The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.
By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable.
7 Nursing Theories To Practice By
In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches. In Sweden, the use of person-centered approaches has been shown [ 1 ] to improve care and increase patient participation. This type of approach requires that the patient is seen and understood as a unique individual [ 2 ] and their story is the core of their care [ 3 ]. The National Board on Health and Welfare has published national guidelines for care in cases of dementia.
These emphasize person-centered care as a way to improve care for people with dementia [ 4 ], although at the time of publication, there was a shortage of scientific evidence in the area. In implementing new programs of care, such as person-centered care, however, there is a risk that the focus will be at organizational level, instead of close to the patient, according to Ahgren [ 7 ].
This can be a problem if the task is to increase patient involvement in care [ 8 ]. Patient involvement can be understood as a way to support patients in their learning about their illness and help them to play an active role in their care and treatment [ 9 ].
Using research to increase patient involvement is a way to build evidence about care development, although the use of research in practice must be recognized as a complex and multifaceted process [ 5 ]. An awareness of research and evidence-based practice may help healthcare providers to ask relevant clinical questions about how to improve both the quality of care and clinical effectiveness [ 5 ]. Knowledge from research can be understood as a conceptual framework that informs policy, enhances understanding and may offer new perspectives on healthcare [ 10 ].
The context of healthcare seems to influence the use of research, as culture, leadership and evaluation of care with a strong focus on cost-effectiveness can be both facilitating and limiting. An efficient workplace culture contains elements such as a person-centered approach, transparent decision-making processes, and a learning culture [ 5 ].
Lorch [ 11 ] described how resistance and fear of change among staff can make it difficult to achieve educational goals and may limit the implementation of guidelines.
Advanced Nursing Theory: Nursing Theory vs. Nursing Practice
Moreover, rapid turnover of staff causes other problems such as losing knowledge and disruption of collaboration. Habit, rather than a shortage of knowledge, skills, attitudes, or motivation may, however, be the main reason why healthcare professionals do not implement and adhere to best practice [ 12 ]. Kent et al. It is, therefore, still questionable which methods and processes are most suitable for increasing the practice-related knowledge of healthcare staff.
Bick and Graham [ 15 ] argued that service users were now more involved in the design, content and evaluation of healthcare delivery.
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An example of patient involvement was work identifying core health domains for the assessment of rheumatoid arthritis. When patients were involved in the process, fatigue and general well-being were added as important outcomes [ 15 ]. Getting used to illness takes time and is typically a struggle for patients [ 17 , 18 ].
Previous research has shown that patients have often been given little or no support to transform the general knowledge presented by e. Patients who do not follow advice from healthcare professionals are often deemed to be noncompliant [ 22 , 23 ]. The attitude that the patient is noncompliant may imply that unreflective healthcare professionals blame the patient [ 25 , 26 ].
This may lead to difficulties for patients who wish to be involved in their care and treatment [ 17 ]. Information and education are often given on a superficial level, and patients are simply expected to do what they are told, which is contrary to person-centered care. Berglund [ 9 ] studied the learning of patients living with long-term illness and how that learning can be supported.
This research suggests that genuine patient learning occurs on a deeper existential level and that there should be support for this. The model is based on a lifeworld approach [ 28 — 31 ]. The four theses in the model are aspects that the nurse and patient focus on during the dialogue. This is not a one-off occurrence; the intention is that the patient is to be more active during the continued dialogue that is resumed at every caring meeting between the patient and nurse.
The aim of this study was to explore and describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The patient contacted one of the researchers MB and departmental leaders, suggesting that nurses in the dialysis center should adopt the model. The hemodialysis center in a mid-sized hospital in southern Sweden consisted of two units, one for self-treatment dialysis and one for assisted hemodialysis assHD. This project was designed for the assHD unit. The nursing staff with primary responsibility for the patients consisted of 11 registered nurses RN , and one team leader TL , who was the registered nurse in charge of the daily care work of the unit.
Each RN had primary responsibility for the regular nursing care of two to four patients.
Advanced Nursing Theory
Participation in the study was voluntary, however, the implementation of the project and the study were carried out simultaneously; both were intertwined. The staff became affected by the project and the study whether they wanted to or not. The department leaders were also invited to participate and consented.
During the study, three RNs ended their employment and therefore their participation, while one of the three RNs who started working at the unit joined the study during its second and final year. The participants were encouraged to focus on developing a dialogue with the patients to make them aware of their own capabilities and to encourage them to participate actively in their treatment. Monthly reflection meetings were also held.
