DNP 815 Case Report: Application of Theory to Organizational Mission, Vision, and the Christian Worldview

Health care organizations are designed to provide the best care to individuals and communities. As a result, they implement different strategies to provide patient care as their visions and missions outline. Inevitably, nursing professionals encounter patients with varying needs in routine care. Understanding these needs is critical to implementing evidence-based interventions. Quality improvement projects allow nurses to implement scientific evidence and guide organizations in improving patient care outcomes. The purpose of this paper is to describe my project in four major areas: the purpose of the project, Christian worldviews, organization’s mission and vision and their connection to nursing theory and model, and pulling it together. The first section describes the project’s purpose.

Purpose of the Project

Pressure ulcers significantly threaten patient safety and care quality and increase morbidity and hospitalization rates. At the practicum site, nurses primarily rely on routine pressure ulcer prevention, necessitating further improvement to optimize outcomes. The purpose of this quality improvement project is to determine if the implementation of a care bundle intervention would positively impact pressure ulcer prevention among elderly and debilitated patients over an eight-week period in a long-term care facility in a suburban Maryland City.

Christian Worldviews

Health care professionals’ worldviews differ depending on their religions, cultures, and patient care experiences. Grand Canyon University (GCU) doctrinal statements outline what it means to live under the guidance of biblical principles (Appendix A). The first statement asserts that the Bible is the true and authoritative word of God and the second statement claims there is only one God who made heaven and earth and all that is seen and unseen (Grand Canyon University, 2022). The implication is that Christians, regardless of their profession, should be inspired by the Bible and should not believe in any other God.  Similarly, Christian health care professionals should use the Bible for guidance and inspiration in routine practice.

The third statement is on salvation that Jesus Christ brought as the only Son of God. The fourth statement develops the salvation concept by describing how Jesus suffered, died, resurrected and will come again to judge the living and the dead (Grand Canyon University, 2022). The fifth statement emphasizes human creation in God’s image and likeness and free from sin. The universal likeness makes humans uniquely and innately equal and nurses should promote the same equality when attending to patients. The fifth statement further outlines how humans inherited the sinful nature, opposing God’s command. Similarly, acting against the biblical teachings is not only an injustice to humans but also contravening God’s command.

The sixth statement underscores humans’ belief in salvation and regeneration through the Holy Spirit. The seventh statement outlines how salvation occurs through the redemption of the whole person (Grand Canyon University, 2022). Salvation is free but requires strong faith in Jesus Christ. The eighth statement emphasizes the role of unity of believes like evangelism and engagement in societal issues as a Christian duty. Such duties express God’s and humanity doctrines as well as God’s love and obedience of Jesus Christ (Grand Canyon University, 2022). The final statement describes salvation as denouncing evil, oppression, and discrimination while ushering the good news. 

Many nursing professionals apply the Christian worldview in everyday practice. There are several valuable concepts that nursing professionals can integrate into patient care as outlined in the GCU Doctrinal Statements. They include uniqueness of humans, equality, and avoiding oppression and discrimination. Nurses should also strive to avoid evil by increasing commitment to doing what is generally good for individuals and communities whether healthy or sick. The Christian worldview is also applicable to nursing professionals who base their practice on other religious worldviews. For instance, equality is a virtue that all nurses should promote regardless of their religious affiliation.

Organization’s Mission and Vision to Theory and Model

Health care organizations cannot operate without a sense of direction. Their missions and visions ensure that health care facilities work to achieve a specific goal and seek progressive growth. Generally, an organization’s mission describes its goals and how it seeks to achieve them. If differently stated, a mission states what the organization provides and how it meets its customers’ needs. The vision is the desired future position. This section of the paper will describe the organization’s mission and vision and its connection to the chosen nursing theory and evidence-based change model.

