Routinely, nurses encounter patients with varying needs, concerns, and attitudes to care. Despite the impacts of these variables on patient care, nurses must continually identify opportunities for change and address issues appropriately. Quality improvement projects utilize different nursing theories and frameworks. The current project seeks to improve outcomes among the elderly and debilitated patients using a preventive bundle to reduce pressure ulcers. Accordingly, the purpose of this paper is to describe the theoretical foundations, evidence-based change model, and the connection between the theory, change model and the direct practice improvement project. The section that follows describes the theoretical foundations.
Theoretical Foundations
Nurses borrow ideas of improving care quality from nursing theories. Grand and middle-range nursing theories are widely applied in direct practice improvement project. This section outlines the selected theory, clinical question, and how the theory has been applied in other practice areas.
Nursing Theory
A nursing theory is an organized body of knowledge that defines what nursing entails. Given this, nursing theories describe why nurses practice nursing and how they should approach different situations. According to Smith (2019), nursing theories provide baseline knowledge of care concepts that explain what nursing professionals should do for patients and the rationale for their actions. Such an approach to care is crucial in the ever-evolving practice since nurses should articulate evidence that validates their practice methodologies.
Imogene King Goal Attainment Theory: broadly, Imogene King’s goal attainment theory is established on the principle that nurses and patients should set mutual goals and the care process should be transactional. As Butts and Rich (2021) explained, the goal attainment theory recognizes the importance of identifying a problem through effective nurse-patient communication and setting goals that must be achieved reciprocally. The implication is that the care process is not one-sided; thus, nurses and patients must be active partners. Butts and Rich (2021) further explained that nurses use their experience and skills to initiate action, reaction, and appropriate interactions between them and care recipients. To achieve the desired outcomes, nurses must share essential information about their perceptions of the situations and care processed to enable both parties to recognize specific goals and implement mechanisms to achieve them with a clear purpose. In summary, the care process through the goal attainment theory involves five concepts/steps: identifying a problem, mutual goal setting, shared roles to attain the goal, agreeing on how to accomplish the goals, and transaction/goal attainment.
The current project involves implementing a pressure preventive bundle to reduce pressure injury incidence among elderly and debilitated patients. The first concept of the goal attainment theory is problem identification through actions and interactions. The problem is clear, and both nurses and patients understand its implications. The second concept is mutual goal setting. The patients must be involved in setting goals to ensure they understand the projected benefits of the preventive bundle and their role in making the project a success. For instance, they can set reminders for repositioning to ensure they are awake as repositioning occurs. Seeking ways to achieve the goal should also be a joint exercise since patients must understand why and when each activity occurs. Mutual goal setting will ensure the nurse and patient’s goals align.
Clinical Question: to what degree does the implementation of a pressure preventive bundle impacts pressure injury incidence when compared to routine care among elderly and debilitated patients in a long-term care facility in suburban Maryland City?
Implementing the pressure preventive bundle is expected to reduce pressure injury incidence in the long-term care facility. The nurse and patients should set mutual goals and identify measures to achieve these goals as the goal attainment theory recommends. Failing to engage the patients implies that the process will not be transactional, and the projected goals will not be achieved.
Synthesis of Theory
Imogene King’s goal attainment theory has been widely applied to set patient goals and optimize care outcomes in nursing research and evidence-based practice. Araújo et al. (2018) evaluated the effectiveness of nursing interventions based on goal attainment theory on patient care outcomes among diabetic people. In this quasi-experimental study, sixty patients were divided into intervention and control groups. In the experimental group, health goals were formulated
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