NURG 700 Assignment: Theory and Philosophy of Nursing Practice

NURG 700 Assignment: Theory and Philosophy of Nursing Practice

NURG 700 Assignment: Theory and Philosophy of Nursing Practice

Theoretical Framework proposal for DNP: Topic was chosen to address the recent nurse staff retention and affect on patient satisfaction. Would like a dual system approach if possible i.e. change model Lewin and definitely use Jean Watson nursing theory for content of what why…Of course need related concepts, definitions and terms as bullet points 4-6 only thanks, specific theory guiding DNP project as mention before (caring model). relationship of concept and theory, assumptions or presumptions , relevant variables ie staff, safety, satisfaction…a conclusion an summary.. There is a need for table of content, abstract 150-200 words, schematic for Jean Watson of caring simplistic that is referenced and in appendix

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NURG 700 – Theory and Philosophy of Nursing Practice

Theoretical Framework Proposal/Presentation Grading Rubric

Directions: Each student is to develop a theoretical framework proposal for the DNP project topic and present it in a paper not to exceed 6-8 pages and in a formal presentation. A theoretical framework is the viewpoint from which you are approaching your topic and serves to organize related theories, principles, generalizations, and research findings. It is within this framework that your DNP project will eventually evolve. The components of the theoretical framework are listed below. The written proposal must adhere to APA guidelines. References from scholarly journals will be used, but a formal review of the literature is not required for this phase of project development. This paper and the PowerPoint file for the presentation will be submitted via the Assignment Drop Box in Canvas©. Grading will be based upon the following criteria:

	Points Possible
Introduction: Introduce the DNP project topic and state why you selected it. Provide a brief historical perspective of the topic and describe why it is important to health care and advanced nursing practice.	10 points
Body of Paper: Develop the theoretical framework by including the following information. ·         Related concepts ·         Specific theory that will guide the DNP project ·         Relationship of concepts and theory to the DNP project- Describe the theoretical framework as it is applied to your topic ·         Define specific terms and how you will use them (include source/reference) ·         Theoretical Assumptions that are made prior to initiating the project ·         Relevant variables that must be considered (professional standards, accrediting bodies, funding, geographic area, health policy, etc., including references)	30 points
Schematic Diagram: Provide a schematic diagram of the conceptual model described in the theoretical framework specific to your DNP project. The diagram will provide a visualization of the theorized relationships and should include labels or details for concepts and theory specific to your DNP project that relate to theoretical framework.	10 points
Conclusion: Summarize the key points discussed and provide a concluding statement on how the theoretical framework will guide your DNP project.	10 points
References: Appropriate references from scholarly journals and texts are used.	10 points
Written Presentation: Adheres to APA guidelines and represents scholarly work. Grading rubric for written presentations will be used.	10 points
Oral Presentation: Verbal presentation, professional dress, audio-visuals, adheres to allotted time frame, etc. Grading rubric for online oral presentations will be used.	15 points
Peer Reviews (those you do) See Peer Evaluation grading rubric	5 points
Total	100 points

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Theoretical Framework Proposal for DNP

 Table of Contents

Abstract 3

Definitions. 4

Theoretical Framework Proposal for DNP.. 5

Introduction. 5

Significance of the Problem.. 5

DNP Research Project’s PICO Question. 6

Theoretical Framework. 6

Jean Watson’s Caring Theory. 6

Similarities and Differences of Watson’s Theory of Caring and Lewis’s Change Theory. 8

Similarities Watson’s Theory of Caring and Lewis’s Change Theory. 8

Differences between the Watson and Lewin’s Theory. 10

Conclusion. 11

References. 12

Appendices: Schematic for Jean Watson of Caring. 14

Abstract

The paper proposes the need to engage a dual approach when dealing with and to evaluate complex healthcare issues like nurse retention and patient satisfaction. The paper describes the essence of the conceptual framework derived from the literature review on nurse retention and patient satisfaction. From the identified theoretical framework, Watson’s theory of Caring, and Lewin’s Change Theory, it is evident that different forces determine patient satisfaction and nurse retention rates. When healthcare management engages the nursing staff negatively, these negative traits will be translated into these nurses’ care to the patients. Such cases then influence patients’ perceptions of a healthcare organization. Engagement, therefore, acts as one determinant of whether nurses will renew their contracts in an organization or look for other competent healthcare employers. Hiring new nurses may seem the most effective strategy, but it brings more complications. Healthcare needs to ensure that nurses live in a favorable healthcare environment to increase their nursing retention, thus positively impacting patient satisfaction.

 

Key Words: Nursing Engagement, Nurse Retention, Patient Satisfaction, Satisfaction, Healthcare Quality.

