Nursing Professional Practice Model of Care in a Dialysis Clinic

It is comprised of goals and values, delivery models for patient care and professional relationships which define identities and roles of the nursing profession (Slatyer, Coventry, Twigg, & Davis, 2016). A Professional practice model supports nurses to provide patient-focused care and create a suitable environment for both patients and nurses. One of the significant advantages of the professional practice model is that it creates a professional practice environment which empowers the nurse, especially at the unit level, to make practice decisions which have a positive impact on improving the quality of care. Nurses, therefore, play a more significant role in fostering an environment that achieves positive patient outcomes through individual accountability. Professional practice models promote accountability, collaboration, teamwork and also consultation. This capstone project aims to develop a professional practice model for nurses working in a dialysis healthcare setting as well as evaluate the perception of the nursing staff in the unit towards it.

The model is also set to align the nurse’s individual values with the organization’s vision and mission and aligned with ANA code of ethics and professional standards. Background According to Chamberlain, Bersick, Cole, Craig, Cummins, & Duffy, Et al (2013), the use of professional practice models has increased significantly in the last two decades. This is to address the frustration and job dissatisfaction which have triggered a massive exodus from the nursing profession. A clear Professional practice model acts as a framework for the nursing staff to provide professional care to patients and the community by supporting the patient-nurse relationship and improving the quality of care (Meehan, 2012). A wide range of literature has shown that developing a clear professional practice model is an important factor that can help improve job satisfaction since nurses share responsibilities with their colleagues to resolve professional practice challenges.

Through collaborative approaches with other nursing, colleagues nurses are empowered to make decisions on issues that affect their practice. They are more accountable to exercise control in the delivery of care under which they are responsible. Professional practice models promote good working environments which improve quality of patient care and help achieve positive patient outcomes. They increase retention and recruitment to the nursing profession as a result of reduced turnover, thereby addressing the challenge of nursing shortages. Watson’s theory of human caring was developed by Jean Watson and published in 1988. It is based on seven assumptions and the 10 primary curative factors on human beings, health, environment, and nursing. The theory has wide applications to the nursing practice, especially on issues with philosophical and ethical implications.

According to the theory, nurses are persons with experiences on human health illnesses mediated by scientific, professional personal, esthetic and ethical human transactions. Nurses have the ability to promote family or individual growth through effective caring. Significance of the project. A wide range of studies has shown that a professional practice model is very important to the nursing profession. Melynk, Fineout-Overholt, Stillwell, & Williamson, (2010), acknowledge that a professional practice model engages and strengthens the nurses with values, structures, and processes to control their nursing practice and to deliver patient-centered care. Brady & Cummings, (2010) also acknowledge that professional practice models promote effective leadership development, which helps create a supportive, protective and caring working environment achieving positive patient outcomes. When implemented, this model will enable nurses to implement performance improvement systems and engage effectively with other staff.

The theory identifies caring at the center of nursing practice on promoting better health. • Dialysis unit – a medical ward or part thereof which is concerned with providing hemodialysis treatment to patients with end-stage chronic kidney diseases. • ANA code of ethics and professional standards- a succinct statement which provides nursing practitioners with obligations, ethical standards, and duties of the profession. Summary Chapter one has provided the background for the project the specific problem through which the project aims to solve. The professional practice model developed in this capstone project aims at solving the challenges experienced in the nursing profession on poor working environments and its impact on job satisfaction and achieving positive patient outcomes. This is because PPM promotes professional values and accountability among nurses as well as enhancing ongoing competence, collaboration, and creativity, which in turn promote robust decision making, reliance on evidence-based practice (Chamberlain et al, 2013).

According to Chamberlain et al, professional practice models share dominant attributes, with their primary goal being supplementing the relationship between the nurse and the patient. Glassman, (2016) also acknowledges that professional practice models elevate the nursing practice by transforming tasks to knowledge and emphasizing on the significance of patients and their families as they are the center to the nursing practice. Resolving numerous challenges experienced in the nursing profession Several studies have developed models to address the numerous challenges that nurses face in their nursing practice. Kallas (2014) estimates that up to 45% and 35% of the nurses and their managers constitute an aging workforce with the turnover in the nursing professional estimated to be as high as 50%. The study analyzed the literature published in the last decade on the effect of the PPM in the healthcare environment, using an integrative literature review.

According to the study, the professional practice models provide a foundation to the nurses to provide high-quality patient-centered care. It enables nurses to reflect on how they communicate, collaborate and develop professionally, which makes it an effective for nurses to assess their effectiveness in the nursing practice. Most important, the study further found out that the PPM provides visual structures that allow the nurses to integrate and coordinate nursing theory into practice, achieving improved nursing and patient outcomes. The results from this study reflect similar finding obtained in a study carried out by Lyons, Specht, Karlman, & Maas (2008), which found out that nurse make measurable contributions using various professional practice models which have a positive impact on patient outcomes. These elements are therefore similar to the elements identified other studies including Ribeiro, Martins, & Tronchin (2016) although they are differences on how these elements are classified.

