Hello This is my h.w instructions

| June 5, 2016

Hello This is my h.w instructions

associate what you have learned about theory in comparison to the case study and reflect on it.

· A comparison of what you have learned from the case study to related theories you have studied. Make sure to cite these theories in APA format.

· A comparison of the case study to your nursing practice, giving one or two examples from your nursing experience in which you might have applied a particular theory covered.

Your reflection should be a minimum of five to six paragraphs

Below are the theories

CHAPTER 12: Evidence-Based Practice and Nursing Theory

Evelyn M. Wills

Melanie McEwen

Helen Soderstrom was stricken with changes in her vision, disturbances of gait, and occasional periods of severe fatigue during her senior year of nursing school. She experienced intermittent periods of normality as well as illness, and the periods when she had no symptoms lasted many months. During a time when her symptoms were unusually active, she sought medical help, and her physician determined that her symptoms were related to stress. Despite the periods of weakness and fatigue, she was able to complete the nursing program and graduated with honors.

During Helen’s first year of practice, she experienced two periods of symptom exacerbation, but each was short-lived. With full insurance, she was able to see a neurologist who concluded that she was experiencing the beginning stages of a neuromuscular disease. Because there was no “cure,” the neurologist worked with Helen to find interventions that helped her manage the symptoms when they became problematic.

After a few years in practice, Helen enrolled in a graduate program to work toward a career in nursing education. During her first year of graduate studies, she seldom experienced neurologic symptoms, but during her practice teaching course, they returned.

The recurrence of symptoms, along with a new understanding of evidence-based practice from her graduate courses, led Helen to make her personal health experience the topic of her final paper. To learn more, she sought resources that would help her gain better control of the neuromuscular symptoms as well as assist her in her studies. To that end, she contacted her University’s neuroscience department and joined a research team. As she learned more about EBP, she considered what system she would use to develop guidelines on symptom management and selected the Iowa Model because of its extensive use in research.

The idea of evidence-based practice (EBP) was introduced in the 1970s by Dr. Archie Cochrane, an Englishman who wrote a dynamic book questioning the efficacy of non–research-based practices in medicine (Melnyk & Fineout-Overholt, 2011). In particular, Dr. Cochrane emphasized the critical review of research, largely focusing on randomized control trials (RCTs) to support medical practice. His influence eventually led to development of the Cochrane Collaboration, an organization charged with developing, maintaining, and updating systematic reviews of health care interventions (Cochrane Collaboration, 2013). Although the notion of EBP was somewhat delayed in being recognized and implemented in nursing, over the past two decades, EBP has appeared with increasing frequency in the nursing literature and now has essentially become the standard for research-based, informed decision making for nursing care.

EBP is similar to research-based practice and has been called an approach to problem solving that conscientiously uses the current “best” evidence in the care of patients (LoBiondo-Wood & Haber, 2010). EBP involves identifying a clinical problem, searching the literature, critically evaluating the research evidence, and determining appropriate interventions. Nursing scholars note that EBP relies on integrating research, theory, and practice and is equivalent to theory-based practice as the objective of both is the highest level of safety and efficacy for patients (Fawcett & Garity, 2009).

Overview of Evidence-Based Practice

The concept of EBP is widely accepted as a requisite in health care. EBP is based on the premise that health professionals should not center practice on tradition and belief but on sound information grounded in research findings and scientific development (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012). Until the early part of the 21st century, the concept of EBP was more common in Canadian and English nursing literature than in U.S. nursing literature. Over the last decade, however, the term has become ubiquitous. This is attributed in part to the guideline initiatives of the Agency for Health Care Quality, the Institute of Medicine, and the U.S. Preventative Services Task Force, among others (Hudson, Duke, Haas, & Varnell, 2008; Melnyk & Fineout-Overholt, 2011).

Many nursing scholars (DiCenso, Guyatt, & Ciliska, 2005; Ingersoll, 2000; LoBiondo-Wood & Haber, 2010; Melnyk & Fineout-Overholt, 2011; Rycroft-Malone, 2004) have pointed out that EBP and research are not synonymous. They are both scholarly processes but focus on different phases of knowledge development—application versus discovery. In general, EBP refers to the integration of individual clinical expertise with the best available external clinical evidence from systematic research. It is largely based on research studies, particularly studies using clinical trials, meta-analysis, and studies of client outcomes, and it is more likely to be applied in practice settings that value the use of new knowledge and in settings that provide resources to access that knowledge.

