Quality and Safety Paper

Quality and Safety Paper

 

Theoretical Basis of Nursing

Patients seek health care services for different reasons, sometimes more than one reason in a single visit. Not all the time are these direct consumers of health care services treated for other health problems that were not their reasons for the visit. The need for holistic and patient-centered care has moved from a theoretical concept to practical nursing. Various nursing theories have been used to base the principle of holistic and patient-focused nursing care. There is also a need for simultaneously providing preventive, promotive, and curative health to patients thereby reducing the need for readmission. Nora Pender’s health promotion theory and the Swiss cheese model are some of the nursing theoretical models and systems models respectively that have provided a conceptual map for providing nursing care in recent decades in health promotions and prevention. The purpose of this paper is to describe Nora Pender’s health promotion theory and Swiss cheese model and their application in providing nursing care to diverse populations across the human wellness-illness continuum and the human lifespan.

Proposed Health Intervention

Type 2 diabetes mellitus affect diverse populations with some populations more predisposed than others. The management of diabetes mellitus type 2 requires both nonpharmacological and pharmacological strategies. Various disciplines are involved in the prevention and treatment of diabetes. In my proposed intervention, a clinical protocol requires all clinicians to participate in diabetes management. This package will require the clinician at the primary care level to screen for diabetes through clinical history taking and clinical investigations. Screening for risk factors for diabetes mellitus in a patient with established risk factors would inform the first step in patients seeking primary care. When the score during this screening is significantly higher the clinician would order for clinical evaluation of the random blood sugar levels that would inform further intervention. Therefore, those patients diagnosed with prediabetes would be offered patient education on lifestyle modification and improvement of physical activity to reduce their risk of developing type two diabetes and referral to dieticians and diabetologists (Chatterjee et al., 2018). Patients with lower random blood sugars will be will not receive a referral to a nutrition and dietician and medical management. Patients with no prediabetic levels of blood sugar and no risk factors would only receive patient education enhancing awareness and preventive health (Habibzadeh et al., 2021). Therefore, this proposed intervention is a package involving stepwise evaluation of patients. Primary and secondary levels of prevention will be utilized in promoting health at the population level. Nurses, doctors, and dieticians are all required to successfully impend this interventional package.

Applying Nursing and Systems Theories in This Intervention

The intervention proposed intervention will be guided by Pender’s health promotion model and the Swiss cheese model. Pender’s model argues that each individual has unique characteristics and personal experiences that influence their actions in health (Khoshnood et al., 2018). These characteristics make a set of variables that significantly motivate their health actions to prevent and protect their health. These theoretical concepts would guide the earlier proposed intervention by aiding in the risk identification of populations at risk of prediabetes and diabetes mellitus, provide them knowledge and patient education that would motivate their behavioral and action change to prevent the occurrence of the disease or prevent progression when still in the prodromal stages (Chen & Hsieh, 2021). This model has bel applied to various preventative health settings in various populations and has shown positive outcomes

The Swiss Cheese model is a systems theory that utilizes the idea of the structure of the Swiss Cheese. Each layer of the cheese has a hole and this is similar to patient safety and preventative measures (Karimi et al., 2021). This systems theory argues that each barrier to preventing health problems and preserving health has an unintended weakness that makes them vulnerable to failure to fully prevent when the ‘holes’ are aligned together. Therefore, the occurrence of unwanted health outcomes is a result of a combination of factors thus the need for multilevel and multimodal approaches to prevent health hazards. Diabetes mellitus results from various risks factors and patient characteristics. In the proposed intervention, the identification of all these risks will reduce the chances of late diagnosis of diabetes mellitus in at-risk individuals. This will prevent the weakness of focusing on one risk factor. The proposed intervention also advocates for referral and interdisciplinary action for at-risk cases. The use of more than one way to prevent diabetes in the population will reduce the chances of late diagnosis and disease progression as well as the occurrence of this disease in the population per the Swiss Cheese Model.

