NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

Application of Theory Ly Tran NR 501 Spring 2020: Session II
Hello, My name is Ly Tran and I’d like to present you to the NR501 Application of Theory PowerPoint Presentation assignment overview. The purpose of this assignment is to allow me to identify a nursing theory or model, which I would use as a framework to resolve an issue related to medication adherence.
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Introduction
Identify and describe a borrowed theory
Application of theory to nursing issue
Issue of medical non-compliance
Apply nursing theory as framework to resolve issue with supportive EBP.
This presentation including identification of the borrowed theory from the behavioral science that we have learned in week 5. The nudge theory from Richard Thaler and Cass Sunstein’s and the Behavioral Systems Model from Dorothy Johnson.
Furthermore, I am also present the application of theory and model to the nursing issue which is medication adherence with scholarly supports from Evidence-Based Practice (EBP), and lastly how the nursing theory and model serve as a framework to support EBP to address the issue.

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NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

Identification of Theory & Model
Nudge Theory- is a concept of behavioral science proposes positive reinforcement and indirect suggestions as way to influence the behavior and decision making of groups or individuals.
(Thaler & Sunstein, 2009) 
Johnson’s Behavioral System Model- describe each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.

Seven behavioral subsystems
Three subsystems
Protection from noxious influences
Provision for a nurturing environment
Stimulation for growth
(Alligood, 2017)

Nudge theory is a concept of behavioral science which proposes positive reinforcement and indirect suggestions as way to influence the behavior and decision making of groups or individuals. The behavioral theorists believe that behavior is learned by reinforcement. The nudge theory is a novel development in behavioral science for influencing behavior, investigated in the science of behavior analysis (cite).

Johnson’s Behavioral Systems Model describes each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual. The patient is defined as a behavioral system composed of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem also has three functional requirements which include (1) protection from noxious influences, (2) provision for a nurturing environment, and (3) stimulation for growth. An imbalance in each system results in disequilibrium. The nurse’s role is to help the patient maintain his or her equilibrium (Alligood, 2017).

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

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Relevant of Theory and Model to APN
Nudge Theory
Useful tool to direct and guide patients toward goals
Tool to influence patient’s decisions and actions

(Mortensen et al, 2018)
Johnson’s Behavioral Systems Model (JBSM)
Purposeful action
Patterned behavior
Feedback
(Johnson, 2002)

In this slide, I am going to talk about the relevant of the Nudge theory and Johnson’s Behavioral Systems Model to advance practice nurses.

From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals (Mortensen et al, 2018).

In my advance role as health informatics nurse, I think its relevant to consider all factors and stressors that contribute to medication adherence. The three core concepts identified in the JBHM are: (a) purposeful action, (b) patterned behavior, and (c) feedback. Patients’ initiating and sustaining medication adherence are dependent on the deliberate decision to take medications based on perceived need, effectiveness, and safety (purposeful action). Then they establish medication-taking patterns through access, routines, and remembering described as patterned behavior. Individuals use information, prompts, or events (feedback) during the appraisal process to evaluate health treatment that, in return, influences individuals’ levels of purposeful action and patterned behavior (Johnson, 2002). I think once we understand the pattern and purposeful actions of how someone can’t adhere to their medication. It would be easier to find solution to assist them.

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

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What is wrong with medication non-adherence?
Medication is essential component for effective treating many diseases.
Ex: When you have the flu, medicines like Theraflu and Nyquil’s help relief some symptoms and shorten illness time otherwise duration of common cold and flu could be lengthen and worsening.
Non-adherence is a hidden epidemic
Statistics: 50% people are adherence to their medication
20-50% shows prescriptions that are NEVER filled.
20% are taking drug holidays??
(Conn et al, 2016)
Consequences of non-adherence
Worsening condition
Increased comorbid diseases
Increased health care costs
Death
( Chisholm-Burns & Spivey, 2015)

One specific issue in healthcare system is mediation adherence. Medication adherence (MA) is an essential component for effectively treating many diseases. Non-adherence is a persistent and pervasive yet hidden epidemic with major health and economic consequences. For instance: When you have the flu, medicines like Theraflu and Nyquil’s help relief some symptoms and shorten illness time otherwise duration of common cold and flu could be lengthen and worsening or potential death.

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

Medication adherence is an essential component for effectively treating many diseases. Non-adherence is a persistent and pervasive yet hidden epidemic with major health and economic consequences. Overall, MA is about 50%, 20% to 25% of prescriptions are never filled, 20% of patients take drug holidays after filling prescriptions, and frequent missed doses are common. The World Health Organization calls poor adherence a “worldwide problem of striking magnitude (Conn et al, 2016).

The impact of medication non-adherence on health outcomes are:

Despite the importance of adherence, medication non-adherence is a serious problem, with the World Health Organization noting that the average non-adherence rate is 50% among those with chronic illnesses. Consequences of non-adherence include worsening condition, increased comorbid diseases, increased health care costs, and death. Non-adherence results from many causes; therefore, no easy solutions exist. The first step to addressing non-adherence is to recognize that collaboration must occur between health care practitioners and patients to increase adherence, with the goal of achieving optimal health outcomes( Chisholm-Burns & Spivey, 2015).

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

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Theory as Framework for EBP
Nudge Theory
Positive reinforcement for positive behaviors
2/3 out of 800 adults would adhere to medications when rewarded for their efforts
Ex: Incentive of $5 or coupons toward grocery for timely refill.
(Commins, 2018)
Johnson’s Behavioral Systems Model (JBSM):
Useful guidelines for providers and nurses for care plan
Critical adaptive vs. maladaptive behaviors
Rate behavior for compliance in rating scale of 1-4
Ex. How often do you take your blood pressure medication?