Definition and Characteristics of Evidence-Based Practice

In medicine, EBP has been defined as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). It is an approach to health care practice in which the clinician is aware of the evidence that relates to clinical practice and the strength of that evidence (Jennings & Loan, 2001; Tod, Palfreyman, & Burke, 2004).

To distinguish nursing from medicine in discussing EBP, a number of definitions have been presented in the literature. Sigma Theta Tau International (2005, para. 4) defined “evidence-based nursing” as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.” Similarly, DiCenso and colleagues (2005) defined EBP as “the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (p. 4). Both of these definitions use similar terms (e.g., best evidence, expertise, patient values). Ingersoll (2000) used slightly different terms when she suggested that evidence-based nursing practice “is the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences” (p. 152).

In nursing, EBP generally includes careful review of research findings according to guidelines that nurse scholars have used to measure the merit of a study or group of studies. Evidence-based nursing de-emphasizes ritual, isolated, and unsystematic clinical experiences; ungrounded opinions; and tradition as a basis for practice and stresses the use of research findings. Other measures or factors, including nursing expertise, health resources, patient/family preferences, quality improvement efforts, and the consensus of recognized experts, are also incorporated as appropriate (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012).

In summary, EBP has several critical features. First, it is a problem-based approach and considers the context of the practitioner’s current experience. In addition, EBP brings together the best available evidence and current practice by combining research with tacit knowledge and theory. Third, it incorporates values, beliefs, and desires of the patients and their families. Finally, EBP facilitates the application of research findings by incorporating first- and second-hand knowledge into practice. Link to Practice 12-1 presents information on databases that nurses and others can access to find specific information on current guidelines and other collections of “evidence” that can be used to improve health care.

Link to Practice 12-1: Key Resources for Evidence-Based Practice

Several important databases have been set up over the last 20 years to promote integration of “evidence” in health care. Information on three of the most influential are presented here.

Cochrane Collaboration – http://www.cochrane.org/

The Cochrane Collaboration is an international network that helps health care practitioners, policy makers, patients, and their advocates make informed decisions about health care. The Cochrane Library prepares, updates, and promotes the accessibility of the Cochrane Database of Systematic Reviews.

Joanna Briggs Institute – http://www.joannabriggs.edu.au/

The Joanna Briggs Institute is an international research and development organization from the School of Translational Science at the University of Adelaide, South Australia. The Institute and its collaborating entities promote and support the synthesis, transfer, and utilization of evidence through identifying feasible, appropriate, meaningful, and effective health care practices to assist in the improvement of health care outcomes.

Agency for Healthcare Research and Quality (U.S. Preventative Services Task Force/National Guideline Clearinghouse) http://www.guideline.gov/

The National Guideline Clearinghouse (NGC) is a database of evidence-based clinical practice guidelines. It is intended to be used by health professionals, practitioners, patients, and others to obtain objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use.

CHAPTER 12: Evidence-Based Practice and Nursing Theory

Evelyn M. Wills

Melanie McEwen

Helen Soderstrom was stricken with changes in her vision, disturbances of gait, and occasional periods of severe fatigue during her senior year of nursing school. She experienced intermittent periods of normality as well as illness, and the periods when she had no symptoms lasted many months. During a time when her symptoms were unusually active, she sought medical help, and her physician determined that her symptoms were related to stress. Despite the periods of weakness and fatigue, she was able to complete the nursing program and graduated with honors.

During Helen’s first year of practice, she experienced two periods of symptom exacerbation, but each was short-lived. With full insurance, she was able to see a neurologist who concluded that she was experiencing the beginning stages of a neuromuscular disease. Because there was no “cure,” the neurologist worked with Helen to find interventions that helped her manage the symptoms when they became problematic.

After a few years in practice, Helen enrolled in a graduate program to work toward a career in nursing education. During her first year of graduate studies, she seldom experienced neurologic symptoms, but during her practice teaching course, they returned.

