nurse. 1990's - NCNR awarded full institute status and the National Institute of Nursing Research came into being. Since the late 90's, studies have become more focused on the practice of nursing, the outcomes of nursing and other health-care services, and the building of a stronger knowledge base. Today - EBP (evidence based practice)

Access to healthcare - Health care reform - ACA

2014 - Health Insurance Marketplace: Designed to help people more easily find health insurance that fits their budget. Every plan must offer comprehensive coverage. People can compare all options in language that makes sense.

A mother brings her 6 year old child into the clinic concerned that her child doesn't skip as well as the other children in his class. In planning assessments and care for this child, the nurse might choose which theory as a foundation for decision making?

A. General systems theory B. Adaptation theory ***C. Developmental theory D. Maslow's theory

Hospitals

Approx. 5000 hospitals in the U.S. Classified as public or private and for profit and non-profit. Vary in size and services but focus mainly on acute medical problems. Inpatient and Outpatient services.

Caregiver

As a caregiver, you will provide care to your patients, combining both art & science of nursing in meeting physical, emotional, intellectual, sociocultural, and spiritual needs. Integrate roles of communicator, teacher, counselor, leader, researcher, advocate and collaborator Promote wellness, prevent illness, restore health, facilitate coping with death/disability (Aims of Nursing)

Mental Health Centers

Assoc. with hospital or private Crisis services or long term counseling Often 24 hr services for those with mental health needs, drug, ETOH, suicidal. RN's - must have excellent communication skills and be familiar with the community services available to provide.

Clinical Role

Care coordinator - organization of patient care activities to facilitate the delivery/quality health care services in an efficient, person-centered manner. Nurses are vital in the coordination of care process either as members of the interdisciplinary team or independently within nursing scope of practice. Managing care requires leadership, interpersonal skills, effective communication, time management, decision making skills, critical thinking, clinical judgment, prioritization.

Rules Within The Clinical Setting

Caregiver Patient advocate Manager

Daycare

Children and adults RN's - teach, counsel, admin. meds and treatments, screenings, coordinate services.

Nurse Coder

Coding system much more complicated than ever before. Mistakes in coding cost facilities huge sums of money Certifying individuals, particularly RNs, due to their extensive knowledge and expertise helps reduce cost and fraud. Course and test can both be done online.

Case Management

Collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs. Key role in controlling resources used in patient diagnosis and treatment Coordinate care & link patients and families with MD, resources and payer (insurance) Goal - help patient obtain high quality, cost effective care while preventing duplication and fragmentation of care. Research has linked active participation by case manager with positive patient outcomes

Manager/Leader Traits

Commitment to excellence, Problem solving skills, Commitment/passion for one's work, Trustworthy, Respectful, Accessible, Caring, Responsible

Manager

Coordinates the activities of members of the nursing staff in delivering nursing care. Has personnel, policy, budgetary responsibility for a specific unit. Uses appropriate leadership styles to create an environment for patients and staff that reflects the values and mission of the organization. Requires collaboration and appropriate support from both superiors and staff to facilitate a highly functioning team and best practice clinical environment. Need to have both management skills and leadership skills. Managers who cannot create a healthy group environment, who fail to resolve interpersonal issues that lower morale and result in complaints from patients, nurses, and physicians and who cannot resolve interpersonal issues lack leadership skills.

Specialized Care Centers

Daycare Mental health Rural health Schools Industry Homeless shelters Rehab centers

Forensic Nursing

Emerging field (term coined in 1992) Combines nursing, law enforcement, and forensics (anything belonging to, or pertaining to, the law). Provide care to victims and families beginning in the ER or crime scene and leading to participation in the investigation and court preceding. Different avenues within forensics (SANE, Legal nurse consultant, death investigator, forensic correctional nurse, forensic psychiatric nurse)

Nurse Entrepreneur

Establishes and runs own business Temporary staffing agencies, nursing education, nurse consultants Also include nurse attorneys, case managers, educators, death investigators, midwives, paralegals, psych nurses, CRNPs. Key qualities: self motivation, passion for the business

New Roles

Forensic nursing Nurse entrepreneur Case manager Nurse coder

Hospice Care

Hospital Community Palliative approach Bereavement follow up Interdisciplinary care Client and family as the unit of care RN's - combine skills of home care with intense focus on pain and symptom management. Goal is to improve quality of life rather than prolong it. Preserve dignity for the patient in death.

