Topic 1

How can the DNP-prepared nurse apply the concepts of a complex adaptive system to individual patient care? Provide examples.

Complex = hard to predict or comprehend; Dynamic = shifting; Adaptive = Adapting to a specific condition or environment. A complex system may be defined as a group of simple agents or units that interact within a system. It represents an extensive system with adapting, changing or evolving behaviors (Resnick & Collins, 1998).

A CAS (Complex Adaptive System) deals with management practice change and reformation of nursing leader thought, problem-solving approach, and behavior. It rejects prior beliefs and adopts the attractor (catalyst which facilitates spontaneous emergence of novel behaviors) and self-organization ideas, promoting the development of innovation and order (Penprase & Norris, 2005). Complexity science emphasizes the fact that an institution’s most powerful mechanisms commence with its workforce, and provides novel nurse leadership approaches to effectively navigate the healthcare setting’s complex, turbulent atmosphere.

One can view the nursing profession and overall healthcare system as CASs to gain fresh insights. According to McNeill and Chaffee (2007), though numerous scholars actually consider nursing a CAS, the discipline is yet to advance a relevant visual model.

DNP-prepared nursing professionals need to recognize the fact that things won’t be exactly in line with theory within actual clinical settings. A CAS is complex owing to the dynamic interactional networks, with linkages not being the sum of distinct static entities. In other words, individual elements’ behavior isn’t predictive of collective behavior. Nurses need to be quick-witted to promptly handle unforeseen events. For example, a nursing staff member may face the dilemma of dealing with a patient who is bleeding excessively and simultaneously having to meet the needs of another diverse patient population; he/she needs to decide which issue to address first. These occasions require nursing professionals to demonstrate leadership and skill. Emergency rooms commonly face such challenging CAS scenarios and nurses need to prioritize saving lives and stabilizing high-risk persons.

Topic 2

Research change theories in scholarly literature and on the Internet. Develop a scenario and describe application of a change theory from the perspective of an advanced practice nurse leader.

Change implies altering the original state of things. It may be unplanned or planned. The former is linked to unpredictable results whereas the latter represents a series of events executed for attaining certain set objectives.

Change Agents in Nursing

Within the context of nursing, change agents are individuals (whether staff nurses, nursing leaders or other persons working in collaboration with nursing staff) who effect change which influences nursing services. Change theories help achieve planned change. It is vital for nursing leadership and staff members to familiarize themselves with change theories in order to be able to choose the appropriate theory which fits the context.

Lewin’s Change Theory

This three-stage theory popular among nursing staff encompasses unfreezing, moving and refreezing (Oguejiofo, 2018). It is governed by resistant and driving forces. The former are staff members who oppose change and the latter are change agents that persuade the workforce to adopt change. This theory’s success necessitates domination of resistant forces by driving forces (Tiffany & Lutjens, 1998).

Rogers’ Change Theory

Rogers came up with a 5-stage modification of Lewin’s theory, including awareness, interest, assessment, acceptance and execution. It is applicable to long-run change projects and works where nursing staff who, up until now, ignored change, decide to implement it by being convinced by the statements of peers who already implemented it.

Within Lewin’s theory of change, ‘unfrozen’ individuals may start moving. The theorist understood change as a process in which an institution needs to shift to a novel state (Study.com, 2018). This step of moving or transitioning is characterized by change implementation or actually effecting change. Therefore, at this point of time, the majority of skeptical individuals struggle with their new reality, rendering this the most challenging stage in the change process (Study.com, 2018). At this stage, individuals start learning new processes and behaviors, and adopt new approaches. With increased preparedness for this phase, completing it becomes easier. Thus, guidance, information, time, and clear communication are crucial to personnel attempting to familiarize themselves with change (Study.com, 2018). Once again, there is a need to stress the importance of careful planning and execution. All through the course of this process, the reasons underlying this change ought to be reiterated before the workforce, in addition to the associated advantages following its full implementation.

Lewin’s theory of change may prove appropriate in the advanced practice nursing setting, when integrating novel technology or adopting novel safety standards within nursing care. ‘Unfreezing’ necessitates considerable driving force for acquiring nurse practitioners’ interest in novel concepts. This phase must incorporate much theoretical and practical learning and. Further, Lewin’s theory would greatly aid attempts at getting ignorant, rebelling employees back on track. Lastly, the theory can build the necessary momentum for change.