Definitions

• Nursing Engagement – the satisfaction and commitment nurses have to a job or the healthcare organization (Oxford English Dictionary, 2020).
• Nurse Retention- an action by the healthcare organizations to prevent nurses from quitting their employment (Oxford English Dictionary, 2020).
• Patient Satisfaction – the measure in which patients becomes satisfied with healthcare services (Oxford English Dictionary, 2020).
• Satisfaction- the level of contentment and pleasure from an individual performance (Oxford English Dictionary, 2020).
• Healthcare Quality- degree of desired health outcomes (Oxford English Dictionary, 2020).

Theoretical Framework Proposal for DNP

Introduction

In a healthcare environment, staff turnover is a problem that has been influencing the healthcare facilities’ nurse retention. The main factors determining nurse retention include the nurses’ engagement with the healthcare governance, career ladder prospects, and professional development opportunities. According to Mcrae (2012), there is strong evidence from the literature that proves that workplaces that present their nurses with high engagement are translated into these nurses’ innovation and initiatives. That happens mostly when the nurses attend to the patients, thus providing these patients with safer nursing care, thus reducing mortality rates and hospital overstays, leading most patients to incur more healthcare costs. The nursing practice is largely impacted by theoretical models which guide the nurses using various concepts. The main reason why theoretical frameworks are essential in nursing is that they provide effective knowledge on ways to offer safe and quality care that will satisfy the patients’ needs and preferences in their healing journey (Cody & Kenney, 2006). The paper presents a Doctor of Nursing in Philosophy (DNP) theoretical framework proposal to address the current staff retention and its influence on patient satisfaction. For effectiveness, the paper will present a dual system approach to extrapolate Jean Watson and Lewin’s change model.

Significance of the Problem

There has been an increase in nurse turnover rates in acute care settings since these nurses have been subjected to long working hours by their healthcare executives, which increases nurse burnout, thus affecting their productivity. When nurse productivity lowers, the most expected outcome is that patient satisfaction will also decrease since there will be an increase in cases like medical errors and hospital overstay (. Hence, it is crucial to assess how healthcare organizations can increase their nurse retention rates to enhance patient satisfaction

DNP Research Project’s PICO Question

For the nurses, how does nurse retention compared to hiring new nurses to influence patient satisfaction?

Theoretical Framework

Jean Watson’s Caring Theory

Nursing is a discipline known for its humanity and ethical values, which revolve around caring. For any healthcare to increase its sustainability and competitiveness, how they value and treat people within these institutions plays a large role (Cody & Kenney, 2006). For instance, a healthcare facility that subjects its nursing staff to long working hours risks an increase in nurse turnover. The main reason is that such an organization may not consider that they are also implicating the health and well-being of their nursing staff. When reflecting on nursing theories, Jean Watson’s theory of caring science is an integral theory that healthcare management must incorporate into their systems Riegel et al. (2018). Through the theory, the healthcare management will be aware of the need to ensure they embrace the spirit, body, and mind factors essential for nurse and patient satisfaction (Figure 1). Jean Watson’s theory is mainly inclined to the insights of Florence Nightingale, who believes that nurses’ major role in a patient life is to make sure that they are placed in a better environment that will help them to self-heal. Nurses act as the main channel of the patients’ healing journey (Walker & Avant, 2005). Hence, through these nurses engaging the patients in positive care by ensuring that they incorporate authentic intentionality and presence, they can easily optimize the patients healing ability (Tuckel et al., 2018). The same happens to healthcare management, where if they consider the nurse’s well-being, these nurses will be more productive, thus meeting the patients’ expectations within the healthcare environment.

In trying to extrapolate the Jean Watson theory to explain factors essential in ensuring nurse retention rates increases to increase patient satisfaction are based on the theory’s carative factors. The first caractive factor concerns engaging in a human-altruistic value system which determines how to engage with other healthcare providers at the interprofessional or interprofessional level (Wei & Watson, 2018). That means, if a nurse attains a higher positional rank, their humanistic-altruistic values will be essential in how they treat their junior. For those nurses that were taught about humility, they will continue being humble even in higher positions. Such consideration will be essential since once the junior nurses feel valued, their productivity and keenness in healthcare will increase, thus increasing patient satisfaction. Hence, if a nurse leader grew up in an environment that belittles other individuals, the same characteristics will be translated into nursing practice. Another important factor from the theory concerns the sense of hope and faith, which are essential for curative and carative processes and the nurses’ relationship with others. In nursing retention, the nurse leader must engage the junior staff with the most effective leadership style. For instance, the authoritative leadership style may limit the nursing staff’s opportunities to engage with their leaders effectively (Melnyk & Fineout-Overholt, 2011). Therefore, there is a high possibility for the nurses to suffer from serious issues that may lead to nurse turnover cases. However, for nurse leaders who engage these nurses using the transformational leadership style, it becomes easier to ensure that they motivate and create a professional bond that helps these overcome any healthcare-related barriers.