Health care settings

Hospitals Primary care centers Ambulatory care centers and clinics Home health care Extended care

Specialized Care Centers- Homeless Shelters

Housing for those who do not have regular shelter. Homeless at increased risk of illness, injury because of exposure to elements, poor nutrition/hygiene. RN's - immunizations, education, treating infection/illness, referrals, health promotion.

Nursing and Health Care Reform

Influx of new clients offers new opportunities and challenges for nurses: ACA - increased emphasis on preventative care Nurse practitioners Political influence Research ACA is the first step in developing a system that will offer all US residents the same type of health care distributed to members of Congress.

Leadership VS. Management

Leadership can be exerted formally or informally. Managers are given the title by a higher authority. Most managers have good leadership skills. Even if not, they are often still the final authority. Good leaders may not be good managers

Rural Health Centers

Located in areas with little access to health care providers Often run by APRN's as primary care providers for illnesses both acute and chronic. Emergencies stabilized and transported to nearest hospital.

Specialized Care Centers- Rehabs

May be free standing or associated with a hospital. Focus on complete recovery and restore a high degree of independence. RN's - direct care, education, counseling Encourage as much self care as able.

Extended Care

Medical and non-medical care for those with chronic illness or disability (both elderly and younger patients). Through a variety of services, provide ADL's/care for those who are physically or mentally unable to care for themselves. Facilities include - transitional subacute care, assisted living, intermediate and long term care facilities, retirement centers, institutions for medically/physically disabled.

Roles of the Professional Nurse

Nurse researcher Nurse Educator Political Activist New roles (forensics, entrepreneur, case manager, coder) Roles within the clinical setting (Care provider, Patient Advocate, Manager, Teacher)

Nursing Education

Nurse with advanced degree who teaches in educational and/or clinical settings. Teaches theoretical knowledge and clinical skills May conduct research Clinical role of educator: Nurses provide education to patients everyday... they also take on the education role

Why Be Politically Active?

Nurses recognize important issues w/in today's healthcare system: Increased acuity of patients who require more care and more complex levels of support than ever before. Increased responsibility of nurses in supervision of unlicensed personnel. Loss of control of the work environment because of managed care. Shorter hospitalizations resulting in patients being sent home 'quicker and sicker'. Attempts by non-nursing groups to alter nurse practice acts and state boards of nursing. Nurses serve as voice for homeless, minorities, women, and children. Government becoming more involved in the delivery/ funding of healthcare and criteria for limiting healthcare, nurses need to advocate for themselves and their patients. Powerful block of voters (3 million or so in the U.S.) Have great potential for influencing health care legislation

Specialized Care Centers- Industry

Occupational health nurses Many large companies have their own clinics staffed mainly by nurses. RN's - focus on prevention of injury/illness. Conduct health assessments, education, caring for minor illness, injury, making referral.

Health care levels of service -Primary

PRIMARY: Refers to health promotion and preventative care Often provided in primary care offices Focuses on health education and on early detection Examples: immunization clinics, family planning, poison control information

Nurse As A Teacher

Patient education - process of influencing the patient's behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health. Educated patients have better health and fewer complications, fewer hospitalizations, trips to the MD, trips to the ER. Patient education is often developed in conjunction with other members of the health team as well as outside agencies. Goal is to help patients develop self care activities to maximize functioning and quality of life.

Access to Healthcare

People have access if they are able to obtain healthcare when they need it. Dependent on the ability to pay and the availability of services. 'Medicaid and the Uninsured' Most of the uninsured have low or moderate incomes More than 75% are in a working family Medicaid and CHIP provide coverage for those who lack access to other affordable healthcare. 25% of uninsured adults go without needed care due to cost Medical bills often leave the uninsured with great debt.