Collecting lived experiences during the implementation period coincided with several activities that were carried out in order to implement the model. This meant that data were collected several times and in several ways. This way of implementing the model and collecting data helped to capture the nuances of any changes in experience and attitude among staff and aimed to capture as rich a description of the phenomenon as possible according to the lifeworld perspective . During the project, one of the researchers MB wrote field notes.
Written stories were collected from the participants who were asked to write two different stories on three occasions during the project start, middle, and end. The sessions covered the challenges met, action taken to address these challenges and what the participants learned as a result. Notes from the monthly reflection meetings were written by the reflection leader and focused on the subjects that had been discussed during the meetings, how the participants wanted to address the problem and what they had learned from it.
The open-ended interviews were carried out as a dialogue, to enable the participant to reflect on their own experiences.
7 Nursing Theories To Practice By | Notes from the Nurses' Station
An inductive hermeneutic approach was used to analyze the data [ 33 ]. This type of analysis can be described as a continuous dialogue with the data, with a focus on meanings [ 33 , 35 ], which in this study were the experience and attitudes of staff of the implementation. The analysis started with the initial whole of the data i.
The researchers read the text and became familiar with the data. The focus of the reading then moved toward individual interviews, notes, field notes and stories, to identify the units of meaning in the data i. The meaning units in the data were unpacked and each meaning was considered compared to the background of the whole, in an ongoing discussion among the researchers. The next phase involved the building and labeling of clusters of meanings.
With the data and clusters of meaning as background, a new text was written and divided into themes. This was an ongoing, dynamic process among the researchers where both names, content and number of themes changed several times before ending in two themes. To validate the themes, quotations have been used to clarify the findings and exemplify the individual lived meanings. As the last step, a comprehensive interpretation was written with the themes, clusters of meaning and data as background, focusing on the changes in experience and attitudes during the implementation process.
This interpretation is presented as a third theme.
When presenting the results, we have tried to respect the confidentiality of the participants, but those who know where and when the project was carried out can probably identify single participants. To minimize the possibility of this, we have chosen not to attach the quotes to individual participants.
Staff experiences of implementing the model to increase patient involvement and autonomy in hemodialysis care are presented in three main themes: 1 Intent to change approach; 2 The importance of supervision and reflection; and 3 Changes achieved through the project. The analysis revealed that there was a perception among the ward leaders and among some of the RNs that the care did not really give the patients enough support to be involved and to take responsibility for their treatment and health.
This mutual impression of care made the ward leaders aware of the importance of mutual learning among staff in order to change the approach to care among them. They also acknowledged the importance of arranging meetings between researchers and staff to enable this learning. The desire to change the caring approach was articulated by the leaders, who saw potential in the interest expressed by the staff in developing new approaches to care, as well as the fact that there were resources available.
They believed that the unit offered unique opportunities for building this kind of caring relationship, since the nurses met the patients on a regular basis. There had already been several discussions in the unit about how to help the patients to make healthy changes in their daily lives:. The willingness to change the caring approach was supported by the view so clearly expressed by the former patient.
This patient believed that the research and the model developed through research would be useful for the nurses. One of the leaders said the following about the model and the willingness to alter the caring approach:.
jadhemarques.com/wp-content/durytypij/2990.php The model fits the need to increase communication with patients in a person-centered way. The leaders valued this and perceived the need for more knowledge and skills among the staff. They identified the model as congruent with their ideas about developing person-centered care in the unit:. Staff explained that their experience of participating in a former research project on empowerment had helped them to understand that they could not simply give the patients power, but that the way in which they, as nurses, acted could influence outcomes.
The participants also suggested that the caring culture of the unit was unsupportive of patient empowerment. There is an awareness of these difficulties, and the staff see empowerment and Motivational Interviewing in which some of the nurses have been trained as useful in helping patients to become more active in their treatment and to improve their well-being. In reaching this understanding, it was expressed that both staff and patients must change their views on the aims of care. A willingness to change the caring approach is crucial for the implementation of a new way of thinking and acting.
This was revealed since some of the nurses did not participate very actively in the project. One of them stated that she was already competent in undertaking a caring dialogue with the patients. The leaders, however, were convinced that everyone needed to develop skills such as learning to ask the patients more questions.
Related Nursing Care: From Theory to Practice
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