On-Campus Reflection: "Theory in Practice"

A few key take-aways from this 'Semester Saturday’ that really helped to provide context, applicability and centeredness to the study of theory were: (1) Theories, models and frameworks are often interdependent with no single best one for any given situation, vary based on context and, simply, and generally stated, provide a structure to our observations and understanding of the world (Nilsen, 2015); (2) Theory is influenced by the lens through which the user views the situation to which the theory is being applied; (3) Theory assists the user in explaining their perspective in a more visually-appealing and easy-to-understand way for their audience; (4) Theories, models and frameworks serve as a guide, providing “bumper-guards” to keep the user focused and away from potential “rabbit holes.

Grasping Theory

With these key take-aways in mind, it was much more gratifying returning to the literature to review potential appropriate theoretical frameworks to fit my project needs and goals. At the completion of Project I, I had settled on two potential “best fit” theoretical frameworks - The Framework for Decision Coach-Mediated Shared Decision Making (Figure 1) and The Ottawa Decision Support Framework (Figure 2), but was unsure how to proceed with making a final selection. My view has now shifted to seeing both frameworks, as well as others, as uniquely applicable to select aspects of the project - interdependent, not independent.

Framework for Decision Coach-Mediated Shared Decision Making.

The Framework for Decision Coach-Mediated Shared Decision Making as the most befitting to serve as the primary framework to underpin the overarching aim of the project - that being widespread adoption of evidence-based shared decision-making during informed consent [for adults (18+) presenting for elective cosmetic procedures] through process redesign from traditional informed consent materials to use of procedure specific decision quality instruments and resulting in treatment decisions reliably concordant with patient goals and preferences - as this aim can be viewed by even a cursory glance at the framework.

Figure 1. Framework for decision coach-mediated shared decision making. (Stacey, D., Murray, M. A., Légaré, F., Sandy, D., Menard, P., & O’Connor, A., 2008)

Ottawa Decision Support Framework.

The Ottawa Decision Support Framework focuses in further on the ‘Decision Coach Role’ and provides specific concepts for construct development of decision quality instrument(s), as well as from which appropriate metrics for improvement evaluation could be derived. Both being process models, they serve as a useful guide in translating best evidence to practice.

Figure 2. Ottawa Decision Support Framework. (O'Connor, A.M., 2006)

Understanding-User-Context Framework.

A newer addition to my list, the Understanding-User-Context Framework (Jacobson, Butterill, & Goering, 2003), is a determinant theory derived from knowledge translation theory, and, as such, is focused on barriers/facilitators that influence implementation outcomes (Nilsen, 2015). This may be of great use for early project development when addressing gaps in perception of information importance between clinicians and patients, as well as considerations for execution approach. The framework is comprised of five domains with associated targeted questions for exploration of the respective domain: (1) the user-group (consideration for all users - patient, clinician, staff); (2) the issue (consideration in construct of procedure-specific core information sets); (3) the research (evidence-based decision quality instruments); (4) researcher-user relationship (credibility/trust considerations with all user-groups); and, (5) dissemination strategies (sustainability and spread) (Jacobson et al., 2003).

DNP Essentials: Essential I: Scientific Underpinnings for Practice; Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking; Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice; Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care; Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

Program Outcomes: Systems Leadership; Scholarship & Evidence Based Practice; Information Management; Quality Improvement & Safety; Health Policy, Finance & Advocacy; Professional Identity

References

Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework for knowledge translation: understanding user context. Journal of Health Services Research & Policy, 8(2), 94–99. https://doi.org/10.1258/135581903321466067

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10, 53. https://doi.org/10.1186/s13012-015-0242-0

O'Connor, A. (2006). Ottawa Decision Support Framework to Address Decisional Conflict. https://decisionaid.ohri.ca/docs/develop/ODSF.pdf

Stacey, D., Murray, M. A., Légaré, F., Sandy, D., Menard, P., & O’Connor, A. (2008). Decision Coaching to Support Shared Decision Making: A Framework, Evidence, and Implications for Nursing Practice, Education, and Policy. Worldviews on Evidence-Based Nursing, 5(1), 25–35. https://doi.org/10.1111/j.1741-6787.2007.00108.x

#theory #DNP #reflection

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