Mission and Vision

ProMedica Skilled Nursing and Rehabilitation (Wheaton) is an affiliate of the extensive ProMedica Health System. Located in Wheaton, the facility specializes in individualized post-hospital skilled nursing care in a comfortable environment. Its mission is to improve health and well-being through its expanded care divisions, including senior care, hospitals, doctors, and insurance plans (ProMedica, 2021). The specialized care focuses on the patients’ needs and interests to promote a smoother and safer transition as patients recuperate. The facility’s vision is a future defined by better care for everyone (ProMedica, 2021). Through an inspired approach to fundamental change and building life-long connections, the facility offers a wide range of services, including cardiac care, diabetic care, outpatient therapy, and stroke and neurological care. Patients receive coordinated, individualized care and rehabilitation services to enhance their independence.

Connection of Mission and Vision to Nursing Theory: nursing theories are organized bodies of knowledge that define what nursing entails. They provide baseline knowledge of care concepts that guide health care professionals in patient care and rationalize their actions (Smith, 2019). Imogene King’s goal attainment theory provides the theoretical foundations of this project. The theory’s fundamental principle is that health care professionals and nurses should set mutual goals and the care process should be transactional; thus, relationship-based (Adib-Hajbaghery & Tahmouresi, 2018). To achieve the desired goals, nurses and patients should identify and solve problems through effective nurse-patient relationships and set goals that must be achieved reciprocally. In this transactional relationship, the nurse’s role is to initiate action, reaction, and appropriate interactions between the provider and care recipients (Butts & Rich, 2021). Patients also need adequate information about the care process and treatment plans to participate actively to achieve the set goals.

The organization’s mission is to improve health and well-being through care that matches the patients’ needs and interests. The mission connects to the nursing theory since it emphasizes patient-centeredness in health care delivery and goal-oriented health practices. As Kuipers et al. (2019) conjectured, patient-centered care is characterized by respectful care and actively engaging the patient in decision-making. Matching patients’ needs and interests denotes a patient-centered practice which the goal attainment theory promotes by ensuring that the care process is transactional. Such an approach ensures the patient understand the care process, individual roles, and the targeted outcomes. Engaging patients in the care process also improves their adherence to treatment plans (Kneuertz et al., 2020). Overall, it is a strategy for optimizing outcomes and ensuring patients are actively involved in their health management.

The organization envisions a future defined by better care for everyone. In the organization, such care is achieved by the active participation of stakeholders in outcomes improvement and by ensuring patient care is purpose-driven. The vision further emphasizes the importance of equality as a fundamental concept since better care for everyone cannot be achieved without perceiving and treating patients equally. In the same view, the goal attainment theory demonstrates the care process as engaging patients in goal setting and attainment irrespective of their conditions. Redefining health to be patient-centered and accessible to everyone will be instrumental in creating healthier and safer populations.

Connection of Mission and Vision to Evidence-based Change Model: the highly appropriate evidence-based change model is Imogene King’s Conceptual System Model. The model is founded on the principle that human beings are open systems that interact continuously with the environment. As Butts and Rich (2021) stated, humans, the environment, and nursing connect as systems. When implementing change or improving care quality, the focus should be on the concept of a person that contains three systems: person, interpersonal, and social. Responding to the needs of each system is critical to achieving quality patient-centered care.  Butts and Rich (2021) further elucidated that the personal system comprises individuals who cope with stimuli based on their expectations. As a result, their needs should be understood, and effective responses developed before moving to the interpersonal system. The defining elements of the interpersonal system are communication, roles, and interactions that transpire during the nursing process. The social system comprises practices and behaviors developed to address the patients’ needs.

The organization’s mission of improving health and well-being through care that addresses the patient’s needs and interests aligns with the fundamental concepts of King’s conceptual system. For instance, the organization depicts patients’ health and well-being as a priority for care providers who should do everything to improve patients’ independence. Nurse-patient communication is also emphasized to enable nurses to make the necessary transactions, such as goal setting and develop mechanisms for improving health, as emphasized under the interpersonal system. A future defined by better care for everyone cannot be achieved without addressing personal, interpersonal, and social systems comprehensively. Accordingly, patients’ needs should be addressed in the order of complexity to facilitate their transition to the lowest level of care possible.