The recurrence of symptoms, along with a new understanding of evidence-based practice from her graduate courses, led Helen to make her personal health experience the topic of her final paper. To learn more, she sought resources that would help her gain better control of the neuromuscular symptoms as well as assist her in her studies. To that end, she contacted her University’s neuroscience department and joined a research team. As she learned more about EBP, she considered what system she would use to develop guidelines on symptom management and selected the Iowa Model because of its extensive use in research.

The idea of evidence-based practice (EBP) was introduced in the 1970s by Dr. Archie Cochrane, an Englishman who wrote a dynamic book questioning the efficacy of non–research-based practices in medicine (Melnyk & Fineout-Overholt, 2011). In particular, Dr. Cochrane emphasized the critical review of research, largely focusing on randomized control trials (RCTs) to support medical practice. His influence eventually led to development of the Cochrane Collaboration, an organization charged with developing, maintaining, and updating systematic reviews of health care interventions (Cochrane Collaboration, 2013). Although the notion of EBP was somewhat delayed in being recognized and implemented in nursing, over the past two decades, EBP has appeared with increasing frequency in the nursing literature and now has essentially become the standard for research-based, informed decision making for nursing care.

EBP is similar to research-based practice and has been called an approach to problem solving that conscientiously uses the current “best” evidence in the care of patients (LoBiondo-Wood & Haber, 2010). EBP involves identifying a clinical problem, searching the literature, critically evaluating the research evidence, and determining appropriate interventions. Nursing scholars note that EBP relies on integrating research, theory, and practice and is equivalent to theory-based practice as the objective of both is the highest level of safety and efficacy for patients (Fawcett & Garity, 2009).

Overview of Evidence-Based Practice

The concept of EBP is widely accepted as a requisite in health care. EBP is based on the premise that health professionals should not center practice on tradition and belief but on sound information grounded in research findings and scientific development (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012). Until the early part of the 21st century, the concept of EBP was more common in Canadian and English nursing literature than in U.S. nursing literature. Over the last decade, however, the term has become ubiquitous. This is attributed in part to the guideline initiatives of the Agency for Health Care Quality, the Institute of Medicine, and the U.S. Preventative Services Task Force, among others (Hudson, Duke, Haas, & Varnell, 2008; Melnyk & Fineout-Overholt, 2011).

Many nursing scholars (DiCenso, Guyatt, & Ciliska, 2005; Ingersoll, 2000; LoBiondo-Wood & Haber, 2010; Melnyk & Fineout-Overholt, 2011; Rycroft-Malone, 2004) have pointed out that EBP and research are not synonymous. They are both scholarly processes but focus on different phases of knowledge development—application versus discovery. In general, EBP refers to the integration of individual clinical expertise with the best available external clinical evidence from systematic research. It is largely based on research studies, particularly studies using clinical trials, meta-analysis, and studies of client outcomes, and it is more likely to be applied in practice settings that value the use of new knowledge and in settings that provide resources to access that knowledge.

Definition and Characteristics of Evidence-Based Practice

In medicine, EBP has been defined as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). It is an approach to health care practice in which the clinician is aware of the evidence that relates to clinical practice and the strength of that evidence (Jennings & Loan, 2001; Tod, Palfreyman, & Burke, 2004).

To distinguish nursing from medicine in discussing EBP, a number of definitions have been presented in the literature. Sigma Theta Tau International (2005, para. 4) defined “evidence-based nursing” as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.” Similarly, DiCenso and colleagues (2005) defined EBP as “the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (p. 4). Both of these definitions use similar terms (e.g., best evidence, expertise, patient values). Ingersoll (2000) used slightly different terms when she suggested that evidence-based nursing practice “is the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences” (p. 152).

In nursing, EBP generally includes careful review of research findings according to guidelines that nurse scholars have used to measure the merit of a study or group of studies. Evidence-based nursing de-emphasizes ritual, isolated, and unsystematic clinical experiences; ungrounded opinions; and tradition as a basis for practice and stresses the use of research findings. Other measures or factors, including nursing expertise, health resources, patient/family preferences, quality improvement efforts, and the consensus of recognized experts, are also incorporated as appropriate (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012).