Political Activist

Politics - process of influencing public policy Nurses have historically avoided becoming engaged in government. Nurses personal lives and professional practice are affected by the political world. State nursing organizations Federal nursing organizations (ANA Political Action Committee).

Concerns about Health care reform

Premium increase Doesn't cover abortions (states may offer coverage or can opt out) Most Americans must have coverage or pay a penalty

Primary care centers

Primary health care services provided in clinics or offices Services include: diagnosis and treatment of minor illnesses, minor surgical procedures, OB care, well-child care, counseling, referrals. RNs - health assessments, technical procedures, assists MD, health education, and counseling. Advanced practice RN (APRN) - NP, midwives, CNS make assessments and provide care, health maintenance, health promotion.

Patient Advocate

Protecting human or legal rights and securing care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. As an advocate for your patients, you act on behalf of your patients and secure their health care rights. You stand up for your patients and speak out, if necessary, against policies or actions that put patients in danger or conflict with their right. Role is very important as in our market driven health care economy, there are no guarantees that the health care system will work to secure the safety and health or our patients. Nurses bridge vulnerable patients and the resources they need to secure health outcomes.

Respite Care

Provided for the caregivers for the homebound ill, elderly, or disabled. Provides time away for the caregiver from their day to day responsibilities. Care often provided by CNA's/volunteers. RN's - provide information to client's/families on how to access respite care/make referrals.

Specialized Care Centers- Schools

RN's provide health assessment, education, screenings, treatments, counseling, referrals, emergency care as well as maintain immunization records during school hours. Role of school nurse has changed in recent years. Children now come to school with complex disabilities and increasing socioeconomic disadvantages. After BS degree, can go on to get school nurse certification (additional credits to be certified as a school nurse (CSN).

Home Health Care

Rapidly growing area in health care Very important part of the health care system today as many patients are discharged 'quicker and sicker' than before, many have chronic illnesses, elderly living longer. RN's - assessments, medications, procedures (wound care), education as well as collaboration with other health providers to provide care to patients. Goal - make it possible for patients to remain at home rather than use hospital or other facility. Lower stress for patients, more positive outlook - can hasten recovery. Usually less pathogens Patients become independent and have a sense of control over their health care and outcomes. Care may be provided by nurses, physical, occupational, speech, respiratory therapists, mental health professionals, social workers.

Manager of Care

Registered nurses are also managers of care. It is the role of the professional nurse to develop a plan of care & see that it is implemented correctly.

Teaching/Learning

Requires problem solving skills, critical thinking. T - Tune into the patient E - Edit patient information A - Act on every teaching moment C - Clarify often H - Honor the patient as a partner in the process May be condensed b/c of time/resources- basic principles applied each time teaching-learning occurs. Consider factors that affect learning: Age/developmental level, Family support/financial resources, Culture, Health literacy Consider learning domains (cognitive, psychomotor, affective) Utilize effective communication techniques - Honesty, interest, and respect, Don't give unnecessary details (stick to the basics), Ask if the patient/family has questions, Avoid lecturing, be supportive, Vary your tone of voice, Clear and concise, Listen and do not interrupt, Conducive learning environment.

Care for the seriously ill or dying

Respite care Hospice care Palliative care

Role

Rights, obligations, and expected behavior patters associated with a particular social status.

Nurses In Office

Running for public office. Becoming knowledgeable about key issues that have effect on health care and profession. Develop political relationship w/ elected official.

Health care levels of service -Secondary

SECONDARY: Emergency and acute care. Services frequently provided in hospitals and other acute care settings. Emphasis on diagnosis and treatment of complex disorders. Examples: diagnosis and treatment of pneumonia using labs, radiology studies, medications etc. in the hospital setting.

Health care levels of service -Tertiary

TERTIARY: Emphasis on rehabilitative services, long term care and care of the dying. Goal is to reduce disability, rehab patients to maximum level of functioning, provide comfort to the dying. Examples: physical therapy to prevent contractures on a patient who had a stroke.

HOW ARE THE FOUR CONCEPTS, COMMON TO ALL NURSING THEORIES, VIEWED WITHIN NIGHTINGALE'S MODEL?

That all patients will receive proper care to get better. Providing environmental changes, but also to use every power we have.

