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Respond to at least two colleagues on 2 different days by suggesting other middle-range theories for them to consider. Support your recommendations with at least one scholarly article to share with each colleague. use 2 sources each 

1. Week 2 initial Discussion NURS 8114

Middle-Range Theories and Patient Care

 According to studies, the discipline of nursing recognizes middle-range theories as one of the contemporary trends in knowledge development to support nursing practice and research that address a particular population of clients (McEwen & Wills, 2019). Data collection, analysis, and formulation of practice are ongoing processes for DNP-prepared providers, which, in return, improve patient care.

Practice Issue: Reducing restraints and seclusion in inpatient psychiatric units.

Restraints or seclusion are the last resort to keep patients from serious harm to themselves or others. Restraints or seclusion are not used if less restrictive alternatives can address the risk of harm. Four categories of restraints utilized at the facility include mechanical, physical, medication, and seclusion. Seclusion occurs whenever a patient is both confined and isolated. Whenever a patient is in restraints or seclusion, a staff person trained to understand, assist, and offer therapy is assigned to attend to this patient.

There is a debriefing process after the restraints or seclusion, where the patient meets with the treatment team to discuss the events contributing to the restraints process. The discussion includes the precipitating circumstances, the actual restraint process, patients’ thoughts and feelings regarding the process, and his/her current behavioral controls. To mitigate the reduction of restraints and seclusion, staff explore what factors precipitated the restraints and seclusion, what interventions might have prevented the restraints and seclusion episode, and any suggestions on how to avoid further restraints and seclusion. Monitoring the rates of restraints and seclusion is a requirement of the hospital’s performance improvement department. Appropriate treatment and interventions need to be explored and implemented to decrease the rate of these episodes and maintain the safety of patients and staff.

Problem-based learning Theory

Problem-based learning (PBL) is a teaching method in which a practice-based challenge engages learners. The reasoning behind PBL is that when seeking to motivate learners, any training should reflect the reality of their work environment. PBL was developed in the 1960s when researchers found that medical students perceived much of the knowledge that they were presented with as irrelevant to practice; instead, the researchers proposed that educators should seek to engage learners by using scenarios and information relevant to solving real clinical problems (Sahota, 2020). Staff working in inpatient psychiatric facilities are required to be trained and demonstrate an understanding of how to identify maladaptive behaviors in patients before they escalate to the point of being restrained or secluded.

 In PBL, a facilitator encourages learners to analyze a challenge they have encountered in clinical practice and identify potential solutions.  One technique facilitators can use to support learners is asking open-ended questions, which enable reflection and discussion, rather than closed-ended questions, which prompt learners to agree or disagree. Another technique is to set learners SMART (specific, measurable, achievable, relevant, and time-bound) objectives (Sahota, 2020). PBL can inform quality improvement projects, result in changes that rationalize practice with new policies, or lead to the implementation of new protocols and standard operating procedures, ultimately strengthening the stability of an organization. PBL could be used to review serious patient safety incidents, identify the factors that led to these incidents, and discuss in practical terms how to prevent similar incidents. PBL could enable them to express their frustrations, explore potential solutions, and attempt to implement these (Sahota, 2020).

Implementing patient safety education through PBL positively affects knowledge, attitudes, and perceptions of patient safety. Nurses are leading healthcare team members. They are responsible for ensuring patient safety. Graduate nurses should have sufficient knowledge to identify potential safety risks. They should be confident in protecting patients against preventable harm or adverse events (Jamshidi et al., 2021).

 Application of Theory in Practice

Patients with psychiatric and mental health disorders in inpatient facilities are present with different conditions at different stages of recovery. They require additional treatment regimens to manage their symptoms. As a doctoral-prepared practitioner and in collaboration with other team members, I will strive to research data that can support the de-escalation techniques and crisis management to reduce episodes of restraints and seclusion. In PBL, problem-solving is used for higher-level learning because it encourages learners to apply theory to practice through experience and teamwork (Sahota, 2020). Educating staff on mental health and how to care for those diagnosed with the disorders will be a crucial factor in decreasing restraints and seclusion, as staff can intervene before behaviors escalate.

References

Jamshidi, H., Hemmati Maslakpak, M., & Parizad, N. (2021, April 29). Does problem-based learning education improve knowledge, attitude, and perception toward patient safety among nursing students? A randomized controlled trial. BMC nursing. Retrieved March 11, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086128/Links to an external site..

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.  