In summary, EBP has several critical features. First, it is a problem-based approach and considers the context of the practitioner’s current experience. In addition, EBP brings together the best available evidence and current practice by combining research with tacit knowledge and theory. Third, it incorporates values, beliefs, and desires of the patients and their families. Finally, EBP facilitates the application of research findings by incorporating first- and second-hand knowledge into practice. Link to Practice 12-1 presents information on databases that nurses and others can access to find specific information on current guidelines and other collections of “evidence” that can be used to improve health care.

Link to Practice 12-1: Key Resources for Evidence-Based Practice

Several important databases have been set up over the last 20 years to promote integration of “evidence” in health care. Information on three of the most influential are presented here.

Cochrane Collaboration – http://www.cochrane.org/

The Cochrane Collaboration is an international network that helps health care practitioners, policy makers, patients, and their advocates make informed decisions about health care. The Cochrane Library prepares, updates, and promotes the accessibility of the Cochrane Database of Systematic Reviews.

Joanna Briggs Institute – http://www.joannabriggs.edu.au/

The Joanna Briggs Institute is an international research and development organization from the School of Translational Science at the University of Adelaide, South Australia. The Institute and its collaborating entities promote and support the synthesis, transfer, and utilization of evidence through identifying feasible, appropriate, meaningful, and effective health care practices to assist in the improvement of health care outcomes.

Agency for Healthcare Research and Quality (U.S. Preventative Services Task Force/National Guideline Clearinghouse) http://www.guideline.gov/

The National Guideline Clearinghouse (NGC) is a database of evidence-based clinical practice guidelines. It is intended to be used by health professionals, practitioners, patients, and others to obtain objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use.

CHAPTER 14: Theories From the Behavioral Sciences

Debra Brossett Garner

Darlene Williams is in a master’s degree program that will allow her to become an adult psychiatric/mental health nurse practitioner. In a course on the application of theory in nursing, one of her assignments is to write a paper describing how she has applied a theory in providing care for a client. Although Darlene has been working as a nurse in a psychiatric hospital for the past 10 years, she is finding this assignment difficult because, thus far in the course, the instructor has focused primarily on grand nursing theories. Darlene knows little about these theories because in her practice, she uses a broad, eclectic approach, predominantly applying theories from the behavioral sciences.

Darlene discusses her dilemma with her professor and learns that she can use any theory or set of theories for the assignment; it is not necessary to rely strictly on nursing theories. The discussion with her professor enlightens Darlene about the necessity of applying non-nursing theories to nursing practice. With the realization of the importance of theories from other disciplines to nursing, Darlene’s interest in the many psychologically based theories is piqued, and she conducts a literature review.

The person that Darlene chooses for her assignment is Alan, a 41-year-old Caucasian male, who is married and the father of two adolescents. Alan was admitted to the hospital with diagnoses of major depression, substance dependence with physiologic dependency, and hepatitis C. Assessments revealed that he had problems with his primary support group, problems related to the social environment, occupational problems, and problems related to interaction with the legal system.

Although this is Alan’s first hospitalization, he has had a long history of alcohol abuse. He also admits to using cocaine or marijuana occasionally on the weekends. His father was an alcoholic who died at the age of 44 years with cirrhosis of the liver. Although not actively suicidal, Alan expresses passive death wishes. Alan is a well-known member of the community and owns a large software business, which is on the verge of bankruptcy. His motivation for entering treatment is that his wife threatened to divorce him unless he stops using alcohol and drugs.

In reviewing Alan’s care, Darlene plans to use a holistic approach, incorporating principles and concepts from various theories. The first theory that Darlene chooses is Freud’s psychoanalytic theory because of Alan’s denial. This theory is relevant because Freud discussed how an individual uses defense mechanisms to decrease anxiety, and Darlene knows that a major defense mechanism of alcoholism is denial. Darlene also thinks the cognitive-behavioral theories are appropriate because she believes that humans need to change cognition to change behavior. Because Darlene assumes that drinking and using drugs are means of coping, she plans to use Lazarus’s coping theory to help Alan develop more effective coping strategies. Finally, Darlene plans to apply humanistic psychology because she believes that Alan, like all individuals, has the potential to change, and social psychology theories address health beliefs and intent to change.