Evaluation of the Proposed Intervention

The proposed intervention will require ways to evaluate its success. The end goal of the intervention is to prevent disease occurrence and progression. The Swiss Cheese Model majorly concerns patient safety (Wiegmann et al., 2022). In the context of the proposed intervention safety will be determined by the absence of disease or related complications (Gorbani et al., 2020). Diabetes mellitus, whether diagnosed already or missed, has been known to cause complications in various systems including but not limited to renal, central nervous, peripheral nervous, vascular, and cardiac systems. Every year, a significant number of patients develop these complications and this poses a significant burden on the health system and the patients (Centers for Disease Control and Prevention, 2020). Cost, mortality, and morbidity effects are witnessed annually (National Diabetes Prevention Program, 2018). The evaluation of this intervention will be quantitatively achieved by assessing the number of patients diagnosed with prediabetes, diabetes, and the number of patients developing complications from diabetes. The pander’s model is concerned with the alteration of health behaviors to improve health and prevent disease. The evaluation of the proposed intervention will be achievable by assessing the outcomes in disease incidence and complications.

Application of Nursing Theories to Care for Diverse Populations

Populations diversify in different characteristics such as age, race, disease patterns among other features. The care for a diverse population should take into account the variety of risk factors that can lead to the occurrence of the same disease in the same population. Nursing theories provide a conceptual guide to providing care in culturally diverse settings. Pender’s health model acknowledges the role of individual characteristics in their health outcomes 10.1016/j.pec.2020.10.003. As a result, these characteristics are the focus of manipulation to avert the occurrence of progression of disease at the individual level in the population. the promotion of their health individual level contributes to the outcomes at the population level. The theory also explains the role of behavior recognition and the individual’s interaction with their environment as important factors to consider in health promotion

The Swiss Cheese model can be used to acknowledge that these characteristics can be more than one thus the need to offer more than one intervention to increase the chances of preventing disease and promote health. The barriers used to prevent these risks should not be one but more than one to ensure that the failure of one intervention is covered by other interventions that concern other present risk factors. Notably, some risk factors for disease are not modifiable such as age, and race. Therefore, intervention can be prophylactically administered such as primary and primordial prevention in such cases. The gating mechanism in the Swiss model allows for the closure of other loopholes of other interventions (Seshia et al., 2018). This model gives the nurse the rational basis for decision-making for using more than one different intervention in providing acre for diverse pupations. The ultimate goal is patient safety and culturally sensitive care.

Conclusion

Health promotion in nursing care takes place in various settings of care. In these settings, there are various populations with individual characteristics that determine their health. The occurrence of the disease is a product of various patient personal factors, environment, and system factors. Nola Pender’s health promotion theory argues that individual characteristics, the individual’s interaction with their environment, and the behavioral-cognition factors contribute to disease occurrence. Therefore, health promotion must aim at intervening at these levels. The Swiss cheese model is a system theory that supplements these ideas by advocating for multimodal interventions to compensate for the unintended weakness of a single intervention. My proposed intervention aims at promoting health for individuals at risk of developing diabetes through screening by history taking, lab investigation, providing patient education for behavior and lifestyle change, and providing necessary referrals for preventing disease progression. The evaluation will be quantitatively at the population statistical level.

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References

Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report 2020. Cdc.Gov. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018). Diabetes structured self-management education programs: a narrative review and current innovations. The Lancet. Diabetes & Endocrinology, 6(2), 130–142. https://doi.org/10.1016/S2213-8587(17)30239-5

Chen, H.-H., & Hsieh, P.-L. (2021). Applying the Pender’s Health Promotion Model to identify the factors related to Older Adults’ participation in community-based health promotion activities. International Journal of Environmental Research and Public Health, 18(19), 9985. https://doi.org/10.3390/ijerph18199985