Development

The act or process of growth or progress

Health care in the U.S.

U.S. spends more per person on health care than any other country, but quality of care ranks 37th in the world and last among the 17 leading industrialized nations. Disparity exists in large part to the cost of health care, not the services available

Roy Adaptation Model

• Focus on adaptation to the environment • Client (patient) - central element is human. Human is affected by various stimuli and displays behaviors to help adapt to the stimuli. This is a continual process. • Health - defined as the location of the client along a continuum between perfect health and complete illness. A person's ability to adapt to stimuli (injury or illness) determines that person's health status. • Environment - Environment consists of all the factors that influence a patient's behavior (internally or externally). • Nursing - Multi-step process (like nursing process) in this model to aid and support the patient's attempt to adapt to stimuli. To determine what help is required to promote adaptation, the nurse must assess the patient first. •Person was in a severe car accident, recovered in rehab and went back to school because they always had dream of becoming lawyer, graduated and become of lawyer. High degree of health because they were able to adapt to the car accident really well.

Watson Model of Human Caring

• Focus on balancing the impersonal aspects of nursing care (technological/scientific) with personal and interpersonal elements of care. • Client - individual who has needs, who grows and develops through life, and eventually reaches state of harmony. Total person more important than the illness that produced need for care. • Environment - viewed negatively as all factors the client must overcome to achieve health. • Health - client must be in a dynamic state of growth and development to reach full potential. • Nursing - nursing is science of caring in which the goal is to assist client in reaching the greatest level of full potential. Includes trust, helping, encouraging client to express feelings, changing environment to make it better for the client.

Johnson Behavioral System Model

• Focus on client behavior as key to preventing illness and restoring health. • Client - behavioral system with whole greater than sum of its parts (has subsystems). • Health - exists when balance and a steady state exist within the behavioral systems. • Environment - all internal and external elements that have an effect on the behavioral system. • Nursing - activity that helps the individual achieve and maintain optimal level of behavior (state of health) through manipulation and regulation of the environment.

Dorthea Orem

• Focus on patient self care needs. • Patient - central element is patient who has capacity for self care. • Health - person's ability to live fully within an environment, achieving a higher level of functioning than lower life forms. • Environment - medium through which clients move as they conduct their daily activities. • Nursing - help patient conduct self care activities in such as way as to reach the highest level of functioning.

King Model of Goal Attainment

• Focus on setting health care goals for clients and directing care to meet those goals. • Client - viewed as an open system that exchanges energy and information with environment. Personal system with needs that change over the life span. Needs cannot be met by the client alone. • Environment - personal and interpersonal systems that are formed based on goals established by the client. • Health - dynamic process that exists in people when they achieve their highest level of functioning. Primary goal of the client in this model. • Nursing - dynamic process and type of personal system based on interactions between the nurse and client.

Betty Neuman Systems Model

• Focus on stress and the client's reaction to the stressor. • Client - individual, group, family, or community that interacts constantly with internal and external environments. • Health - relatively stable internal functioning of the client. • Environment - composed of internal and external forces or stressors, that produce change or response in the client. • Nursing - role is to identify at what level or which boundary, a disruption in the client's internal stability has taken place and to aid the client in activities that strengthen or restore the integrity of that boundary.

Implementing EBP

• In 2001, IOM (Institute of Medicine) challenged health care providers to provide care based on scientific evidence. • Quality and cost - need evidence that services and interventions being funded or reimbursed are effective. • Prior to mid 90's, hospitals had their own researchers and practiced based on their own research. • Today, few hospitals use findings from internal research to direct practice. • Tons of literature available.

Ethics- Human Subjects Protection

• Must protect the overall well being of any patient involved in clinical research. • Nuremberg Code - developed after WWII -Voluntary consent without coercion. -Experiment should yield results for good of society. -Avoid all unnecessary physical and mental suffering. -Only scientifically qualified people should be conducting research. -Subject can withdraw from experiment at any time.

