Connecting Nursing Theory and Evidence-based Change Models

In recent years, evidence-based practice has formed the backbone of nursing practice and has been integral in improving patient outcomes. With evidence-based practice as the basis, a direct practice improvement project is applied to measurable patient outcomes to ensure better patient outcomes. The implementation of direct practice improvement is most effective when guided by both an EBP change model and a nursing theory (Smith, 2019). The implication is that the individual has to choose the right theory and model that can effectively guide the project. As such, the purpose of this write-up is to explore an EBP change model and a nursing theory that will form the basis of the DPI project. The project focuses on exploring the impact of permanent supportive housing among homeless patients in reducing substance abuse. The next section focuses on the theoretical foundations.

Theoretical Foundations

            The theoretical frameworks applied in nursing are usually based on nursing theory. Nursing theory helps in improving practice as it enables professionals to explore and translate evidence into practice which in most cases seeks to bring change in practice for positive patient outcomes (Butts & Rich, 2018). While the nursing theories are developed to support practice, the formulated nursing theory has to be validated in the nursing practice. From the earlier discussion, it was evident that the project focuses on the impact of permanent supportive housing among homeless patients in reducing substance abuse. Therefore, the nursing theory chosen to guide this project is Dorothea Orem’s Self-Care theory.

Nursing Theory

            Nursing theories have formed an integral part of nursing practice as they help in guiding nursing practice. In this project, Dorothea Orem’s Self-Care theory will be used. This theory was developed and propagated by Dorothea Orem. She defined the theory in broad terms as an act of helping others in terms of offering and managing self-care to maintain or enhance human functioning at the home level effectiveness (Butts & Rich, 2018). This theory focuses on an individual as well as the type of activities that a person can start and engage in on their own behalf to maintain well-being, health, and life.

Dorothea Orem’s Self-Care theory

As earlier indicated, this theory focuses on an individual as well as the type of activities that a person can start and engage in on their own behalf to maintain well-being, health, and life. Sometimes known as the self-care deficit theory of nursing, this theory is composed of three interconnected sub-theories. The three sub-theories include the theory of nursing systems, the self-care deficit theory, and the theory of self-care (Butts & Rich, 2018). The theory is also based on the requirement for nursing in an individual in the absence of the ability to have a sufficient amount of therapeutic self-care capable of sustaining health and life as well as recovering from injury or disease or even having to cope with the impacts of the disease.

Orem’s theory has various assumptions. One of the assumptions is that in order for an individual to remain functional and sustain life, they have to be involved in communication with each other and connect with both humans and the environment. The other assumption is that the power to deliberately act is exercised in the needs identification as well as arriving at the best judgment. The other assumption is that human beings have various experiences, such as privations which take the form of action both in caring for others and self and entail performing function-regulating and life-sustaining actions (Butts & Rich, 2018). The next assumption is that the human agency is fulfilled through the discovery, development, and transmission of strategies for identifying the needs of others and, in some cases, in self. The final assumption is that individuals with structured relationships group tasks and assigned responsibilities for offering care to various group members.

Orem proposed various concepts that support the theory. The concepts include self-care, health, environment, humans, and nursing. From her definition, nursing entails an art through which a nurse professional offers a specialized service to a person with some disabilities. Therefore, such assistance is not just ordinary but meets self-care needs. Humans entail children, women, and men who are cared for. The environment has various biological, chemical, and physical features entailing the community, culture, and the family (Butts & Rich, 2018). In addition, health refers to functional and structural soundness or wholeness and entails the health of groups and individuals.

Orem’s theory can be key in supporting the proposed project since, by offering the permanent supportive housing; it is hoped that the self-care efforts and aspects of the identified patients will be boosted to help fight the effects of substance abuse for better patients outcomes (Butts & Rich, 2018). Through the use of the theory, the identified patients will be offered supportive housing solutions which offer a conducive and enabling environment. The enabling environment can then be key in helping the patients keep off the substance and drug abuse. Through the theory, the patients will also be trained and supported to participate in self-care activities that can positively impact their health.

Orem’s theory has widely been applied in nursing, and therefore, many research articles have been published regarding the same theory. Some of these sources are seminal sources. For example,  a publication by Denye et al. 2001. This publication is quarterly, and Orem is one of the main contributors. The source explores Orem’s theory of self-care and presents it as a foundational science. This source also brings in other aspects of self-care requisites as well as what is needed to meet the standards.

           

              Clinical Question.

To what degree does the implementation of permanent supportive housing impact substance abuse among homeless patients when compared to no intervention in the clinical patient setting in twelve months?  

              Synthesis of Theory.

              As earlier indicated,  Orem’s theory has widely been used in various aspects of evidence-based practice. Therefore, it has been applied in peer-reviewed projects, research projects, and evidence-based articles. For example, not long ago, Orem’s theory was applied by Si et al. (2021). These researchers applied this theory in research involving patients with stroke. The theory was focused on improving their cognitive function, neurological function, and the day to day living activities. By the end of the study, the researchers noted that the patients experienced notable improvements in terms of cognitive function, neurological function, and living activities.

            Orem’s theory also formed the central part of the research focused on improving outcomes for patients living with type 1 diabetes. Using the theory, the researchers embarked on finding out how the parents of the children with type 1 diabetes were offering care for their children. Through the theory, they were able to offer training and education on how well and best they could obtain self-care and independence (Rumahorbo et al., 2021). Ali et al. (2018) also applied Orem’s theory among psychiatric patients. Through the use of the theory, the researchers realized that these patients need constant support to undertake everyday care activities. The use of the theory by the nurses enabled the patients to care for themselves. In addition, Orem’s theory was key in helping the care team identify what the patients needed and coming up with relevant strategies to care for them.

Summary

              Orem’s theoretical underpinnings make it suitable to be applied in various projects as the basis of the theoretical framework. It is, therefore, not surprising that the theory has widely been applied in nursing practice, patient care, and education. It is important that the theory’s concepts fit in well with the proposed project of lowering the incidences of substance abuse among homeless patients through the use of supportive permanent housing. The next section focuses on the evidence-based change model that can be used together with the theory to support the project.

Evidence-based Change Model

            Nursing practice heavily hinges on nursing research. Through the use of change models, professionals can translate research into practice. This project proposes to use the Plan-Do-Study-Act model as the change model.

The Plan-Do-Study-Act Model

            This model is one of the most famous models which was majorly applied in the business world but has since found its way into nursing practice. This model has four major phases, plan, do, study and act. This model is appropriate for the project as the four phases can be used in implementing various aspects of the project (England, 2021). The first phase will entail identifying the homeless patients exposed to the potential substance and drug abuse. Do phase then entails coming up with proposals on how to offer the supportive permanent housing plans. The study phase will involve considering the possible impacts; in addition, The Act phase will involve the actual implementation of the process. Among the possible seminal sources for this model is Taylor et al., 2014. The researchers published a systematic review focusing on the model and how it has been applied in various published literature

            Clinical Question.

              To what degree does the implementation of permanent supportive housing impact substance abuse among homeless patients when compared to no intervention in the clinical patient setting in twelve months?  

            Synthesis of Evidence-based Change Model.

The Plan-Do-Study-Act model has also been applied widely and therefore is common in peer-reviewed projects, research projects, and evidence-based articles. Recently, Nuss et al., 2020 applied the model in research involving emergency transfers to the intensive care units involving children suffering from sepsis. Another research article is that of Kim et al. (2019). This research entailed enhancing the quality of life among patients with cardiac arrest. Through the model, the researchers focused on improving bystander cardiopulmonary resuscitation. Si et al. also combined this model with Orem’s theory to improve the patient outcomes among patients living with stroke.

Summary

              The Plan-Do-Study-Act model is key in implementing quality improvement projects. It is envisioned that the model will be used together with Dorothea Orem’s theory as a basis for the proposed direct practice improvement project. The concepts in the model and the theory will be key in guiding the proposed project. The next section deals with how the change model and the nursing theory are linked with the proposed direct practice improvement project.

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

              Homelessness is a major public concern in many countries, the USA included; patients who happen to be homeless are exposed to various adverse things such as substance abuse. The gap that exists is that the impact of permanent supportive housing on these individuals remains largely unexplored. Therefore, the purpose of this project was to determine if or to what degree the implementation of permanent supportive housing would impact substance abuse when compared to no intervention among homeless patients in the primary care setting over twelve months.

Conclusion

            Homeless patients require support to help them have better outcomes. For example, the various forms of support such as permanent supportive housing help them overcome problems such as substance abuse. Orem’s theory and the Plan-Do-Study-Act model will be used in supporting the project since the patients will be needed to engage in self-care acts while the project will be implemented in stages. It is known that homeless individuals may lack the self-care activities capable of sustaining health and reducing the chances of substance abuse, so the theory will be key in this respect. The other example is that the aspect of the environment will be modified by offering supportive housing for better outcomes. As such, both the model and the theory support the project.

References

Ali, B. H. I. (2018). Application of Orem self-care deficit theory on psychiatric patient. Annals of Nursing and Practice, 5(1), 1-3. https://www.semanticscholar.org/paper/Application-of-Orem-Self-Care-Deficit-Theory-on-Ali/d9791850e0d3f114e45f46c28be350095c5138b3.

Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing science quarterly, 14(1), 48-54. https://doi.org/10.1177%2F089431840101400113.

England, N. H. S. (2021). Plan, Do, Study, Act (PDSA) cycles and the model for improvement. https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf

Kim, J. Y., Cho, H., Park, J. H., Song, J. H., Moon, S., Lee, H., … & Lewis, R. J. (2020). Application of the “plan-do-study-act” model to improve survival after cardiac arrest in Korea: a case study. Prehospital and disaster medicine, 35(1), 46-54. https://doi.org/10.1017/S1049023X19005156

Rumahorbo, H., Karjatin, A., & Hamzah, A. (2021). INKOLA based on Orem’s Self-Care Model and its effectiveness on the quality of life and HbA1C in children with type 1 diabetes mellitus. Family Medicine & Primary Care Review, 23(3), 341-346. https://doi.org/10.5114/fmpcr.2021.108201.

Nuss, K. E., Kunar, J. S., & Ahrens, E. A. (2020). Plan-Do-Study-Act Methodology: Refining an Inpatient Pediatric Sepsis Screening Process. Pediatric Quality & Safety, 5(5). https://dx.doi.org/10.1097%2Fpq9.0000000000000338

Si, Y., Yuan, H., Ji, P., & Chen, X. (2021). The combinative effects of orem self-care theory and PDCA nursing on cognitive function, neurological function and daily living ability in acute stroke. American Journal of Translational Research, 13(9), 10493. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507085/

Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety, 23(4), 290-298. http://dx.doi.org/10.1136/bmjqs-2013-001862