Theoretical Framework
Roy’s adaptation theory seems to be a suitable theoretical framework for the study. According to Phillips and Harris (2013), Roy’s theory provides an invaluable mechanism of assessment of personal, group, and family adaptation needs. The identified PICO question deals with the comparison of the new status of nurse practitioners with their position before the proposed intervention. In the process of expanding authorities and assuming new responsibilities, an adaptation process appears to be inevitable.
The framework has a goal of preserving health, quality of life, and maximal comfort at the end of life. Adaptation is one of the key concepts of the theory is seen as a natural purpose of the human interaction with the environment. The adaptation process, according to the theory, happens in the four domains, namely: psychological, self-concept, role fulfillment, and interconnection (Phillips & Harris, 2013). The nursing process is divided into six stages. The first stage includes observation of a person’s or group’s behavior. The behavior can be identified either as adaptive or nonadaptive. Then, what provokes such behavior is researched. If the unadaptive behavior is the case, then a diagnosis and goal-setting follow. As a result of the latter, an intervention is elaborated and, after its implementation, concluded by the evaluation stage. If the desired outcomes were not achieved and the behavior is still not adaptive, the intervention is altered, and implementation is repeated.
Although Roy’s adaptation model is primarily designed to provide nurses with a framework for addressing patients’ needs, it may also be applied to nurses themselves. In this particular research, the subjects of study are family nursing practitioners, who can be viewed as patients from a theoretical point of view. All six stages appear to be applicable to nursing specialists. The sample’s behavior and behavioral incentives will be analyzed and identified as adaptive or unadaptive. If the adaptation process is hindered, the diagnosis and goal setting stages will define the problem and allow forming a solution. After the change in family NPs’ authorities, the assessment stage will reveal whether the nurses adapted and the healthcare sector benefited. Thus, Roy’s adaptation theory seems to be in accord with the set PICO question and provides a fitting theoretical framework for the study. The question also benefits from the theory due to the fact that it offers clear guidance on how to divide the outlined intervention into steps.
Change Model
According to Huebner (2007), there are three managerial strategies for facilitating change: change through power, reason or re-education. The first encompasses motivating and incentivizing others to change. The second leads people to change through reason and logical explanation. The third requires providing knowledge and skills to invoke positive transformations. Those three strategies intertwine with structural, behavioral, and technological approaches to change that are enacted through the organization, communication, and automation respectively (Huebner, 2007). The change model that was used to establish patient-focused care by the American Association of Critical Care Nurses encompasses and combines several strategies and approaches. It will be chosen as a change model for the current research project.
The model consists of several interventions encompassing those that demonstrate several approaches stated above. Thus, to enact change, a vision was created that enabled people to combine practical and theoretical knowledge. Ethical committees and performance evaluations were also established. These actions were designed in accord with behavioral and structural approaches and featured change through reeducation and power.
In accordance with the elaborated PICO question, the chosen change model will be implemented through certain steps. Firstly, the research project needs to develop a set of values promoting multidisciplinary knowledge exchange. Secondly, structural changes facilitating the transition from the current status of family nursing practitioners to the new will be in order. Thirdly, assessment tools need to be elaborated to evaluate both the process and the results of acquiring new functions intrinsic to the modified role of the family nurses. The chosen change model will incorporate motivation through the belief in values that promote reeducation. It will include structural and behavioral approaches that consist of organizational and communicational change.
The accepted change model will allow implementing the proposed intervention with a solid theoretical, practical, and ethical basis. Moreover, it will help assess the impact the intervention has on healthcare and the role of family nursing practitioners. The results featuring problems of design, positive and negative outcomes that will be assessed after the implementation stage will allow identifying implications for further research and areas for improvement. Therefore, the chosen model of change-facilitation seems to be a valid choice for the set PICO question and the practical research that will follow. The model is also useful to the question due to the fact that it provides an insight on how to proceed with the outlined intervention. It also outlines steps towards the implementation of the proposed intervention.
References
Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20), 1898-1906.
Duncan, C. G., & Sheppard, K. G. (2015). The full practice authority initiative: Lessons learned from Nevada. The Journal for Nurse Practitioners, 11(6), 610-617.
Huebner, C. (2007). Models of change. The Journal of Nursing Administration, 37(9), 388-91. doi:10.1097/01.NNA.0000285137.26624.f9.
Liu, L., Guarino, J., & Lopez, R. (2012). Family satisfaction with care provided by nurse practitioners to nursing home residents with dementia at the end of life. Clinical Nursing Research, 21(3), 350-367. doi:10.1177/1054773811431883
Phillips, K., & Harris, R. (2013). Roy’s adaptation model in nursing practice. In M. R. Alligood (Ed.), Nursing Theory: Utilization & Application (pp. 263-284). Atlanta, GA: Elsevier.
Poghosyan, L., Nannini, A., Smaldone, A., Clarke, S., O’Rourke, N. C., Rosato, B. G., & Berkowitz, B. (2013). Revisiting the scope of practice facilitators and barriers for primary care nurse practitioners: A qualitative investigation. Policy, Politics, & Nursing Practice, 14(1), 6-15.