Research Process

• Orderly series of steps that allows a researcher to move from asking the question to finding an answer. • Identifying an area of inquiry (ID a problem) • Define purpose of the study • Review literature • Formulate hypotheses and variables • Select research design • Select population and sample • Collect data • Analyze data • Communicate findings

Ethics- IRB (Institutional review Board)

• Primary responsibility is to safeguard, in every way, the rights of any individual participating in a research study. • Panels of individuals that review research proposals to ensure ethical standards are met in the protection of human rights. • Ensure that researchers do not engage in unethical behavior or conduct poorly designed research studies. • Every university, hospital, and agency that receives federal money must have an IRB composed of at least 5 members. • Members should be from a variety of professional, occupational, ethnic, cultural backgrounds. • Must be unbiased.

Nursing Process

• Systematic: ordered sequence of activities, each dependent on the accuracy of the activity that precedes it. • Dynamic: presented as an orderly progression of steps but there is a lot of overlapping and no step is a one time phenomenon. • Interpersonal: Ensures that nurses are person centered and not task centered. • Outcome oriented: Focus on outcomes determined together with patients. • Universally applicable: Used in all nursing situations. Provides a framework for all nursing activities.

Nursing Theory & the Nursing Process

• Theory provides autonomy and self governance in the profession. • Having a body of knowledge specific to the discipline allows members to be viewed as 'experts' in the field. • Professional nurses use theories from nursing and other disciplines to collect, organize, and classify patient data. • Also helps nurses to understand, analyze, and interpret patient situations. • Theories guide all phases of the nursing process. • Concepts from theories guide the nurse in determining which information is relevant and should be collected to make assessments and form nursing diagnoses. • Concepts suggest nursing interventions and outcomes to be included in the plan of care.

Nursing Knowledge

• Traditional - Part of nursing practice passed down from generation to generation. (i.e. changing bed linens daily). • Authoritative - Comes from an expert and is accepted as truth based on perceived expertise (i.e. senior RN teaches new RN a more efficient way of doing a procedure). Generally remains unchallenged as long as presumed authorities maintain their expertise. • Scientific - Obtained through scientific method (research)- Best practice. • All are useful in the body of knowledge that constitutes nursing however traditional and authoritative are subjective, limiting their use. Increasing focus on scientific knowledge to provide care.

Why Theory?

• Understanding and utilizing theories/models of nursing will help you to become a better nurse and provide better care to patients, families, groups. • Help to direct nursing actions, using a systematic and structured approach (improves organization of interventions, improves problem solving skills • Raises nursing from a task oriented job to the level of a profession that uses judgment and knowledge to make informed decisions about patient care. • Provides rational and knowledgeable reasons for nursing interventions • Gives nurses the knowledge base necessary for acting and responding appropriately in nursing care situations • Increases knowledge base

Nursing Process

•5 step systematic method to direct the nurse and the patient as they together, accomplish: - Assessment - Diagnosis - Planning - Implementation - Evaluation

Research & EBP

•As a baccalaureate degree grad: • You will be expected to be intelligent consumers of research by understanding each step of the researchprocess to interpret, evaluate, and determine the credibility of research findings. • Uphold ethical principles of any research involving human participants. • Follow ANA code of ethics regarding research. • Distinguish between findings that are 'interesting' and those that should be included in practice.

Evidence Based Practice (EBP)

•Began with physicians in 1990s as evidence based medicine. •Utilized research as the gold standard for care. •Broadened its application from medicine to nursing and other professions. •Actively applying current best evidence to make the optimal decisions about the treatment of clients using statistical data to estimate risk-benefit ratio supported by high quality research studies. •Takes a long time to fully embed research into care.

ANA Code of Ethics

•Charge to protect every person from harm. •Extends into research.

History of Nursing Research

•Early nursing research began with Florence Nightingale - Kept careful and objective records. - Used data to prove the need for health care reform. - Provided baseline data to determine which interventions were the most effective.

Goals of Nursing Research

•Expand and clarify the body of knowledge unique to the discipline. •Purpose is to test, refine, and advance the knowledge on which improved education, clinical judgment, and cost-effective, safe, ethical care rests.

