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Nursing

long term adherence to the medication regimen.

Respond to the following 3 discussion posts:
1. To improve adherence to medication regimen
the use of a medication dispensing system will improve compliance.” In the following weeks I
had continued to research and improve my theory. The revised theory is the use of: “A
multifaceted approach and interventions that are specifically designed to the individual will
improve long term adherences to the medication regimen.” The first concept of this theory is
that nonadherence to the medication regimen will resolve with the use of alternative
medication dispensing devices. The second concept is that the use of a multifaceted approach
will improve long term adherence to the medication regimen.
Osterberg & Blaschke (2005) helps with the operational definitions to this concept of
nonadherences as a patient who does not take their prescribed medication as advised with
missed doses and times. Alternative medication dispensing devices are referred to and defined
as reminders, weekly bubble packs, pillboxes, and electronic medication dispensers. The
operational definition of a multifaceted approach is the use of more than one intervention to
achieve the goal of adherence. Lastly, the operational definition of medication regimen is the
prescribed medications for the individual.
Empirical indicators are the measurement of adherence for the medication regimen. Sun,
Weon-Young, Hwang, Hong, and Morisky (2017) states that this can be done in two ways, direct
or indirect measurements. Direct measurements are observation, and measure of serum and urine
mediation levels (Sun et al, 2017). Indirect include self-reporting, interviewing, counting pills, assessment of refill history, and by assessing the expected clinical outcomes (Osterberg & Blaschke, 2005; Sun et al, 2017). In a research study I would use the multiple approaches to measure the results. The Morisky Medication Adherence Scale ( MMAS-8) is an eight-question questioner where the first seven questions are yes or no and the eight question is a scale of likeliness (Sun et al, 2017). In addition, direct and indirect methods of measurement would be included.
2. In my theory that I developed in Week Two, I argued that education (Concept A) may improve (Proposition) the reduction of blood sugar fluctuations in Hispanic American individuals in Southern California (Concept B). I see that this theory is quite limited in applicability so I improved it by broadening its scope and clarifying Concept B. I came up with the theory that education (Concept A) may increase (Proposition) the time within acceptable blood sugar targets for diabetic patients (Concept B). To define my operational definitions “education” can be assessed by using validated tools such as those provided by the Compendium of Surveys for Nutrition Education and Obesity Prevention which can be easily accessed online to measure nutritional knowledge. “Acceptable blood sugar targets” are from established blood glucose guidelines such as having a fasting plasma glucose (FPG) of less than 100 mg/dl (ADA, 2021). “Proper diet” can be defined as an eating plan that helps manage your weight and includes a variety of healthy foods (CDC, 2021).
In a research study, I would measure the concepts and proposition by the following. Concept A (education) would be measure as years spent in school or classes taken specifically on diet/health. Proposition (may increase) can be measured by taking measurements of Concept B (the time within acceptable blood sugar targets for diabetic patients) by using continuous blood sugar monitoring, or CGM, which continually checks glucose levels throughout the day and sends excursion alerts to the user (e.g., Freestyle Libre or Dexcom G6). The less time out of the target range indicates an increase in Concept B. I chose the CGM because simple assessment tools are particularly effective because they do not place the burden on nurses or patients and are more likely to be followed.
3. Dr. Jaqueline Fawcett is most credited for her advancement of nursing knowledge through the Conceptual-Theoretical-Empirical Model (CTE). She believed as nurses “you don’t just blindly do procedures, but you understand the procedures” (Umb.edu, 2015). Conceptual models and theories guide knowledge in nursing and “conceptual models help nurses treat each person as a unique individual, (tailoring their care and treatment)” (Umb.edu, 2015). Fawcett created a five-level structure related to nursing knowledge depending on the level of abstraction. At the highest level is the metaparadigm of nursing, next the philosophies of nursing science, then conceptual models of nursing: grand theories and middle-range theories, practice theories, and lastly the empirical indicators (Marrs & Lowry, 2006).
In week 2, I proposed a theory that daily cleansing with 2% Chlorhexidine Gluconate (CHG) around the PICC line dressing (Concept A) will work to reduce (proposition) the number of CLABSI occurrences (Concept B). In following the CTE model starting at the top, the Metaparadigm is the environment, health, person, and nursing as the most abstract concepts relating to this theory. The philosophies include the totality and simultaneity paradigms in that this theory has a cause and effect nature, and people are considered to be in a linear and reciprocal relationship with their environment. One conceptual model relating to this theory is “Florence Nightingale’s environmental theory and how it has changed the face of infection control exponentially” (Gilbert, 2020). Additionally, a grand theory to consider is Jean Watson’s Theory of Human Caring. Her 10 caritas processes are aimed at caring for the person holistically through consideration of their mind, body, and spirit. The middle-range theory on self-care is essential in the long term management of chronic illnesses as it discusses how, through patient education in self care, patients are able to influence their health care outcomes. Finally, in an effort to improve the above practice theory, I propose that an infection control policy establishing the use of 2% Chlorhexidine Gluconate for PICC line management, taught to healthcare workers, patients, and family members will reduce the occurrence of CLABSI infections; thereby improving patient safety and reducing organizational costs.
The empirical indicators are an infection control policy for PICC line care, standardized educational material for patients and family on PICC line maintenance at home, and the percent of compliance by healthcare workers utilizing CHG for PICC line care can be included in a pilot study. The organization can collect data on the percentage of identified CLABSI infections and compare their study to the national percentage rates of the same adverse outcomes (Petroulias, 2016). Furthermore, a literature review and supporting guidelines from the Center of Disease Control and the U.S. Centers for Medicare & Medicaid Services can all be used to support the theory that “patients who received educational interventions about PICC line care were more likely to experience fewer incidents of infection” (Petroulias, 2016). Including healthcare worker, patient, and family education to the proposed theory aligns with Dr. Watson’s seventh caritas process by, “engaging in genuine teaching-learning experience that attends to unity of being and meaning and attempts to stay within other’s frame of reference” (Alligood, 2014, p. 100). Additionally, PICC line education parallels Dr. Fawcett’s belief that nurses don’t just do (CHG baths and PICC line care), but we understand the theory of ensuring strict infection control measures with PICC line patients because of the high risk of deadly and costly complications associated with PICC line insertions.