Gorbani, F., Mahmoodi, H., Sarbakhsh, P., & Shaghaghi, A. (2020). Predictive performance of Pender’s health promotion model for hypertension control in Iranian patients. Vascular Health and Risk Management, 16, 299–305. https://doi.org/10.2147/VHRM.S258458

Habibzadeh, H., Shariati, A., Mohammadi, F., & Babayi, S. (2021). The effect of educational intervention based on Pender’s health promotion model on quality of life and health promotion in patients with heart failure: an experimental study. BMC Cardiovascular Disorders, 21(1), 478. https://doi.org/10.1186/s12872-021-02294-x

Karimi, A., Abbasi, M., Zokaei, M., & Falahati, M. (2021). Development of leading indicators for the assessment of occupational health performance using Reason’s Swiss cheese model. Journal of Education and Health Promotion, 10, 158. https://doi.org/10.4103/jehp.jehp_1326_20

Khoshnood, Z., Rayyani, M., & Tirgari, B. (2018). Theory analysis for Pender’s health promotion model (HPM) by Barnum’s criteria: a critical perspective. International Journal of Adolescent Medicine and Health, 32(4). https://doi.org/10.1515/ijamh-2017-0160

National Diabetes Prevention Program. (2018, May 4). CDC Diabetes State Burden Toolkit. Cdc.Gov. https://nationaldppcsc.cdc.gov/s/article/CDC-Diabetes-State-Burden-Toolkit-1525289366524

Seshia, S. S., Bryan Young, G., Makhinson, M., Smith, P. A., Stobart, K., & Croskerry, P. (2018). Gating the holes in the Swiss cheese (part I): Expanding professor Reason’s model for patient safety. Journal of Evaluation in Clinical Practice, 24(1), 187–197. https://doi.org/10.1111/jep.12847

Wiegmann, D. A., Wood, L. J., Cohen, T. N., & Shappell, S. A. (2022). Understanding the “Swiss cheese model” and its application to patient safety. Journal of Patient Safety, 18(2), 119–123. https://doi.org/10.1097/PTS.0000000000000810

Final Paper

Students will write a paper applying and integrating the information written about the concept map you have worked on throughout the course. You should finalize the concept map by identifying and discussing a nursing theory and a systems theory to an appropriate clinical practice situation common to advanced nursing care. You will also need to select an appropriate nursing intervention that would aid in using the selected theories to demonstrate appropriate applications of the nursing theories. It is strongly recommended you use the nursing theory previously identified for the Concept Map assignment. You will be adding a systems theory to this final paper. The paper will demonstrate how systems theory and nursing theories are used in the design, delivery, and evaluation in healthcare. Students will also evaluate how these theories can be utilized to deliver care to diverse populations.

Rubric for Final Paper

Criterion

(points possible)

Exceeds

Expectations

Meets

Expectations

Nearly

Meets

Expectations

Does

Not Meet

Expectations

Comments

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10

8.5

7

<7

 

Introduction

(10)

The introduction clearly and concisely states the paper’s purpose in a single sentence that is engaging and thought-provoking. The introduction clearly states the clinical practice situation and previews the structure and content of the paper.

The introduction states the paper’s purpose in a single sentence, but it fails to be engaging. The introduction states the clinical practice situation but does not adequately preview the structure of the paper.

The introduction does state the paper’s purpose is convoluted and not engaging. The introduction does not clearly state the clinical practice situation or preview the structure and content of the paper.

Incomplete or unfocused purpose statement. There is no clear introduction of the clinical practice situation and/or the structure of the paper is missing.

 

 

5

4

3.5

<3

 

Organization/
Structure

(5)

Writer demonstrates logical and subtle sequencing of ideas through well-developed paragraphs; transitions are used to enhance organization.

Writer demonstrates logical sequencing of ideas through well-developed paragraphs; transitions are typically used to enhance organization.

Logical organization: but some ideas are not fully or consistently developed. Transitions are awkward at times, but the flow is adequately maintained.