Common Concepts

•FOUR COMMON CONCEPTS IN NURSING THEORIES - The person (patient) - The environment (how different aspects of environment relate and effect a patients health) - Health - Nursing

Theorists

•Florence Nightingale •Sister Callista Roy •Imogene King •Betty Neuman •Jean Watson •Dorthea Orem •Dorothy Johnson

Nightingale's Theory

•Focus of nursing is caring through the environment and helping the patient deal with the symptoms and changes in function related to an illness. •Viewed nursing as not limited to administration of meds and treatments but oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. •Her theory provides nurses with a way to think about patients and their environment.

Interdisciplinary Base for Nursing Theory

•General systems theory- Discusses breaking whole things into parts and learning how parts work together in bigger systems. (Bertalanffy) •Adaptation theory- How people react to stress •Developmental theory- How humans growth and development is predictable. Important in pediatrics. (Erikson)

Ethics-Confidentiality

•Guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.

Evidence Based Practice

•Integrates use of best evidence in combination with clinical expertise and patient preferences in making decisions about care. •Nurses are constantly making decisions regarding patient care. •Patient safety and health should be the #1 priority. •Can have adverse outcomes if most current, best evidence is not utilized to answer questions and make appropriate decisions.

Barriers to Research

•Lack of understanding •Unquestioned practices •Lack of incentive •Resistance from managers

Ethics-Informed Consent

•Mandatory for all subjects in a research study. •Research subjects are given full and complete information about the purpose, procedures, data collection, potential harm/benefits, and alternative methods, treatments. •Capable of fully understanding research and implications of participation. •Have the power of free choice to voluntarily consent or decline participation. •Understand how the researcher maintains confidentiality or anonymity.

Apply Research to Practice

•Much of what bedside nurses do constitutes research, although many nurses do not see or realize this. •Nursing Process represents basic framework of the research process. •Research findings need to be used by bedside nurses to improve quality of care. •As a student, you will learn why one course of action is preferable to another - all based on research.

Research Designs

•Quantitative - involves concepts of both applied and basic research. Data expressed in numbers. •Qualitative - conducted to gain insight by discovering meanings. Differs from quantitative in that the researcher primarily analyzes words or narratives rather than numbers. Thoughts, feelings, perceptions.

ANA Standards

•Standard 9: EBP and Research - The Registered Nurse: •Utilizes current evidence based nursing knowledge, including research findings to guide practice. •Incorporates evidence when initiating changes in nursing practice. •Participates as appropriate to education level and position, in the formulation of evidence based practice through research. •Shares findings with colleagues and peers.

Theory in Summary

•Systematic conceptualizations of nursing practice. •Help describe, explain, predict, and control nursing activities to achieve goals of client care. •Allow nurses to better incorporate theoretical information into practice and provide new ways of approaching care to improve practice and patient outcomes. •Development of these and other theories indicate the maturing of the profession.

Nursing Research

•Systematic process for answering questions through the discovery of new information with the ultimate goal of improving client care. •Complex process in which knowledge (in the form of discovery) is transformed from the findings of a study into possible nursing interventions, with ultimate goal of being used in clinical practice. •Shows which approaches to care work and which do not. •Key element in defining nursing as a profession.

Nursing Theory & Nursing Research

•The relationship between the two builds the scientific knowledge base of nursing, which is then applied to practice. •As more research is conducted, the discipline learns to what extent a given theory is useful in providing information to improve care. •The relationships of components in theories often help drive research questions. •Research is sometimes used to identify new theories. •In Orems theory have led researchers to test interventions to improve patient care. Ex: older adults were able to learn medications schedules and improve daily living before discharge.

Challenges to Theory

•Theory will continue to change and respond to the dynamic trends of society •Older models will either be replaced or modified to include new concepts •Theory must be flexible and adapt to new discoveries

Nursing Theory Terms

•Theory: speculative statement involving some aspect of reality that has not been proved. •Model: hypothetical representation of something that exists in reality. Purpose is to explain a complex reality in a systematic and organized manner. •Nursing Theory: developed to describe nursing. Goal is to describe and explain a nursing action to make a hypothesis, which predicts the effect on a patient outcome, such as improved health or recovery from illness. Differentiates nursing from other disciplines. •Often based on other theories.