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Models and Theories of Practice
Professional practice models have always been defined differently in the nursing world; however, the collective definition narrows down to the reliance on professionalism for the delivery of care which the main objective is always to improve the outcomes of patients. The delivery of care has undergone numerous changes in the last two decades. During the years of the 1990s the hospitals had fragmented systems of operation which led to an increase in frustration among nurses, dissatisfaction in the job, and an exodus from the occupation of nursing. The nurses regularly left the patients side due to such issues as lack of ability and supplies for advocating for the patient and also the lack of participation when the care plans are being developed. As the knowledge base of the science of nursing is built models are used to guide the practice of the professional framework. Models make the foundation that sets a mutual goal and facilitates the priority for the care of the patient via the entire team involved in healthcare.
With a clear model, it is easier to articulate the impact that the nursing care has and thus apply such structures in fostering decision-making, job satisfaction, professional identity, interdisciplinary communication, and improved family and patient outcome (Melnyk & Fineout-Overholt , 2004).
Attributes of Models of Practice
They reflect the nursing value which is important in exemplifying the organization culture. The most common attributes are in the autonomy of nursing, cost-effective, empowerment, and quality care. The primary objective of a practice model is in supporting the relationship between the patient and the nurse. When the nurses are involved in the decision-making process, the quality of care is improved, and satisfaction of the patient and family is enhanced. Also, the characteristics are associated with nurse recruitment, retention, and engagement. If a nurse of an organization signs up for a model of practice, the results are patients’ comfort, wellness, healing, prevention, and wellness. Nurses, on the other hand, have improved communication and practice, autonomy, powerful teams, engagement, and interaction with patients.
The evidence practice model in the field of nursing is available for various conditions inclusive of heart failure, diabetes, and asthma. The practices are however not usually implemented in the delivery of care and the abound practices variation (DiCenso , Ciliska , & Cullum , 2005). EBP refers to the judicious and conscientious application of the best evidence coupled with the expertise of clinicians and the values of patients to provide the guidance in decision making for the health care system. Here best evidence represents the empirical evidence sourced from the controlled trials that are randomized, evidence from other methods of science including qualitative and descriptive research and also the case reports information, principles of science and expert opinion (Institute of Medicine, 2001).
Models of Practice
| Model Characteristics for the Evidence-based practice model | Application to Your Advanced Practice Role |
| Characteristic 1: health care delivery is dynamic | Because the health care practice is subject to change, it is best if the delivery is based on well-researched methods backed up by evidence. |
| Characteristic 2: need for change in the nursing practice | Because different stakeholders are involved in the health sector Internal data about a given organization and the system being used is important for nursing. External data also helps in improving the application of internal data which enhances delivery of health care services which gives an assurance of satisfaction to the patient and family (DiCenso , Ciliska , & Cullum , 2005). It is relatively important that a problem is identified when tackling a given situation in the hospital. |
| Characteristic 3: outcome and intervention in problems. | Involves using the systems of classification that are standardized inclusive of the language. Identification of potential activities and interventions. Selection of indicators for the outcomes in the nursing practice. |
| Characteristic 4: synthesis of the best evidence | Searching in the research literature which is related to the major variables involved in the field of practice. Weighing and critiquing of the evidence collected. Assessing the benefits, risks, and feasibility of the activities and evidence collected from them. |
| Characteristic 5: designing the changes in the practice. | Definition of the change that has been proposed in the sector practice. Identification of the resources needed to effect the change. Planning on the process of implementation for a smooth transition (Titler , 2006). Definition of the outcomes expected as a result of the change implementation. |
| Characteristic 6: evaluating and implementing the changes required in practice. | Conducting demonstrations through pilot studies. Evaluating the outcome and process due to the change implementation Decision-making on whether to adopt, reject, or adapt the change in the practice as proposed as related to the outcome. |
| Characteristic 6: Maintenance and integration of the change in the practice | Communicating to the stakeholders on the recommendations for change Presenting in-service of the staff education regarding the change in practice. Integrating the practice standards into the organization. Monitoring both the process and outcomes to ensure that the change process is implemented as desired and where possible, changes are made to adapt to the situation of practice. |
The model above makes a pragmatic provision on the framework that is theoretically driven ensuring that the clinicians are empowered when implementing the practice that is evidence based. The major objectives that are to be achieved by the implementation of the model include:
- The development of skills and knowledge in the assembling of topics that are critically appraised as is sourced from the questions in nursing.
- Recognition of the gaps in knowledge and articulating clinical questions that are well articulated and answerable (Titler , 2006).
- Evaluation and searching of the literature in health sciences and nursing in collaboration and guidance from the Library Sciences (Institute of Medicine, 2001). A review initially conducted on the retrieved citations shows that there are a variety of potentially interesting terms of indexing.
- Presentation of the conclusions that are evidence-based to the nursing practice application.
- Using the interaction between teams and groups as a means toward the education on the process of EBNP and in learning within the organization.
- Development of a culture that allows for self-perpetuation on the sector of the EBNP process.
Conclusion
The models used in nursing have
received so much criticism despite the earlier enthusiasm that was associated with the development of such
models. The criticism has been either extrinsic or intrinsic. The intrinsic
criticism is related to the model itself and may be such factors as the
language applied to the model or the
values and beliefs. The extrinsic on the other hand are related to external
model factors inclusive of the approach taken towards implementation, motives
that led to the development of such models, and the change attitudes
accompanying the model. That said, the models have come as a significant stage
in the nursing practice and the
development of the discipline (Melnyk & Fineout-Overholt ,
2004).