  1. Daily 2. Weekly 3. Sometime 4. Never
    (Alligood, 2014)
    Compliance is behavioral issue. The nudge theory proposes positive reinforcement and indirect suggestions as ways to influence the behavior and decision making of the patient, and came about as a result of the researchers’ aim to understand why patients were failing to adhere to their medication prescriptions (Smith, 2019).

Two-thirds of the 800 chronically ill adults polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts. Those numbers vaulted to 88% for adults ages 18-34 (Commins, 2018). For instance: Common pharmacies such as Wal-Mart, Jewel-Osco, Walgreens, and CVS can provide incentives for their customers who fill their prescriptions as scheduled time, not earlier or later. Incentive could be $5 reward or coupons toward grocery.

The first step to addressing non-adherence is to recognize that collaboration must occur between health care practitioners and patients to increase adherence, with the goal of achieving optimal health outcomes (Commins, 2018)

Johnson’s Behavioral Systems Model (JBSM) offers useful guidelines for providers and nurses to assist patients who are having difficulty with of the subsystems. It used in conjunction with the nursing process, it has provided a useful conceptual map to plan patient care. With each subsystem operationalized in terms of critical adaptive and maladaptive behaviors. The behaviors were ranked into categories according to their assumed level of adaptiveness. Nurse clinicians can rate each behavior for compliance by using an activity rating scale of 1 to 4. This scale provided a basis for allocating nursing resources to help patients achieve equilibrium (Alligood, 2014).  

For instance: How often do you take your blood pressure medication? 1. Daily 2. Weekly 3. Sometime 4. Never . If someone answers is either 3 or 4, then plans of care would be focused on reasons why patient cannot adhere to their medication daily. Available nursing resources can help modify and enhance those non-adherence behaviors.

NR501-63233 Week 7 Application of Theory: PowerPoint Presentation LT

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Insight of Theory and Model
Nudge Theory
Know how people think so it’s easier choose for them
Science behind leading people to right decision
Handy concepts for organizations
(Thaler & Sunstein, 2009) 
Johnson’s Behavioral Systems Model
Achievement of goals measure
80% achieved goals by the time of discharge

(Poster et al, 1997)
According to Richard Thaler and Sunstein’s book Nudge published in 2009, It’s about making it easier for them to make a certain decision by knowing how people think, we can make it easier for them to choose what is best for them, their families and society. Nudge theory is the science behind subtly leading people to the ‘right’ decision. It works on the principle that small actions can have a substantial impact on the way people behave. For organizations wanting to drive positive behavior change, it’s a handy concept to know about.

I think The Johnson Behavioral System Model (JBSM) was not only serve as nursing conceptual framework but also measure achievement of goals for patients. Although there is a great deal of interest in the outcome of the nursing care of psychiatric patients, there is little empirical research about the effectiveness of nursing care. The predicted patient outcome related to patient demographics, acuity, nursing diagnosis, short-and long-term goals, and nursing interventions. This study showed the importance of the nursing database in the medical records and the effectiveness of nursing interventions on predicted patient outcomes achieved by the time of discharge. Overall, 80% of the predicted patient outcomes were achieved by the time of discharge, with increased length of stay being a factor in increasing the likelihood of achievement of goals (Poster et al, 1997).
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Conclusion


In summary to my presentation, I have learned to analyze and applied The Nudge Theory and Johnson Behavior Systems Model to advance nurse practice role.
The nudge theory serves a positive reinforcement framework for medication adherence. I think that nudge theory could be applied in different behavioral changes other than medication adherence which have seen in workforce. On time and hard working workers could have wage increases and promotion.
The JBSM is a model to measure and foster balance in patient subsystems to tailor an individualized care plan. The Three core concepts identified in the JBSM helps identify pattern and purposeful actions of how someone can’t adhere to their medication.
I have also mention about the detrimental consequences of medication non-adherence which can lead to death.
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References


 Alligood, M. R. (2017). Nursing theorists and their work. Retrieved from https://ebookcentral-proquest- com.chamberlainuniversity.idm.oclc.org
Alligood, M. R. (2014). Nursing Theory: Utilization and Application (5th ed.). St. Louis, MO: Elsevier Mosby.
Chisholm-Burns, M. A., & Spivey, C. A. (2015). The ‘cost’ of medication nonadherence: Consequences we cannot afford to accept. Journal of the American Pharmacists Association, 52(6), 823-826. doi:10.1331/JAPhA.2012.11088
Johnson, M. J. (2002). The Medication Adherence Model: A Guide for Assessing Medication Taking. Research and Theory for Nursing Practice, 16(3), 179-192. doi:10.1891/rtnp.16.3.179.53008
Poster, E. C., Dee, V., & Randell, B. P. (1997, June). The Johnson Behavioral Systems Model as a framework for patient outcome evaluation. Journal of the American Psychiatric Nurses Association, 3(3), 73-80. doi:10.1016/S1078-3903(97)90021-5
Smith, A. (2019, March 29). Boots tests ‘behavioral nudge theory’ for medication adherence. PharmTimes. Retrieved from http://www.pharmatimes.com/news/boots_tests_behavioural_nudge_theory_for_medication_adherence_1282881
Thaler, R. H., & Sunstein, C. R. (2009). Nudge: Improving Decisions About Health, Wealth, and Happiness. New York, NY: Penguin Group.

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