Theoretical Framework, Nursing Theory, and Change Model

Theory underpinning DNP Quality Improvement Projects is paramount to their success.

Transformational-Servant Leadership Style

Transformational-Servant leadership style integrates the servant leader’s ethic of care, humility, and service with the transformational leader’s vision, inspiration, and capacity to drive change. This fosters both individual flourishing and organizational transformation (Divya & Suganthi, 2018; Harrison et al., 2021).

Dorothea Orem's Self-Care Deficit Nursing Theory

Orem's Self-Care Deficit Nursing Theory (SCDNT) posits nurses empower patients and their support systems as active participants in their care to achieve optimal well-being. On a larger scale, this theory applies to nurses overcoming challenges to maximize care delivery. Nurse leaders accomplish this through professional partnerships and promoting people-centered policies for holistic population health strategies (Hartweg & Metcalfe, 2021).

Theory Aligning with Project

Orem's SCDNT aligns with the QI project outlined in this paper. SCDNT encompasses the foundational goal to increase patient investment and autonomy in their own sobriety journey. SCDNT also focuses on partnerships between stakeholders to overcome obstacles to patient empowerment and success (Hartweg & Metcalfe, 2021).

Approach to Care

People-centered underpinnings will humanize guidelines and protocol implementation. Reviewing literature that outlines care disparities within incarcerated populations and PWUS will ensure this is considered while developing the protocol.

Leadership and Systems Improvement

Using SCDNT, the nurse leader strives to network with stakeholders. This keeps the ideal of patient well-being a priority in all decision-making and protocol generation. Working groups create connection between health care leaders and frontline workers to expand resource access, support system collaboration, and patient investment in health outcomes. In SCDNT, both those implementing the change and the patient population involved are empowered through their engagement in program development, creating a higher likelihood of success (Hartweg & Metcalfe, 2021).

Kotter's Eight-Step Change Model

Kotter's Eight-Step Change Model is the most appropriate theory for QI projects involving many stakeholders. It avoids common project shortfalls such as poor engagement, inadequate communication, and lack of sustainability (Harrison et al., 2021).

Kotter's model has three main themes:

Acquiring, executing, and maintaining change.
Attracting committed stakeholders.
Evolving the work culture to embrace change (Graves et al., 2023).

Why Kotter's Model Aligns with Project

Kotter's theory provides structure for the proposed QI project. The themes of Kotter's theory and their relevance for implementation and sustainability of creating a standardized withdrawal protocol are outlined below.

Create Necessity. There is a sense of urgency underlying this project as the volume of PWUS entering our corrections facilities in active withdrawal is significant (Butler, 2021). No correctional facilities in BC use a pre-printed order at this time and provider groups have identified this as a gap in care services.

Build Leadership Team

For my leadership team, I will utilize the NP Director, Physician Director, and Addictions Team Lead from the health authority executive. At my site, I will include the nursing manager, care coordinator, nurse educator, and OAT RN. These team members will provide oversight from all parts of the prescribing and medication administration process.

Form Roadmap

The roadmap will be formulated with the above stakeholders and include a literature review, collection of data showing current state for measurable outcomes, protocol creation, review by peers, modifications, and six-week trial at Kamloops Regional Correctional Centre (KRCC). The trial data will be collected and evaluated. Conclusions will be made with recommendations for implementation province-wide.

Enlist Subject-Matter Experts

The protocol will draw from pre-existing resources to create corrections-specific protocols through collaboration with other addictions specialists. Feedback throughout the process will be conducted with physician/nurse practitioner (NP), and nursing focus groups.

Generate Immediate Milestones

Short-term wins create engagement by stakeholders (Graves et al., 2023). The first success with this project occurred when the quality improvement concept outlined in this paper was presented to a provincial physician/NP corrections group. There was genuine interest and engagement from those in attendance.

Sustain Momentum

Periodic check-ins with the physician/NP group and other stakeholders will keep them motivated to see the project through to fruition.

Institute Modification

Once a robust protocol has been created, it will be trialed at the writer's worksite, KRCC, for six weeks. Data will be reviewed to determine benefits, obstacles, and areas for improvement. Once refined, the pre-printed order protocol can be implemented at other correctional centers to provide standardization across the province's ten facilities.

References

Divya, S., & Suganthi, L. (2017). Influence of transformational-servant leadership styles and justice perceptions on employee burnout: A moderated mediation model. International Journal of Business Innovation and Research, 15(1), 119–135. https://doi.org/10.1504/IJBIR.2018.088475.

Graves, L., Dalgarno, N., Van Hoorn, R., Hastings-Truelove, A., Mulder, J., Kolomitro, K., Kirby, F., & van Wylick, R. (2023). Creating change: Kotter's change management model in action. Canadian Medical Education Journal, 14(3), 136–139. https://doi.org/10.36834/cmej.76680.

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176.

Hartweg, D. I., & Metcalfe, S. A. (2021). Orem's self-care deficit nursing theory: Relevance and need for refinement. Nursing Science Quarterly, 35(1), 70–76. https://doi.org/10.1177/08943184211051369.