NUR 700 Theory Selection and Critical Analysis

Chatham University

DNP Program

NUR700: Structure and Application of Contemporary Nursing Knowledge

Theory Selection and Critical Analysis (55 points / 25% of final grade)

Supports SLO: 2, 3, 5, and 6

For this assignment you will explore, identify, and critically analyze, a theory that could be used as a framework for directing the future actions you identified in the Ways of Knowing assignment. In addition, you will professionally reflect on your critical analysis and describe how exposure to a theory may lead an individual to think differently about their own experience, professional role, and future directions of their work. Note: The content of this assignment could serve as draft for a discussion related to ”Theory” in Chapter 3 of the final capstone document.

Assignment Guidelines:

To begin this assignment you will first select a theory. The theory can be either borrowed or from the discipline of nursing. After you select the theory, you will address each of the items below in a written scholarly paper. The items reflect the processes involved in forming a complete description of a theory as discussed in Chapter 8 of Chinn and Kramer.

Begin this assignment with an introduction. The introduction should include a discussion that provides:
A brief succinct overview of the professional experience and future actions discussed in the Ways of Knowing
A statement that explains the purpose of the assignment (e.g., The purpose of this assignment is to……).
After your introduction, discuss the following content using appropriate APA level headings:
Description of the Theory – Provide the name of the theory. Identify if the theory is borrowed, or if from the discipline of nursing. Then, identify the author of the theory, and the date the theory was established. Utilize primary rather than secondary resources. NUR 700 Theory Selection and Critical Analysis
Purpose of the Theory – Provide a descriptive summary of the purpose of the theory. In your summary specifically speak to the context and situations in which the theory is useful. In your summary clearly identify how the purpose of this theory is linked to the future actions you identified in the Ways of Knowing
Concepts of the Theory – Provide a descriptive summary of the concepts (words or groups of words that represent objects, properties, and / or events) within the theory. In your summary clearly identify how the concepts are linked to the future actions you identified in the Ways of Knowing
Definitions in the Theory – Provide a clear definition for each concept that was identified. The definitions should be presented in conceptual terms within the context of the theory.
Relationships in the Theory – Provide a descriptive summary of the linkages among and between the concepts associated with the theory.
Structure of the Theory – Provide a clear description of the structure of the theory (choose from one of the examples on pg 195 of Chinn and Kramer). In your description clearly identify how you arrived at your conclusion.
Assumptions in the Theory – Provide a clear description of the assumptions associated with the theory. In your description clearly identify if the assumptions are factual assumptions or value assumptions. Also in your description clearly speak to how the exposure to differing assumptions may open new perceptions with regards to going “outside of the box” of common practice and procedures.
Application to Professional Practice – Provide a descriptive summary your critical analysis findings. In your summary thoroughly discuss the application of the theory in terms of providing guidance for the future actions identified in the Ways of Knowing
End your paper with a conclusion. The conclusion should present a brief summary of the key takeaway points of the paper. The conclusion should not present any new information. NUR 700 Theory Selection and Critical Analysis
Scholarly Writing Guidelines:

Grammar, spelling, and APA writing style will be graded according to doctoral level expectations. Please proofread carefully.
Your paper should be double-spaced with one inch margins, and include:
A title page and a reference page (Note: all in-text citations and sources listed on the reference page should be according to APA 6th edition).
Times New Roman 12 pt font throughout entire document.
Page numbers.
A running head.
APA 6th edition formatted subject level headings.
Rubric:

Criteria and Total points Student Points
Introduction = 3 points
· Provided a brief succinct overview of the professional experience and future actions discussed in the Ways of Knowing assignment (2 points)

· Stated the purpose of the assignment (1 point)

Components of Complete Description of a Theory = 40 points
· Description of the Theory – Provided the name of the theory. Identified if the theory is borrowed, or if from the discipline of nursing. Identified the author of the theory, and the date the theory was established. Utilize primary rather than secondary resources. (4 points)

· Purpose of the Theory – Provided a descriptive summary of the purpose of the theory. Specifically spoke to the context and situations in which the theory is useful. Clearly identified how the purpose of this theory is linked to the future actions identified in the Ways of Knowing assignment (6 points)

· Concepts of the Theory – Provided a descriptive summary of the concepts within the theory. Clearly identified how the concepts are linked to the future actions you identified in the Ways of Knowing assignment (6 points) NUR 700 Theory Selection and Critical Analysis

· Definitions in the Theory – Provided a clear definition for each concept that was identified. The definitions are presented in conceptual terms within the context of the theory (4 points)

· Relationships in the Theory – Provided a descriptive summary of the linkages among and between the concepts associated with the theory (4 points)

· Structure of the Theory – Provided a clear description of the structure of the theory with a sound rationale (4 points)