A systematic review carried by Twigg, Davis, Coventry, & Slatyer, (2016) including articles published up to 2012 in English searched from the major nursing databases which include CINAHL, MEDLINE, EMBASE, Scopus and the ISI Knowledge web, further acknowledges the six essential components of the professional practice models. These include the patient outcomes, the practice environment, dependent and the interdependent nurses’ practice, recognition, development, and reward for nurses and lastly research and innovation. The study further shows that majority of the study identified the patient outcome as the most essential or central to the practice model. Practice environment The practice environment component was associated to contribute to care delivery and promoting retention of nurses. Professional practice models in dialysis unit setting There is limited literature on the development and implementation of professional practice models in the dialysis unit.

However, according to Storey, White & Weber, (2011), professional practice models are applicable in the different healthcare settings primarily hospitals and clinics. They redesign the patient care activities by enabling nurses to work as a team to meet the patient’s needs. Storey et al (2011) further suggest that the professional practice models may vary depending on the role of the nurses in various practice settings, so as to address the different activities that nurses are responsible for performing as a result of differentiation of tasks. Professional practice models enhance the general health care system, enabling nurses to make faster and quicker, diagnosis and treatment, which improves the quality of healthcare. The first phase was a development of a professional practice model for a dialysis unit.

The second phase of the project was implementing the professional practice model and the third was evaluating the perception of the nurses towards the developed model from registered nurses working in the unit. Developing the professional practice model Chamberlain, et al (2013) has pointed out significant advantages of integrating professional practice models in both nurses work environments, by providing guidance on the theoretical task in theory. The current model was developed for the American Renal Associates. The company is one of the largest dialysis service providers in the United States, attending to customers with most advanced stage chronic kidney disease. Self-caring for nurses was identified as the foundation for patient care. The next step was to define the various components of the developed model.

The structure of the developed model includes six essential PPM components that consist of organizations mission, vision and core values, commitment towards professional practice standards of governance and professional ethics, commitment towards a caring culture to achieve patient safety, quality outcomes and service excellence and efficiency in nursing professional roles. Other elements include accountability for teamwork, collaboration, leadership and best practice. The central core of the model includes caring for patient, family, colleagues, community, and self. The researcher organized a meeting for the staff working in the dialysis unit to evaluate the draft model and provide feedback before the model was adopted after the suggested significant changes. The staff also came up with suggestions on concepts to depict the model as means of involving them to support the model.

The developed model was shared with the management of the company for feedback before the model was adopted. Based on the simple curriculum developed by the author and a colleague, the staff was given pretest survey (Appendix 1) on the caring practices as well as other components of the developed model. They were then educated on the model and caring practices in two sections, with the first section focusing on caring practices, which is the core of the model and the other section focusing on the other aspects of the professional practice model. Determining the perceptions of the nurses towards the model was carried out based on a questionnaire developed by the researcher (appendix 3). The questionnaire evaluated how familiar the nurses are with the PPM, the impact it has on their work environment and the overall satisfaction with the developed model.

Evaluating the perception of the nurses towards the PPM important because it shows that it can be implemented effectively to achieve positive outcomes for both nurses and patients (Basson, 2012). Successfully implementing a professional practice model requires nurse’s commitment, hence, evaluating their perception was used to determine if it will be implemented successfully. The perception of the nurses towards the model was evaluated using a non-experimental descriptive survey design, with the aim of evaluating the perception of nurses towards the model using convenience sampling. Another limitation is the small size of the sample participating in the research, which limited the study generalizability. Another restriction was the limited time frame, needed to plan and conduct the study hence some of the factors impacted by the PPM were not adequately accessed.

In addition, the non-probabilistic sampling method used to select the participants does not give a true representation of the perceptions held by nurses. The major assumption Ethical assurances The consent and permission were obtained from the clinic administration to administer the questionnaire to the selected population participating in the project. Filling out the survey will be considered giving consent to participate in the project. According to Chamberlain et al (2013), the use of professional practice models anchored in teamwork, collaboration, individual responsibility, and quality patient outcomes has increased significantly in the last two decades. This use resulted in improving the patient nursing relationship, which has not only enhanced the quality of patient care but also increased job satisfaction for nurses. The current model was aimed at helping dialysis nurses provide efficient patient care, promote a good working environment, and improve patient outcomes by helping nurses to more actively engage with their work.