Topic 3

Which science-based theories do you think are the most useful to advanced practice nurses, and why?

In my opinion, the change theories put forward by Lewin, Spradley and Rogers would prove most valuable as they all address change planning and promote adoption of the most advanced systems to further the field of nursing. The two latter theories are based on the former. Spradley’s theory of change encompasses the following steps: symptom recognition, issue diagnosis, analysis of alternatives, change selection, change planning, change implementation, change evaluation and change stabilization. Meanwhile, Rogers’ theory incorporates the steps of awareness, interest, assessment, acceptance and execution. It basically confirms Lewin’s unfreezing idea by galvanizing ignorant and uninterested employees through banking on the experiences of their peers who have already adopted change.

Topic 4

Explore various science-based theories. Select two theories to describe to your peers. How is each of these theories relevant to application for a DNP-prepared nurse?

According to Peplau, nursing is an interpersonal therapeutic interactional process between a patient and nursing professional trained especially to recognize and appropriately respond to the patient. This educative tool and maturing force entails interactions among at least two persons having a shared objective (Peplau, 1997). Within the nursing care context, the above shared objective is a motivating factor, with patient as well as nurse respecting one another as people and growing and learning from the interaction (Peplau, 1997). A person learns by selecting and reacting to the selected environmental stimuli.

Fawcett, Peplau and Helene Fuld Health Trust (2005) understand interpersonal psychology’s contribution to conflict and anxiety management. DNP-prepared nurses are a great public asset, owing to their advanced community-level knowledge and expertise. Well-prepared nursing professionals need to be able to identify patients’ needs and deliver relevant therapeutic interventions.

A relatively newer nursing theory – Transcultural Nursing – was put forward by Madeleine Leininger in the year 1978. The theorist claims the nursing profession aims at providing care in line with patients’ cultural traditions, values, and outlook (Leininger & McFarland, 2011). Care forms the core of the nursing profession, and its characteristic, unifying and influential feature. Without caring, cure is impossible, but caring and curing may occur together (Busher Betancourt, 2015). Healthcare providers ought to attempt to understand care and diverse cultural values, lifestyles and health beliefs. This constitutes the basis of delivering culturally-sensitive patient care.

DNP-prepared nursing professionals need to be capable of catering to the needs of patients hailing from diverse cultural backgrounds. They need to effectively engage in therapeutic interpersonal communication with patients for relieving them of their anxiety, and resolving practice-related conflicts.

References

Busher Betancourt, D. A. (2015). Madeleine Leininger and the Transcultural Theory of Nursing. The Downtown Review. Iss, 2(1), 1–8.

Chaffee, M. W., & McNeill, M. M. (2007). A model of nursing as a complex adaptive system. Nursing Outlook, 55(5).

Leininger, M. M., & McFarland, M. R. (2011). Transcultural nursing: Concepts, theories, research and practice. New York: McGraw Hill Professional.

Oguejiofo, N., (2018). Change Theories in Nursing. Retrieved 12, February, 2018, from https://bizfluent.com/about-5544426-change-theories-nursing.html

Peplau, H. E. (1997). Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162–167.

Peplau, H. E., Fawcett, J., & Helene Fuld Health Trust. (2005). Hildegard Peplau: Interpersonal relations in nursing. Athens : FITNE

Penprase, B., & Norris, D. (2005). What nurse leaders should know about complex adaptive systems theory. Nursing Leadership Forum, 9(3), 127–32.

Resnick, M., & Collins, A. (1998). Adventures in Modeling: Exploring Complex Dynamic Systems with StarLogo. New York Teachers College Press National Science Education Standards A Political Document Journal of Research in Science Teaching, 35(7 SRC-GoogleScholar FG-0), 711–727.

Study.com (2018). Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing. Retrieved 12, February, 2018, from: https://study.com/academy/lesson/lewins-3- stage-model-of-change-unfreezing-changing-refreezing.html

Tiffany, C. R., & Lutjens, L. R. J. (1998). Planned change theories for nursing: Review, analysis, and implications. Thousand Oaks, Ca: Sage.

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