· Assumptions in the Theory – Provided a clear description of the assumptions associated with the theory. Clearly identify if the assumptions are factual assumptions or value assumptions. Clearly addressed how the exposure to differing assumptions may open new perceptions with regards to going “outside of the box” of common practice and procedures (6 points)

· Application to Professional Practice – Provided a descriptive summary of the critical analysis findings. Thoroughly discussed the application of the theory in terms of providing guidance for the future actions identified in the Ways of Knowing assignment (6 points)

Conclusion = 2 points

· Provided a brief summary of the key takeaway points of the paper (2 points)

Scholarly Writing = 10 points

· Demonstrated appropriate grammar, spelling, and APA writing style (5 points)

· Paper is double-spaced with one inch margins, and includes (5 points):

a. A title page and a reference page.

b. All in-text citations and sources listed on the reference page are formatted according to APA 6th edition.

c. Times New Roman 12 pt font is throughout entire document.

d. Page numbers are included. NUR 700 Theory Selection and Critical Analysis

e. A running head is present.

f. APA 6th edition formatted subject level headings are included.

Total Points Possible = 55 points

Theory selection and critical analysis

Name

Institution

Introduction

During my shift, I was debriefed by the RN of a patient was refusing vital signs, was mute upon presentation and the caregiver was available to give collateral information even though visibly anxious, almost in tears while describing patient’s behavior in the past month characterized with refusal of medication for blood pressure and psychotropic drugs. The patient is paranoid, exhibits bizarre behaviors and bad eating habits coupled with stopping to talk. Patient has a diagnosis of paranoid schizophrenia, which is a serious mental illness (SMI). Paranoid schizophrenia is the most common form of schizophrenia, a type of brain disorder that can make it difficult for you to tell the difference between reality and fantasy. Prior to approaching the patient, I had reviewed her chart. I noted she had her last refills in September of the previous year and had not followed up at the clinic for several months. The

In mental healthcare, providers experience a challenge when people with mental health conditions suddenly stop taking their medication, or to altogether avoid seeking a prescription. This choice can be profoundly frustrating for loved ones and clinicians alike, particularly when the disorder is one that is often easily treated with the right medication (Garcia-Cabrera, I., Diaz-Caneja, C.M., Ovejero, M, & de-Portugal, E, 2018). While the decision to avoid medication isn’t always a wise one, understanding the motives behind patients’ decisions to stop taking medication can help clinicians, community organizations, friends, and family work together to encourage healthy choices without undermining the autonomy of people struggling with mental illness (Garcia-Cabrera et al., 2018). As such, this paper seeks to select a theory related to the following case scenario and present a critical analysis of the same.

Lewin’s Change Theory

The Lewin’s change theory was developed using unfreezing, changing and refreezing steps (Kurt, 1947). This theory was developed in 1940s by Kurt Lewin. Kurt is a German-American psychologist popularly known as the father of psychology for pioneering the social, organizational and applied psychology in the United States. He was born in 1890 in Prussia by a Jewish family on September 9th and died in February 12, 1947 at the age of 56. He studied medicine from University of Freiburg and later biology from University of Munich and later in his career, appointed as a Psychological Institute of the University of Berlin in 1921. His change theory is a nursing theory that has since then become the most influential in management. It was developed using three steps which include the unfreezing, changing and refreezing and sought to bring an understanding of the change process in simplified form (Kurt, 1947).

Purpose

The purpose of the Lewin Change theory in mental health is to initiate organizational change. As such it is essential in developing and implementing interventions that promote the drug adherence among the patients (Belcher, DiBlasio, Siegfried & Turnquist, 2017). However, it is also used in team building trajectories as an excellent strategy of bringing about the change of mentality among the employees. This involves improving the provider’s attitude towards the not adhering patient and getting to encourage them on how to approach such patients in a manner that does not lower their self-esteem. It also helps in creating awareness of the advantages of change in an organization or an individual. In this case, the purpose of the theory will be to impose changes towards modifying the patient’s behavior to improve their adherence to his care plan.

Concepts

The Lewin’s change theory has three concepts. These include the driving forces, restraining forces, and equilibrium. Driving forces are considered to be the factors that push towards the direction of the change. They cause a change to take place. In this case, these forces will push the client towards adherence to medication as desired for them to recover from their mental illness. On the other hand, the restraining forces are factors that counter the driving forces. These forces discourage the patient from adhering to medication and can be the side effects of medication or other personal reasons (Sabin, 2016). These factors shift the equilibrium in the direction that opposes change while the driving forces shift the equilibrium in the direction of the desired change. The equilibrium is a state of balance between the driving forces and the restraining forces whereby no change occurs. However, the patient’s recovery is influenced by these two forces. NUR 700 Theory Selection and Critical Analysis.