Based on Jean Watson’s caring theory, the current model aimed at promoting patient care as well as self-care for the nurses working at American Renal Associates, one of the largest dialysis service providers across the United States. Developing and implementing the model involved participants working in the dialysis unit, where it was important that the colleagues embrace the model and demonstrate the enthusiasm to implement it. According to the pretest survey (appendix 1), participants gave varying responses on the first question, with only the nurses providing a detailed description of a professional practice model. Similarly, none of the participants accurately defined the different components of a professional practice model, (appendix 5). The same case applied to the third question, where participants gave varying responses on the relevance of the professional practice model (appendix 5).

After the process of developing the professional practice model, all of the participants indicated an understanding of what embodied a professional practice model (appendix 5). The schematic presentation of the model was important to duplicate the description of the model and its application to the dialysis clinic. 6% indicated that there were some areas of their daily work routine that had not been addressed by the model and 50% acknowledged that they had a thorough knowledge of the professional practice model (appendix 6). All the participants indicated that they were satisfied with the developed PPM and 67% felt that more information and education on the model would benefit them in implementation. Overall, there was a statistical improvement by the nurses in understanding their roles for better achieving high standards of care.

Action plan All six participants completed the action plan (Appendix 4). The purpose of the action plan was to assess enculturation with the developed professional model. Cain, & Haque (2008) further acknowledge that implementing systems which ensure well-designed workflow has an impact on work patterns, communication, and also enables nurses to accommodate necessary tasks. This, in turn, would have a direct impact on implementing the model in a dialysis unit setting by helping nurses clearly define roles, responsibilities, and processes which enable them to integrate the model in their nursing practice. The action was designed to improve efficiency and was also critical in ensuring the success of the nurses’ efforts in implementing the model. The third action was to promote teamwork to ensure safe and reliable care by engaging the staff to develop measure targets in compliance with regulatory standards.

The goal was to use evidence-based research in decision making to optimize high-risk patient outcomes within the next three months. According to the results, the developed professional practice model had a significant impact on the participants and could be expected to significantly help them enhance patient care. The participants demonstrated the support for the development and implementation of the professional practice model to achieve an efficient and effective delivery of quality patient care services. According to Koloroutis, (2004), use of professional practice models significantly improves patient care and safety, patient satisfaction, staff satisfaction, and the relationship between the nurses and the organization. The findings of the project show that the developed model helped nurses work together as a team to deliver excellent care.

This was one of the important contributions of the developed model. In conclusion, based on the posttest survey (appendix 2) questions aimed at evaluating the nurses’ perceptions of the model were successful. CHAPTER 5: IMPLICATIONS, RECOMMENDATIONS, AND CONCLUSIONS Professional practice models have a huge impact on the nursing practice by acting as frameworks for nurses to provide patients with quality care (Glassman, 2016). The professional practice model depicts the values and processes needed to guide nurses in controlling their practice and enhancing the quality of care. A wide range of literature has demonstrated that a professional practice model has a significant impact in addressing the challenges facing the nursing profession. It promotes sharing of responsibilities, empowers nurses in making appropriate decisions on issues that affect their practice, and advocates accountability in the delivery of care.

According to Mark, Salyer, & Wan, (2003), a professional practice model is linked to positive patient outcomes in terms of patient satisfaction, reduced length of patient stay in hospitals, and decrease in the rate of medication errors. A professional practice model is also linked to improved work satisfaction and a decrease in the nursing turnover. This model will have a significant impact on promoting nurses’ accountability and support in achieving patient care and improving nursing knowledge of patient safety. In addition, the model will improve the nurses’ experiences, confidence, skills, knowledge and decision making, thus providing enhanced patient care. Overall, the project would benefit the institution significantly by improving the working environment the relationship between patients and staff and promoting quality patient care.

It is therefore recommended that the management of the clinic allocate more resources to educating and training their staff on effectively implementing the model. Unfortunately, there were a number of challenges in completing the project. A major challenge was the time constraint for developing and implementing the model. The participants were not punctual and fully committed to participating in completing the project on time, which prevented finalization on schedule. Hence, when working on future projects it is recommended to select participants who are committed to their careers and eager to create a better work environment. The results of the pretest (appendix 1) and posttest (appendix 2) surveys show a significant improvement in knowledge by the participants when recognizing the professional practice model, its different components, and significance in the nursing practice.

The staff further developed an action plan (Appendix 4) on how they plan to integrate the model into their nursing practice to enhance patient care. This model, therefore, has significant implication in the nursing practice and the dialysis clinic in enhancing patient care. Involving the nurses in developing the model made it easy for them to understand the plan, and to integrate it with the nursing practice and daily activities. However, more feedback is recommended in the future to identify the impact of the professional practice model on the working environment within the dialysis clinic in order to develop appropriate changes to ensure the model is more effective in the future. Ayala, A. J. , Dimitrov, K. M. , Becker, C. P. , Goujgoulova, G.

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