Improving Nursing Practice

Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two. (Included towards the end)
Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.
Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.
This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.
Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.
If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).
Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.
Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion.
Present your outcome in an APA formatted paper that meets the University’s standards for a written assignment.
Assignment Prompt (Brief explanation given in the Syllabus)
Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two.
Identify the concept in Watson’s Theory of Caring that could represent or include the outcome. In our example, the outcome would be the changes in self through the change in the patient’s floor covering practice. Identify a practice that can be changed or implemented that may influence the outcome. Identify the concept in Watson’s Theory of Caring that includes the practice. In our example, the practice could be to improve the understanding of fall hazards through the engagement in a teaching-learning experience, one of Watson’s Caritas Processes. Identify exactly how these two concepts will be measured with their operational definitions. Develop a proposition between the two. Present your outcome in an APA formatted paper meeting the University’s standards for a written assignment.

Please coordinate the two for your understanding. My professor pays close attention to detail, therefore; best to follow through with the detailed explanation.

My Week 2: Concept Theory
Theories are created and often generally begins with observation; in this case we will be looking into my clinical experience in neurology (Utley et al., 2018). It is said that a nursing theory is a set of concepts that provides a mechanism for caring for and treating patients. While working in the neuroscience floor, our work involves heavily with patient who comes in with symptoms of stroke. Symptoms that may be presented in a stroke patient is dysphagia, slurred speech, sensory deficient, ataxia, change in vision, and unsteady gait. This study stated that out of 100 patients with cerebrovascular accident, approximately 50-60% have dysphagic symptoms, and about half of these patient’s course got complicated with evidence of aspiration, and 20% developed aspiration pneumonia (Shaker & Geenen, 2011). Aspiration precautions is highly empathized on of unit especially patient with stroke. It is something that should always be assessed and to make sure the correct measures are being taken to prevent it. One of the tools that is used to assess patients who might be at high risk for aspiration is the Yale Swallow screen. This is a clinical practice recommendation for nurses to perform it within the first 24 hours after stroke (Fedder, 2016). This screening helps determine further work up on consult with speech and determine the type of diet to start. Patients who cannot swallow should have a nasogastric tube placed or endoscopic gastrostomy tube depending on severity. It is suggested that patients who are kept nothing by mouth should be started with intravenous fluids until a formalized evaluation by speech-language pathologist.
Nasogastric tube feeding is another alternative to provide nutrient to patient who suffer from illness including but not limited to the following: dysphagia, poor voluntary intake, chronic neurological or guy dysfunction. However, despite the benefits and widespread use of enteral tube feeding, patient do experience complications such as aspiration pneumonia (Blumenstein et al., 2014). Interventions to minimize aspiration is to check order to see if clear to use, assess for placement, pause tube feeding when repositioning patient, and elevating head of the bed to at least 30 degrees if not contraindicated. All these interventions will help to prevent complication of aspiration with patient having to utilize nasogastric tube feeding,
The theory here is that on a neuro floor, nurse may have observed that if the head of the bed is elevated for patient with nasogastric tube (concept a) it will reduce (Proposition) the risk for aspiration pneumonia (concept b). The concepts here are head of the bed elevation and aspiration pneumonia. Proper positioning of patient with nasogastric tube feeding is an important nursing intervention which decreases gastroesophageal reflux as well as aspiration pneumonia. As research suggested with the head of the bed at 30 to 45 degrees elevated, the esophagus is above horizontal and reflux of gastric content is counterbalanced by gravity and will help reduce the risk of aspiration (Schallom et al., 2015). Since most stroke-related pneumonia is due to dysphagia and the subsequent aspiration of oropharyngeal food materials (Feng et al., 2019). It is crucial to have early dysphagia screening to reduces stroke-related aspiration pneumonia and improves stroke outcomes.
References
Blumenstein, I., Shastri, Y. & Stein, J. (2014). Gastroenteric tube feeding:
Techniques, problems and solutions. World Journal of Gastroenterology,
20(26): 8505-8524. doi: 10.3748/wjg.v20.i26.8505
Fedder, W. (2016). Review of Evidenced-Based Nursing Protocol for Dysphagia Assessment. AHA Journals. file:///C:/Users/tseng/Downloads/STROKEAHA.116.011738%20(1).pdf
Feng, M. C., Lin, Y. C., Chang, Y. H., Chen, C. H., Chiang, H. C., Huang, L. C., … & Hung, C. H. (2019). The mortality and the risk of aspiration pneumonia related with dysphagia in stroke patients. Journal of Stroke and Cerebrovascular Diseases, 28(5), 1381-1387
Schallom, M., Dykeman, B., Metheny, N., Kirby, J. & Pierce, J. (2015). Head-of-
Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration, and
Pressure Ulcers: A Feasibility Study. American Journal of Critical Care,
24(1). doi: http://dx.doi.org/10.4037/ajcc2015781
Shaker, R., & Geenen, J. E. (2011). Management of Dysphagia in stroke patients. Gastroenterology & hepatology, 7(5), 308–332.
Utley, R., Henry, K., & Smith, L. (2018). Frameworks for advanced nursing practice and research: Philosophies, theories, models, and taxonomies. New York, N.Y: Springer. ISBN: 978-0-8261-3322-9