As discussed in Chapter 1, nursing is a practice discipline, and practice disciplines are considered to be applied sciences rather than pure or basic sciences (Johnson, 1959). The object of both pure and applied sciences is the same (to achieve knowledge), but according to Folta (1968), the difference between the two is their emphasis. In pure science, the emphasis is on basic research, which focuses on the application of the scientific method to add abstract knowledge. In contrast, the emphasis in applied science is on research related to the application and testing of the abstract concepts. Thus, applied sciences use the scientific method to apply and test fundamental knowledge or principles in practice. Historically, nursing science has drawn much of its knowledge from the basic sciences and then applied that knowledge to the discipline of nursing.

In learning about theories used in nursing, it is important to remember that nursing has evolved over decades and that the knowledge base for the discipline is a compilation of phenomena from many different disciplines. In the case study, Darlene discovered the notion of “shared” or “borrowed” versus “unique” theory. Johnson (1968) has defined borrowed theories as knowledge that has been identified in other disciplines and is used in nursing. According to Johnson, knowledge does not belong to any discipline but is shared across many disciplines; thus, nursing science draws on the knowledge of other disciplines to enhance the knowledge required for nursing practice.

One of the areas from which nurses draw theoretical understanding are the psychological sciences, sometimes referred to as the behavioral sciences. The contribution of the behavioral sciences to knowledge in nursing science and nursing practice cannot be denied. Even though the basic theories, concepts, and frameworks are derived from another discipline, they are applied in nursing practice. Additionally, they are frequently applied in nursing research as well as nursing education and administration.

There are many psychological theories, and it would be impossible to cover all of them in this chapter. Major theories were chosen to illustrate concepts that are used in nursing. For the purposes of this chapter, the psychological theories will be viewed in four categories: psychodynamic theories, behavioral and cognitive-behavioral theories, humanistic theories, and stress-adaptation theories. These theories look at an individual and how an individual responds to stimuli. In psychology, there is also a special field known as social psychology, which examines how society or groups of individuals respond to various stimuli. This chapter will examine two theories of social psychology commonly used in nursing: the Health Belief Model and the Theory of Reasoned Action.

Psychodynamic Theories

The late 1800s saw the creation of a new discipline, psychology/psychiatry, with a new body of knowledge. Before Sigmund Freud presented his radical works describing human thoughts and behaviors, people were considered to be either “good” or “bad,” “normal” or “crazy.” His work led to a major paradigm shift as scientists began to consider the thought processes of “man” and to speculate about human personality. From this paradigm shift came a number of psychological theories.

Freud’s thinking was considered radical in the early 1900s. Even now in the early 21st century, many people still consider his work radical, yet others believe it to be antiquated. Despite this, his basic ideas and concepts have been used and modified extensively in the development of numerous theories about human thought and behavior.

Psychodynamic theories attempt to explain the multidimensional nature of behavior and understand how an individual’s personality and behavior interface. They also provide a systematic way of identifying and understanding behavior. This section describes three psychodynamic theories—the works of Freud, Erikson, and Sullivan. These three theories are also called “stage theories,” meaning that they describe clearly defined stages at which new behaviors appear based on social and motivational influences. Table 14-1 compares the developmental stages of the three theories.

Table 14-1: Stages of Development

Theorist

Developmental Emphasis

Stages

Sigmund Freud

Psychosexual

· 1. Oral

· 2. Anal

· 3. Phallic

· 4. Latency

· 5. Genital

Erik E. Erikson

Psychosocial

· 1. Trust versus mistrust

· 2. Autonomy versus shame and doubt

· 3. Initiative versus guilt

· 4. Industry versus inferiority

· 5. Identity versus identity confusion

· 6. Intimacy versus isolation

· 7. Generativity versus stagnation

· 8. Integrity versus despair

Harry S. Sullivan

Interpersonal

· 1. Infancy

· 2. Childhood

· 3. Juvenile

· 4. Preadolescence

· 5. Early adolescence

· 6. Late adolescence

Psychoanalytic Theory: Freud

According to Freudian theory, behavior is nearly always the product of an interaction among the three major systems of the personality: the id, ego, and superego. Even though each of these systems has its own functions, properties, and components, they

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