Sahota, S. (2020). Using problem-based learning to improve patient safety in the emergency department. Emergency Nurse, 28(2), 37–42. https://doi.org/10.7748/en.2020.e1958

ReplyReply to Comment

  • Collapse SubdiscussionSolomon Soroibe OkwuezeSolomon Soroibe Okwueze
    TuesdayDec 5 at 5:34amManage Discussion EntryHi Marygoretti,
    Thanks for the great post. This is an excellent discussion post. Another middle-range theory that I suggest could complement the problem-based learning (PBL) approach is the self-efficacy theory by Bandura (Bandura, 2019). This theory focuses on the belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations. In the context of psychiatric patient care, this theory could benefit the staff and patients.
    For staff, incorporating training that enhances their belief in their ability to manage challenging situations without resorting to restraints or seclusion can be beneficial. When staff feel more confident in their skills, they may be more likely to employ alternative strategies for de-escalation and patient engagement. For patients, focusing on building their self-efficacy can empower them to better manage their behaviors and participate more actively in their treatment plans. An example of applying the Self-Efficacy Theory is through tailored educational programs that provide staff with realistic simulations of patient interactions. These simulations can challenge the staff progressively, enhancing their skills and confidence in handling difficult situations.
    Additional research supports the relevance of self-efficacy in healthcare settings. A study by Bandura (2019) explored the broad applications of the theory, emphasizing its role in health promotion and disease prevention. Another research by Schwarzer and Fuchs (2019) highlighted the importance of self-efficacy in adopting healthy behaviors, which can be particularly relevant for patients with psychiatric conditions.
    In support of this recommendation, a study by Levett-Jones et al. (2020) demonstrates the effectiveness of simulation-based learning in improving nurses’ self-efficacy and preparedness for clinical practice. This aligns with the Self-Efficacy Theory by showing how specific training can enhance one’s belief in their abilities, leading to better patient care outcomes.

    Reference:
    Bandura, A. (2019). Self-efficacy: The exercise of control. W.H. Freeman.

    Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., Arthur, C., & Roche, J. (2020). The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Nurse Education Today, 30(7), 705-710. https://doi.org/10.1016/j.nedt.2010.01.004

    Schwarzer, R., & Fuchs, R. (2019). Self-efficacy and health behaviours. In M. Conner & P. Norman (Eds.), Predicting health behaviour (pp. 163-196). Open University Press.

2.Exploring Middle-Range Theories and Framing Practice Issues

Although there is a greater awareness of mental health issues than there was a few years ago, getting treatment is still stigmatized (Holthaus, 2019). This thus gives rise to the practical problem of treatment non-adherence, which has an impact on the general health and safety of the patient. In order to improve patient outcomes, the psychiatry nurse practitioner’s job is to enhance the patient’s perspective on seeking treatment by facilitating appropriate channels of involvement throughout the entire process.

Barker’s tidal mental health recovery model is the first useful middle-range theory based on the practice issue. This theory offers a paradigm for enhancing patient adherence to therapy and is unique to the field of mental health. Empowerment, self-discovery, and holistic care are the key ideas discussed (McEwen & Wills, 2019). The philosophy places a strong emphasis on empowering the patient by allowing them to use their story to express themselves. Through their voice, identity, life experiences, and the impact of societal pressures on their mental health, the patient can communicate their needs (Bag, 2019). This dialogue is beneficial because it gives the patient a sense of empowerment and helps to counteract any discriminatory feelings they may have. It is the nurse’s responsibility to foster an atmosphere that permits this kind of dialogue.

I would also use Madeleine Leininger’s model as my second theory. In certain cultures, stigma and discrimination are more common than in others. Consequently, by comprehending the theory’s ideas, the nurse is able to incorporate a culturally competent mental health treatment plan that is tailored to the patient’s needs. The nursing profession must meet the needs of a community that is becoming more diverse. By incorporating this approach, nurses may provide patients with the best possible care while taking into account the cultural differences between them. Understanding culture and using it with tact are beneficial in the field of mental health. (2020, Stubbe).

References

Bag, B. (2019). Tidal model in mental health and psychiatric nursing practices. Psikiyatride Güncel Yaklaşımlar, 11(4), 547-560. doi:10.18863/pgy.411672

Holthaus, J. (2019, May 2). The Importance of Mental Health Awareness – Pine Rest Newsroom. Pinterest. https://www.pinerest.org/newsroom/articles/mental-health-awareness-blog/

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.  

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49-51.

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