No evidence of structure or organization.

Ideas are not fully developed. Minimal use of transitions throughout the paper.

 

 

15

14

13

<13

 

· Identifies a proposed

Intervention

(15)

 

 

The proposed intervention is thoughtfully and systematically developed and relevant with background and the current state of the clinical evidence that is applicable to the identified clinical practice situation.

The proposed intervention is systematically developed with background and the current state of the clinical evidence that demonstrates applicability to the identified clinical practice setting

The proposed intervention is developed with background and the current state of the clinical evidence but demonstrates limited applicability to the identified clinical practice setting.

The proposed intervention is not developed and the state of clinical evidence is not addressed. The proposed intervention does not demonstrate applicability to the identified clinical practice setting.

 

· Discuss how the chosen systems theory and nursing theory would be used to guide the proposed intervention

(15 points)

 

The chosen systems theory and nursing theory are clearly identified and clearly demonstrates how each theory guides the implementation of the intervention in the identified clinical practice situation.

The chosen systems theory and nursing theory are identified and demonstrates how each theory guides the implementation of the intervention in the identified clinical practice situation.

Either a systems theory or nursing theory is identified but not both. The identified theory demonstrates how the theory guides the implementation of the intervention in the identified clinical practice situation.

Neither a systems theory of a nursing theory is identified that demonstrates how it an guide the implementation of the intervention in the identified clinical practice situation.

 

· Discuss how the chosen systems theory and nursing theory would be used to evaluate the proposed intervention

(15 points)

 

The chosen systems theory and nursing theory clearly demonstrates how each theory guides the evaluation of the intervention in the identified clinical practice situation.

The chosen systems theory and nursing theory demonstrates how each theory evaluates the intervention in the identified clinical practice situation.

Either a systems theory or nursing theory is identified but not both. The identified theory demonstrates how the theory evaluates the intervention in the identified clinical practice situation.

Neither a systems theory of a nursing theory is identified that demonstrates how it can guide the implementation of the intervention to the identified clinical practice situation.

 

· Discuss how nursing theories can also be utilized to deliver care to diverse populations (15 points)

The chosen systems theory and nursing theory clearly demonstrates how each theory guides the delivery of care to diverse populations

 

 

The chosen systems theory and nursing theory demonstrates how each theory guides the delivery of care to diverse populations

 

 

Either a systems theory or nursing theory is identified but not both demonstrates the delivery of care to diverse populations.

 

Neither a systems theory of a nursing theory is identified that demonstrates the delivery of care to diverse populations

 

 

5

4

3

<3

 

Conclusion (5 points)

Clearly and concisely states the paper’s conclusion in a single sentence that is engaging and thought provoking. Reviews the main topics presented, clearly

Clearly and concisely states the paper’s conclusion in a single sentence that is engaging. Reviews the main topics presented.

The conclusion summarizes the contents of the paper.

Incomplete or unfocused conclusion statement.

 

 

10

8.5

7

<7

 

References

(10 points)

Based on >10 references with at least 3 research references; only websites used were .gov, .edu, or .org.

Based on 8-10 references with at least 3 research references; only websites used were .gov, .edu, or .org.

Based on 5-7 references with less than 3 research references and/or use of some .com websites

Based on less than 5 nonresearch references; liberal use of .com websites

 

 

10

8.5

7

<7

 

Writing Mechanics

(10 points)

No errors in punctuation, capitalization, or spelling. No errors in sentence structure or word usage.

Few errors in punctuation, capitalization, spelling, sentence structure or word usage which do not impact or distract from the content of the paper.

Several errors in punctuation, capitalization, spelling, sentence structure, or word usage with minimal impact on or distraction from the content of the paper.

Numerous and errors in punctuation, capitalization, spelling, sentence structure, or word usage with significant impact on the content and detracts from the paper.

 

Total Possible Points: 100

 

Score and summary comments: