Assignment 2: Middle Range or Interdisciplinary Theory Evaluation

 

As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

Note: This Assignment will serve as your Major Assessment for this course.

 

To prepare:

 

• Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources (see under list of Required Readings and attached pdf file)
• Select a clinical practice problem that can be addressed through an evidence-based practice project. Note: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Week 7 Assignment 1.
• Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
• Formulate a preliminary clinical/practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.

Write a 10- to 12-page paper (including references) in APA format and a minimum of 8 references or more, using material presented in the list of required readings to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question (refer to the sample paper attached as “Assignment example”). Include the level one headings as numbered below:

1)       Introduction with a purpose statement (e.g. The purpose of this paper is…)

2)       Briefly describe your selected clinical practice problem.

3)       Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.

4)       Evaluate both theories using the evaluation criteria provided in the Learning Resources.

5)       Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

6)       conclusion

MY PRACTICE PROBLEM IS AS FOLLOWED:

 

P: Patients suffering from Type 2 Diabetes Mellitus

 

I:  Who are involved in diabetic self-care programs

 

C: Compared to those who do not participate in self-care programs

 

O: Are more likely to achieve improved glycemic control

 

THE THEORIES USED FOR THIS MODEL ARE:

Dorothea Orem Self-Care Theory and The Self-Efficacity in nursing Theory by Lenz & Shortridge-Baggett, or the Health Promotion Model by Pender, Murdaugh & Parson (Pick 2)

 

Required Readings

 

McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

• Chapter 10, “Introduction to Middle Range Nursing Theories”

Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research.

• Chapter 11, “Overview of Selected Middle Range Nursing Theories”

Chapter 11 continues the examination of middle range theories and provides an in-depth examination of a select set of theories

·         Chapter 15, “Theories from the Biomedical Sciences”

Chapter 15 highlights some of the most commonly used theories and principles from the biomedical sciences and illustrates how they are applied to studies conducted by nurses and in nursing practice.

·         Chapter 16, “Theories, Models, and Frameworks from Administration and Management”

Chapter 16 presents leadership and management theories utilized in advanced nursing practice.

·         Chapter 18, “Application of Theory in Nursing Practice”

Chapter 18 examines the relationship between theory and nursing practice. It discusses how evidence-based practice provides an opportunity to utilize research and theory to improve patient outcomes, health care, and nursing practice.

 

 

 

 

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

• Chapter 6, “Objectives, Questions, Variables, and Hypotheses”

Chapter 6 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.

·         Review Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice”

·         Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”

This section of Chapter 19 examines the implementation of the best research evidence to practice.

 

 

 

Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.

Note: You will access this article from the Walden Library databases.

This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.

 

DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.

Note: You will access this article from the Walden Library databases.

This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.

Note: You will access this article from the Walden Library databases.

This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.

 

Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x

Note: You will access this article from the Walden Library databases.

This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.

 

 

Amella, E. J., & Aselage, M. B. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia. Journal of Clinical Nursing, 19(1/2), 33–41. doi:10.1111/j.1365-2702.2009.02969.x

Note: You will access this article from the Walden Library databases.

This article presents findings from a meta-analysis of 48 research studies that examined mealtime difficulties in older adults with dementia.

 

Frazier, L., Wung, S., Sparks, E., & Eastwood, C. (2009). Cardiovascular nursing on human genomics: What do cardiovascular nurses need to know about congestive heart failure? Progress in Cardiovascular Nursing, 24(3), 80–85.

Note: You will access this article from the Walden Library databases.

This article discusses current genetics research on the main causes of heart failure.

 

Mahon, S. M. (2009). Cancer Genomics: Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing, 13(4), 373–3 76.

Note: You will access this article from the Walden Library databases.

This article advocates for nurses to stay abreast of the rapid changes in cancer prevention research and its application to clinical practice.

 

Mayer, K. H., Venkatesh, K. K. (2010). Antiretroviral therapy as HIV prevention: Status and prospects. American Journal of Public Health, 100(10), 1867–1 876. doi: 10.2105/AJPH.2009.184796

Note: You will access this article from the Walden Library databases.

This article provides an in-depth examination of potential HIV transmission prevention.

 

Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management, 41(3), 40–44. doi: 10.1097/01.NUMA.0000369499.99852.c3

Note: You will access this article from the Walden Library databases.

This article provides an overview of genomics and how nurses can apply it in practice.

 

Yao, L., & Algase, D. (2008). Emotional intervention strategies for dementia-related behavior: A theory synthesis. The Journal of Neuroscience Nursing, 40(2), 106–115.

Note: You will access this article from the Walden Library databases.

This article discusses a new model that was developed from empirical and theoretical evidence to examine intervention strategies for patients with dementia.

 

Fineout-Overholt, E., Williamson, K., Gallagher-Ford, L., Melnyk, B., & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. The American Journal Of Nursing, 111(1), 54–60.

This article outlines the efforts made as a result of evidence-based practice to develop rapid response teams and reduce unplanned ICU admissions.

 

Kleinpell, R. (2010). Evidence-based review and discussion points. American Journal of Critical Care, 19(6), 530–531.

This report provides a review of an evidence-based study conducted on patients with aneurismal subarachnoid hemorrhage and analyzes the validity and quality of the research.

 

Koh, H. (2010). A 2020 vision for healthy people. The New England Journal Of Medicine, 362(18), 1653–1656.

This article identifies emerging public health priorities and helps to align health-promotion resources, strategies, and research.

 

Moore, Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18.

This article discusses the largely preventable problem of pressure ulcers and the importance of nurses being well-informed of current prevention strategies.

 

Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances In Nursing Science, 34(1), 67–77.

This article discusses how personal and professional knowledge can be used in concert with health theories to positively influence nursing practice.

 

Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: The Medicaid experience. Disease Management & Health Outcomes, 16(6), 421–428.

This article explores the barriers associated with chronic illness care and other factors faced by disease management programs for Medicaid populations.

 

Sobczak, J. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. doi: 10.1111/j.1745-7599.2009.00422.x

This article discusses a method found which positively impacts patient outcomes used with highly-acuity-depressed patients.

 

Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. doi: 10.1016/j.ijnurstu.2008.05.001

The article explores the use of qualitative research methodology with the current evidence-based practice movement.

 

 

 

Optional Resources

 

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

 

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. doi: 10.1016/j.outlook.2009.05.001

 

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

Community Health Assessment / Windshield Survey

Community Assessment

A community health assessment (sometimes called a CHA), also known as community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Community health assessments use such principles as

• Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation
• Proactive, broad, and diverse community engagement to improve results
• A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations
• Maximum transparency to improve community engagement and accountability
• Use of evidence-based interventions and encouragement of innovative practices with a thorough evaluation
• Evaluation to inform a continuous improvement process
• Use of the highest quality data pooled from and shared among, diverse public and private sources

(Retrieved from https://www.cdc.gov/publichealthgateway/cha/plan.html)

Windshield Survey:

“A  windshield survey is an informal method used by community health nurses to obtain basic knowledge about a given community. It provides a subjective view of the various physical characteristics of a communal area as observed while driving or walking through a neighborhood.

.”(Retrieved from;

mynursingprofessionalportfolio.weebly.com/uploads/8/9/3/3/8933086/windshieldsurvey.docx).”

As stated in the syllabus please present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion board title  “Week 1 discussion questions”.  A minimum of 2 evidence-based references is required (not counting the class textbook) no older than 5 years. A minimum of 1000 words are required.  Make sure the assessment is based in the community where you live.  I don’t want community health assessment from other communities, once again it must be from the community you live.  Please mention the zip code of your community on the first page of the assignment.

Please follow the instructions given in the syllabus  Discussion Question (DQ) Participation Guidelines” and “Discussion Question (DQ) Submission Guidelines.  

 

 

According to Dr. Goeppinger, if healthcare is my calling, Midwestern University is my home. I am certain that Chicago College of Osteopathic Medicine will provide me with precisely the type of osteopathic medical education I seek because of its dedication to fostering innovation in medicine and teaching and success producing primary care doctors of integrity. I especially look forward to bridging traditional classroom learning and real-life clinical experience at the Clinical Skills and Simulation Center. The center will serve as a place to master medical procedures and collaborate closely with peers from other disciplines. In addition, attending CCOM would grant me the opportunity to contribute to the development of a dynamic institution through research and further my quest to provide excellent primary care. My motivation to pursue general medicine stems from the declining number of primary care physicians. This motivation is reinforced by witnessing poverty and lack of care both in my hometown and while serving San Francisco General Hospital’s disadvantaged patient population. Doctors under increasing pressure to see more patients can only result in less accurate diagnoses, lower quality treatment plans and less time for doctors to make a human connection with their patients. Earning the opportunity to study at CCOM will allow me to accomplish our shared objectives of making deep connections with our patients and exemplify the “Midwestern difference”.

 

Why should CCOM accept you into this year’s class? (1500 characters)

 

Chicago College of Osteopathic medicine should accept me into this year’s class for my demonstrated commitment to osteopathic medicine and cultural diversity and perspective I will bring to the program. I came out to my family 10 months ago and I was forced to abruptly uproot myself to Seattle, Washington in order to live my truth. I am an Armenian Christian female who identifies as a lesbian. Navigating towards a career in medicine from a disadvantaged background was incredibly challenging yet rewarding. Being an active member of cultures that have been historically oppressed instilled an appreciation for hard work and commitment to reaching my goals. Despite these recent financial and emotional set-backs, my determination to pursue osteopathic medicine was reaffirmed. My fearlessness and ability to rebuild and progress regardless of external circumstances will make me an excellent candidate.

 

 

 

 

Upload a copy of your resume or curriculum vitae, which will include, but not be limited to the following information:

· Educational History (colleges attended and degrees earned) · Employment History · Medically related work and volunteer experiences · College extracurricular activities, honors, and leadership responsibilities · Community activities, honors, and leadership responsibilities · Hobbies and nonacademic interests

 

1. As an advanced practice nurse, what are three actions you can take to mitigate social impacts to marginalized women?

One of the actions that an advanced practice nurse can take to mitigate social impacts to marginalized women is providing advocacy for the development of policies that protect women from social discrimination. Studies have indicated that there are many policies at the government, state, and local levels that prevent women from accessing healthcare services (Prodan‐Bhalla & Browne, 2019). Since nurse practitioners are influential and policymakers can listen to them, which gives them the advantage to advocate for policies that protect women from marginalization. Another action as an advanced practice nurse would be providing women-friendly healthcare services that are individualized per patient needs, building trust with the women, and making health services easily accessible to them. An advanced practice nurse can also research to understand the social and cultural sources of women marginalization and how they can be mitigated. The research can also focus on unearthing policies that promote discrimination of women and recommend more women-friendly policies.

2. What role does policy at either government, state, or local level play in the marginalization of women and childbearing families?

Policies at government, state, or local levels have played a role in the marginalization of women and childbearing families. Research has indicated that in various communities, there are discriminative and unjust structural policies that limit women’s access to healthcare and promote health inequities. There are state policies, for example, which effect women`s access to childcare, maternity leave from work, and care for older women. Other policies do not promote women access to employment opportunities, often leading women to low income, high employment rates, and lack of opportunities to get educated (Prodan‐Bhalla & Browne, 2019). Policymakers at levels have an opportunity to change laws and policies to reduce the marginalization of women. Nurse practitioners can advocate for better policies from government, state, or local levels to reduce social injustices towards women.

3. Identify one policy that impacts marginalized groups (include whether the policy is at the federal, state, or local level).

Among the policies that have an impact on marginalized groups in the United States is the healthcare policy. The policy, which is at the federal level, should make healthcare accessible and affordable to all citizens in the country. Healthcare policy seeks to create and implement laws, rules, and regulations that govern the national health system. Young and the most disadvantage women are not able to access high-quality healthcare services due to their socio-demographic background (Daniel et al., 2018). The federal policy should implement health equity by ensuring universal healthcare access to all citizens in the country.

4. Discuss how policy impacts marginalized group either positively or negatively.

Policies represent what the government, institution, or any entity intends to do and directs what is supposed to be done by all the individuals or sectors affected by that policy. When governments or other entities issue a policy, it has to be followed and dictates how things will be done within its jurisdiction or scope of authority. Due to this, policies can affect marginalized groups sometimes in positive and other times in a negative way. For example, policies that deny women equal opportunities for employment result in many of them being without sources of income (Prodan‐Bhalla & Browne, 2019). Such an example of women indicates how policies that impact marginalized groups negatively. The policy may also have a positive impact on marginalized groups of people. For example, health policies ensure healthcare services are accessible and affordable to all citizens through programs such as Medicare and Medicaid. Through the policy, even low-income earners, disabled, and older adults are able to access and afford high-quality healthcare. It shows how policy impact marginalized groups in a positive way. Policymakers should strive to ensure that policies have positive as opposed to negative impacts.

References

Daniel, H., Erickson, S. M., & Bornstein, S. S. (2018). Women’s Health Policy in the United States: An American College of Physicians Position Paper. Annals of Internal Medicine, 168(12), 874. https://doi.org/10.7326/m17-3344

Prodan‐Bhalla, N., & Browne, A. J. (2019). Exploring women’s health care experiences through an equity lens: Findings from a community clinic serving marginalized women. Journal of clinical nursing, 28(19-20), 3459-3469. https://doi.org/10.1111/jocn.14937