Effective communication and engagement is the common denominator that brings along a helping-trust relationship, feelings expression, and ways to engage in scientific problem-solving to make decisions (Melnyk, B. M., & Fineout-Overholt, 2011). That is because once the nurse leaders present healthy engagement and communication with the nurses, it becomes easier to solve healthcare problems. However, nurse leaders must first acknowledge their feelings to identify any loophole that may advance the current issue. For instance, relieving nurses of their duties is not an option when they make mistakes. Instead, the nurse leader should get to the root of the problem to prevent such an issue from ever prevailing again in the healthcare setting.  Watson’s theory also enlightens interpersonal teaching-learning and means to manipulate internal and external environments to provide physical and mental well-being. Hence, in increasing nurse retention in a healthcare facility, the nurse leader must acknowledge the need to engage nurses in regular training and workshops, especially after implementing a new project (McEwan & Wills, 2021; Udod, S., & Wagner, 2018). Lack of skills can affect nurses’ productivity, thus reducing their retention rates. That means that once nurses cannot cope with a new system, they will be prone to errors, thus affecting patients’ safety and privacy.

Nursing leaders need to ensure that they engage human needs gratification. Each need in healthcare essential will influence the positivity towards the organization, patients, or the nursing staff (Udod & Wagner, 2018). The best way to achieve the human need gratification is through providing an allowance to the existential-phenomenological forces. The main reason for observing these two causative factors is the need for individuals to face challenges and work on overcoming them. For instance, when nurses fear an occurrence of a pandemic disease like Covid-19, they will not manage to confront different nursing practice challenges. In return, it will also be hard for nurses to help their patients to gain the courage to confront death or life occurrences.

Similarities and Differences of Watson’s Theory of Caring and Lewis’s Change Theory

Similarities Watson’s Theory of Caring and Lewis’s Change Theory

Caring is an essential factor within the healthcare setting. Hence, ensuring that the environment is favorable for the nurses should be a priority for healthcare organizations. The reason is that nurse satisfaction with their healthcare setting determines their chances for retention and patient satisfaction. Hence, there are various considerations of Watson and Lewis’s theories in creating a change to increase engagement in healthcare. According to (Udod & Wagner, 2018; Walker & Avant, 2005), the main Change Theory involves three concepts, namely the driving, restraining, and equilibrium forces. Driving forces are more of those forces that lead to a direction that may trigger change. Such factors are mainly aligned with a change that will lead the patients in the desired direction. For instance, an increase in nursing engagement within a healthcare facility will mainly trigger nurse retention, thus ensuring that the experienced nurses still attend to their assigned patients with quality and safe care, thus achieving the healthcare organization’s goal of providing patients with satisfactory healthcare services.

That means if the healthcare organization subjects its nursing staff to unfavorable conditions, the patients’ safety and quality healthcare factors may deteriorate, thus affecting patient satisfaction and increased turnover rates. As Teguh et al. (2019) postulates, the driving forces cause an equilibrium shift that leads to change. When reflecting on Watson’s theory, these driving forces include humanistic- altruistic system formation, acts of sympathy, interpersonal relationships, and problem-solving skills as part of the carative factors. Such assertion forms their basis on the fact that how a healthcare leader forms their humanistic-altruistic systems determines how the nurses’ reactions to such values will affect the patients (McFarlan et al., 2019). Therefore, if the nurse leaders are rude, there is a higher possibility of these nurses transitioning such hatred to the patients, thus impacting how they perceive the healthcare services.

The restraining forces in Lewis’s theory counter the initiated driving forces in healthcare. They are referred to as restraining because instead of pushing the patients in the direction the healthcare wants them to be in, they take a different direction (Barto, 2019). For instance, when nurse retention rates lower, the newly hired talents may not have adequate skills to serve the patients. For instance, if the previous nurse did not orient a newly hired nurse on a former patient’s treatments, there is a high possibility of a medical error. Hence, despite the healthcare facility thinking that hiring a new nurse will solve the nurse turnover rates, the situation complicates the issue, thus increasing patient dissatisfaction. Hence, restraining forces toward patient satisfaction shift nurse retention. Some of these restraining forces from Watson’s theory include human needs gratification, where the healthcare organization leaders may face restraining forces once they fail to identify and value overall nurses’ and patients’ needs.