Pulling it Together

A quality improvement project provides nurses with an excellent opportunity to improve health outcomes in their facilities. As a professional obligation, health care professionals implement quality improvement projects to standardize health care processes to improve patient outcomes and reduce variation (CMS.gov, 2021). The current project on implementing a preventive bundle to reduce the incidence of pressure ulcers is designed to achieve similar goals. The following section will describe how the project’s purpose connects to the Christian Worldviews (CWV), the organization’s mission and vision, and the nursing theory and evidence-based model.

Concerning how the concepts are aligned, the project seeks to improve care quality in the facility by reducing the incidence of pressure ulcers. Among many principles, CWV emphasizes equality, fairness, and concern for others’ needs. These principles are among the basic guidelines for the project since nurses cannot be motivated to implement quality improvement projects without being empathetic to patients’ needs. On the mission and vision, a health care organization’s primary purpose is to provide patient care. Quality and value-based care should be the target, achieved by continuous process improvement and integrating the right values, such as CWV, where appropriate. Imogene King’s goal attainment theory and the conceptual system provide a framework and procedure for project implementation and quality improvement.

CWV and the organization’s mission and vision also support the project’s purpose. From a Christian dimension, humans do not deserve suffering, and the role of health care professionals is to heal and enhance comfort (Pfeiffer, 2018). Comprehensive healing is achieved by implementing patient-centered and evidence-based care processes such as the current project. The organization’s mission and vision also support creative approaches to care delivery and interventions that provide lasting solutions. The project provides innovative and effective interventions since a preventive bundle will reduce the current incidence and prevent high rates of pressure ulcers in the future. However, nurses and patients must identify mutual goals and develop strategies to achieve them together, as recommended in King’s theory and conceptual system.

To a significant extent, I am applying what I have learned about GCU’s CWV to the DPI project I am developing. Under the Christian worldview, all humans are created in God’s image and likeness (Grand Canyon University, 2022). Humans must also denounce evil, injustice, discrimination, and oppression. I am strongly aligned to this worldview since it promotes equality, empathy, and justice in patient care. Utilizing them implies caring for all patients and ensuring their needs and concerns are adequately addressed. Health care practitioners guided by the Christian worldview also unite for a common purpose and prioritize patients’ needs over individual interests. The project applies a similar approach to reduce the incidence of pressure ulcers in the facility.

Conclusion

In routine practice, health care professionals encounter many issues that hamper care quality. Implementing quality improvement projects allows nurses to address such problems innovatively and comprehensively. The purpose of this paper was to describe the project’s goals, connection with Christian worldviews, the organization’s mission and vision, and the nursing theory and evidence-based change model. As described in detail, the project’s purpose is to reduce the incidence of pressure ulcers in the facility by implementing a preventive care bundle. The organization’s mission and vision support such projects since the primary objective is improving health and well-being. Implementing the project will also be fundamental to achieving the organization’s vision of quality care for everyone.  

References

Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141-144. doi: 10.4103/2322-1488.235636

Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.

CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations.

Grand Canyon University. (2022). Doctrinal statement. https://www.gcu.edu/sites/default/files/media/documents/about/christian-identity-heritage/doctrinal-statement.pdf

Kneuertz, P. J., Jagadesh, N., Perkins, A., Fitzgerald, M., Moffatt-Bruce, S. D., Merritt, R. E., & D’Souza, D. M. (2020). Improving patient engagement, adherence, and satisfaction in lung cancer surgery with implementation of a mobile device platform for patient reported outcomes. Journal of Thoracic Disease, 12(11), 6883–6891. https://doi.org/10.21037/jtd.2020.01.23

Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 1-9. https://doi.org/10.1186/s12913-018-3818-y

Pfeiffer, J. (2018). Strategies Christian nurses use to create a healing environment. Religions, 9(11), 352. https://doi.org/10.3390/rel9110352

ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#