Definitions in the theory

The definitions presented by the Lewin’s theory include behavior which is defined in this model as “a dynamic balance of forces working in opposing directions (Teguh, Hariyati & Muhaeriwati, 2019).” The theory also defines equilibrium as a state of no change due to balanced driving and restraining forces. The change theory is also defined as a three-stage model of change that is known as the “unfreezing-change-refreeze model”

Relationships in the theory

The Lewin’s theory of change informs multiple relationships. These include the nurse patient relationship whereby, it seeks to develop a trusting link between the two parties in order to facilitate initiation of changes. Another relationship in this model is the one between the nurses and the organization which supports adaptation and successful implementation of change in the clinical setting. Moreover, collaborative relationships among the nurses as the theory develop positive attitudes towards understanding particular concepts through inquiry and building of teamwork (Salinas, Johnson, Conrardy, Adams & Brown, 2019). A relationship between the nurse leaders and the staff members is also evident when change is suggested and during the implementation.

Structure of the theory

The theory is composed of unfreezing, changing and refreezing components. The unfreeze feature of the theory ensures that the employees are ready for the change. Recognizing the need for change and creation of awareness about the change takes place here. in this case, the RN recognized the need for adherence to the treatment plan and encouraged the replacement of the old behavioral patterns and attitudes with new positive behaviors. This follows change whereby the execution of the intended change is conducted. Finally, the refreeze feature of the model entails ensuring that the change that is implemented becomes permanent.

Assumptions in the theory

The Lewin’s change theory has various assumptions. These assumptions are related to conflicts and motivational processes in human nature and they create the bases for the three stages of the model NUR 700 Theory Selection and Critical Analysis. They include (Teguh, Hariyati & Muhaeriwati, 2019):

An Individual or group performance is prone to regression unless some measures are taken to institutionalize the improved performance level
There is a tension in person whenever a psychological need or intent exists, and the tension is released when the need or intention is fulfilled.
This tension may be positive or negative, and under conflict situation this is identified as “force field”. Hence the term is known as force field analysis so as to evaluate the tension between positive or facilitating forces and negative or constraining forces the given change plan.
Other assumptions related to conflict include:

Individuals stand mid-way between two positive goals of approximately equal strengths; for e.g. Individual has to choose between two good systems, so which one to buy.
Individuals find themselves between two approximately equal negative goals; for e.g. if an individual has to make a choice between two things which he dislikes, that is a choice of lesser evil.
Individuals are equally exposed to opposing positive and negative forces
Application to professional practice

Lewin’s change theory has attracted many applications in the current professional practice. It is applied in finding a better understanding of how change impacts the organization. This is because; it seeks to introduce change patterns that seek to improve the outcomes of the patients. It is also applied in determining the barriers or restricting factors to achieving successful implementation of change in the organization and among patients with diverse medical needs and treatment plans (Umotong, 2016). Moreover, the model identifies the forces that drive the positive modification of human behavior as well as the opposing forces towards recovery. This helps in developing strategies that overcome resistance and facilitate collaboration between the nurses and the patients.

Conclusion

Refusal of drug adherence can result in fatal consequences. However, the application of Lewin change theory in such scenarios can assist in developing an organizational culture of encouraging patients through positive behavioral changes. This theory is essential in recognizing the need, implementing change and ensuring the sustainability of the change through its structural components. NUR 700 Theory Selection and Critical Analysis

References

Belcher, J. L., DiBlasio, F. A., Siegfried, L. D., & Turnquist, A. G. (2017). Overcoming medication refusal using a patient-centered approach. Social Work in Mental Health, 15(6), 690-704.

Garcia-Cabrera, I., Diaz-Caneja, C.M., Ovejero, M, & de-Portugal, E. (2018). Adherence, insight and disability in paranoid schizophrenia. Psychiatry Direct, 270, 274-280. Retrieved from www.sciencedirect.com/science/articles/abs./pii

Lewin, Kurt (June 1947). “Frontiers in Group Dynamics: Concept, Method and Reality in Social Science; Social Equilibria and Social Change”. Human Relations. 1: 5–41. doi:10.1177/001872674700100103.

Sabin, J. (2016). Medication Refusal in Schizophrenia: Preventive and Reactive Ethical Considerations. AMA journal of ethics, 18(6), 572-578.

Salinas, D., Johnson, S. C., Conrardy, J. A., Adams, T. L., & Brown, J. D. (2019). Sustaining nursing grand rounds through interdisciplinary teamwork and interorganizational partnership. AJN The American Journal of Nursing, 119(4), 41-48.

Teguh, A., Hariyati, R. T. S., & Muhaeriwati, T. (2019). Applicability Of Lewin’s Change Management Model For Optimization Management Function In Nursing Delegation Between Head Nurse And Team Leader: A Mini Project In Jakarta Military Hospital. International Journal of Nursing and Health Services (IJNHS), 2(2), 66-74.

Umotong, E. (2016). Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit. The Journal of nervous and mental disease, 204(12), 950.

Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s system approach for change. Online journal of issues in nursing, 21(2) NUR 700 Theory Selection and Critical Analysis.

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