Connecting Nursing Theory and Evidence-Based Change Models

Connecting Nursing Theory and Evidence-based Change Models
January 29th, 2022
The adoption of computerized provider order entry (CPOE) facilitates the prescription of patient services by physicians through electronic means instead of paper-based entries. People with dementia need full-time care, especially during the later stages of their conditions. Besides, the caregivers require access to reliable information about their treatment, which impacts the quality of care and outcomes (Soong et al., 2020). Medication errors often occur among multimorbid older patients with complex daily medications. Conditions such as dementia, delirium, or acute stroke are common among geriatric patients and significantly impact the quality of communication and care. However, the well-being of persons with dementia may be enhanced using appropriate nursing interventions supported by evidence-based practice (EBP). Using Swanson’s mid-range theory of caring and Lewin’s Theory of Change, this paper will outline how effective implementation of CPOE can reduce medication errors among patients with dementia in a long-term care setting in nursing homes.
Theoretical Foundations
Believing, knowing, being with, doing for, and enabling patients through EBP is the foundation of providing better nursing care to geriatric patients with dementia in long-term care. These elements are outlined in Swanson’s mid-range theory of caring, which involves five processes. The use of CPOE in caring for this vulnerable population embraces Swanson’s theory of nursing that not only focuses on understanding the needs of dementia patients but also further calls for supporting them in their conditions.
Nursing Theory
Kristen Swanson’s (1991) middle-range theory of caring defines care of patients and their family members through five processes of caring, including maintaining belief, knowing, being with, doing for, and supporting or enabling them (Michele, 2018). Understanding the five steps or processes in Swanson’s theory is critical to the application of CPOE intervention in reducing cases of medication errors while caring for dementia patients.
Swanson’s (1991) Theory of Caring. In her mid-range theory of caring, Swanson (1991) describes five processes: knowing, believing, being with, doing for, and enabling patients during their illnesses (Michele, 2018). Knowing involves striving to understand the events or the patients’ conditions and how they impact their lives. In this process, care providers avoid assumptions by focusing on the patient, assessing, seeking cues, and engaging them during the care process. In maintaining belief, Swanson outlines that care providers should sustain faith in the patients’ capacity to achieve better outcomes. In achieving these goals, nurses should maintain a hope-filled attitude and offer realistic and optimistic settings that will enable patients to realize the care objectives. The theorist defines being with as getting emotionally connected with the patient during care and striving to understand the patients’ conditions and what they mean in terms of the quality of their lives. Besides mere understanding of the patients’ plight, Swanson directs that nurses should be emotionally open to the realities the patients are undergoing. The fourth process is doing for patients what they are not able to do for themselves. This aspect involves anticipating, comforting, and protecting their needs professionally and with high competency levels. While implementing the process of doing for, nurses should demonstrate the highest levels of professionalism to preserve dignity. Lastly, the process of enabling facilitates patients to transition and achieve expected outcomes (Michele, 2018). This step should support patients throughout the process of healing during care interventions.
The application of CPOE in preventing medication errors among geriatric patients with dementia in long-term care settings embraces Swanson’s theory of caring as evidenced by the five processes described in the model. As a nurse educator, Michele (2018) maintains that it is important to understand students’ personal and academic needs to be able to tailor effective teaching strategy that meets their individual needs. Similarly, CPOE ensures the collection and storing of accurate records about patients’ data and breaks the barriers of communication that are characterized among elderly patients. However, while nurses may rely on the technology, there are ways of interacting with the patient to understand how they are progressing in their conditions by taking notes for CPOE. This is another aspect of Swanson’s theory where care providers believe that issues such as medication errors would be avoided by maintaining accurate records, and patients will ultimately have better outcomes. The emotional connection will only be achieved by discussing with the patient accurate information about their condition. If errors occur in recording this information due to paper-based systems, this connection will be lost. CPOE also makes it easy for practitioners to carry out some tasks that dementia patients might not be able to do for themselves, like remembering when and how to take medications. Lastly, the technology also facilitates the enabling process and achieves the anticipated goals.
Clinical Question. The clinical question seeks to investigate the impact of CPOE in reducing medication errors in patients with dementia in long-term care, and the PICOT question will be:
To what degree implements computerized provider order entry (CPOE) (I) impacts medication safety (O) when compared to paper-based entries (C) among dementia patients (P) in a long-term care setting in the United States.
CPOE has been around for more than a decade in the United States and has helped providers deliver safe and quality care. Fisher et al. (2020) have found that while the use of CPOE between 2014 and 2016 increased from 58 to 67 percent in the United States, there are still challenges in the implementation of this intervention in reducing medication errors. Besides, it has been shown that less than the optimal application of this technology largely impacts patient outcomes (Fisher et al., 2020). Providers will only gain a better understanding of their patients and be able to support their needs if they have accurate accounts of their clients/patients. This understanding is the foundation of better care and patient outcomes, as outlined in Swanson’s theory of caring.
Synthesis of Theory. Martenson et al.’s (2020) study has developed and tested a Caring Behavioral Colding Scheme that is based on Swanson’s theory that aims to code different encounters between patients and their care providers. The authors realize the importance of defining and assessing verbal and non-verbal caring and non-caring behaviors during care delivery in maintaining the well-being and dignity of patients as well as alleviating their suffering. Michelle (2018) argues that Swanson’s middle-range theory is appropriate for nurse educators who can utilize the caring processes in teaching nursing students through the cultivation of meaningful and healing relationships. Michelle’s (2018) paper offers an example of how this theory can be applied among nursing faculty members to their teaching pedagogy. It serves as a guide to therapeutic teaching and encourages further research into examining t...