Further reflection on Semester Saturday’s theme, ‘Theory in Practice,’ brings much clarity to practicality of theory with respect to DNP project development.
Theory in a New Light
Upon completion of the Project I course, I was feeling fairly confident in my progress with my early project development, but I was viewing theory as a bit more of an afterthought, as something that is needed but not necessarily useful. Wow, was I wrong! After spending the first couple weeks of this semester really diving into the material for NRSG 713 and Semester Saturday on theory, a lightbulb turned on – having a good understanding of theory makes everything easier! Incorporating one or more theoretical frameworks in project development doesn’t add work, it streamlines it! Just as Dr. Simpson commented, ‘theory is like your bumper guards – it keeps you focused on what your trying to accomplish and helps to prevent getting sidetracked down rabbit holes.’
DNP Project Development
Building on the brilliant work of others, utilizing existing applicable theories helps to guide a more practical approach to problem-solving (Nilsen, 2015). For my own project development, I am seeking to improve the informed consent process for elective cosmetic procedures. In a nutshell, the problem with the current system [from observation, interviews and review of the literature] is that patients are given ever-growing consent forms to sign prior to undergoing a procedure that are often written at too high of a reading level [from a health literacy perspective] and is presented in such fashion as a legal formality rather than a facilitator of patient understanding or outcome of shared decision-making between patient and provider. Furthermore, no expert consensus has been established of what patients must understand prior to undergoing the procedure, and, being a preference-sensitive field, the importance of matching treatment choices with patients’ goals and preferences is heightened when compared to more ‘single best option’ medical decisions (e.g., the need to undergo a cardiac catheterization).
When re-examining this improvement goal, that I have set to accomplish, through my refocused lens of theory, the path starts to become much clearer… (1) To underpin the overall aim, the Framework for Decision Coach-Mediated Shared Decision Making offers a simple picture that allows the project to basically be communicated in seconds (Stacey, D., Murray, M. A., Légaré, F., Sandy, D., Menard, P., & O’Connor, A., 2008); (2) the model for development of ‘core information sets’ describes a method for deriving expert consensus of what patients must understand prior to undergoing a procedure using a Delphi process (Main et al., 2017), and the Ottawa Decision Support Framework (O'Connor, A., 2006) helps guide actual construct of informed consent materials; (3) lastly, the Understanding-User-Context Framework (Jacobson, Butterill, & Goering, 2003) and the Consolidated Framework for Implementation Research (Damschroder et al., 2009) provide a comprehensive approach to guiding implementation and sustainability.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science: IS, 4, 50. https://doi.org/10.1186/1748-5908-4-50
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
Main, B. G., McNair, A. G. K., Huxtable, R., Donovan, J. L., Thomas, S. J., Kinnersley, P., & Blazeby, J. M. (2017). Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians. BMC Medical Ethics, 18. https://doi.org/10.1186/s12910-017-0188-7
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