The equilibrium state is mainly when no change occurs between the restraining and driving forces (Barto, 2019). The state can lower or raise depending on the changes that restraining and driving forces experience. From Watson’s theory, these factors can include the helping-trust relationship and feelings expressions. For instance, when patients visit a healthcare facility, they come in good faith that they will receive the best quality and safest healthcare services. However, if the healthcare management does not value the efforts of the nursing practitioners, such patients’ positive feelings will be affected by the nurses’ negative feelings. The same happens when patients meet new nurses, thus affecting their perception of treatment.

Differences between the Watson and Lewin’s Theory

Unlike the three steps that Lewin’s theory uses in assessing change, Watson theory engages four steps. Lewin’s stages involve unfreezing, change, and refreezing (Teguh et al., 2019). Hence, when assessing ways to increase nursing retention to influence patient satisfaction positively, the researcher can first find methods essential to abandoning old cultures. That can happen by ensuring that the driving forces, like employee engagement, increase to meet patients needs and preferences through nurse staff retention. Such actions will result from changing the ways nurses engage with the healthcare management, like engaging the transformational leadership style, thus refreezing older habits and introducing a more interactive organizational culture. Watson’s theory process must assess the problem to create a viable conceptual framework. After assessing the problem, the researcher then plans for the procedure to assess the situation, then proceeds to collect and evaluate the analyzed data to derive a meaning. Hence, Watson’s Theory of Caring is most preferred for the research proposal since it will offer a systematic problem identification and review.

Conclusion

Nursing practice has to rely on a different theoretical framework concept for its viability. Therefore, it is important to follow a theoretical approach in evaluating how nurse retention influences patient satisfaction through increased engagement between nurses and their leaders. The proposal engages two prominent theories, Watson’s Theory of Caring and Lewin’s Change Theory. The Watson Theory of Caring outlines ways nurses should engage with their patients. However, the lessons from the carative factors are essential in determining nurses’ engagement with their management to improve patient satisfaction. Lewin’s theory outlines that the relationship between driving, restraining, and equilibrium may affect a patient. The only differences that both theories pose regard the issue of steps in solving a problem. Hence, considering the systematic influence that Watson’s theory engages in when solving a problem, it will be more effective in answering the PICO question.

References

Barto, Donna. “Nurse-driven protocols.” Nursing2020 Critical Care 14, no. 4 (2019): 18-24. doi: 10.1097/01.CCN.0000560104.63793.d9

Cody, W. K., & Kenney, J. W. (Eds.). (2013). Philosophical and theoretical perspectives for advanced nursing practice. Jones & Bartlett Learning.

McFarlan, S., O’Brien, D., & Simmons, E. (2019). Nurse-leader collaborative improvement project: improving patient experience in the emergency department. Journal of Emergency Nursing, 45(2), 137-143. https://doi.org/10.1016/j.jen.2018.11.007

McRae, N. (2012). Whitner Nursing Model?  The value of nursing theory in the context of EVB and multidisciplinary healthcare. Journal of Advance Practice Nursing, 68, 222-229 doi 10.1111/j.1365-2648.2011.05821.x

McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Oxford English Dictionary (2020). Volume 20. Second Edition

Riegel, F., Crossetti, M. D. G. O., & Siqueira, D. S. (2018). Contributions of Jean Watson’s theory to holistic critical thinking of nurses. Revista Brasileira de Enfermagem, 71, 2072-2076. https://doi.org/10.1590/0034-7167-2017-0065

Teguh, A., Hariyati, R. T. S., & Muhaeriwati, T. (2019). Applicability of Lewin’s change management model for optimization management function in nursing delegation between head nurse and team leader: A mini project in Jakarta military hospital. International Journal of Nursing and Health Services (IJNHS), 2(2), 66-74. DOI: https://doi.org/10.35654/ijnhs.v2i2.136

Turkel, M. C., Watson, J., & Giovannoni, J. (2018). Caring science or science of caring. Nursing Science Quarterly, 31(1), 66-71. https://doi.org/10.1177/0894318417741116

Udod, S., & Wagner, J. (2018). Common change theories and application to different nursing situations. Leadership and influencing change in nursing. Open Textbook

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (Vol. 6). Prentice Hall.

Wei, H., & Watson, J. (2019). Healthcare interprofessional team members’ perspectives on human caring: A directed content analysis study. International journal of nursing sciences, 6(1), 17-23. https://doi.org/10.1016/j.ijnss.2018.12.001

Appendices: Schematic for Jean Watson of Caring

Appendix 1: Jean Watson’s Caring Theory (spirit, body, and mind components)