NSG8815 Troy University Depression among Prisoners with Chronic Diseases Paper I have attached requirements below. My PICO is will implementation of depres

NSG8815 Troy University Depression among Prisoners with Chronic Diseases Paper I have attached requirements below. My PICO is will implementation of depression screening increase depression diagnosis in individuals with chronic disease in an adult make prison?

EBP Models to compare to topic in paper is Iowa model of EBP

Middle Range Nursing theory to compare to topic in paper is Pender’s Health Promotion Model

I have also attached an example paper if needed! NSG 8815 Evaluation Methods for Improvement of Clinical Outcomes
Middle-range Theory and EBP Model Paper
This paper is designed to assist in the identification and development of two
theories/models that will guide the DNP project. You will search the literature for one
middle range theory and one EBP model and select the two that are most relevant to
your area of advanced nursing practice and/or DNP project. You must use one EBP
model and one middle range theory. The paper will be divided into two parts; the first
part will focus on a detailed description of the theory/model and the second part of the
paper will focus on rationale for your chosen theory/model to your practice area or DNP
project. This paper should be no more than 10 pages not including title and references
and written in APA format.
The paper must include:
1. Identify the middle range theory and EBP model most relevant to your area of
advanced nursing practice and/or DNP project including:
a. Description of the two models including:
1. author(s)
2. purpose
3. relevant assumptions that relate to your topic
4. major concepts/constructs that relate to your topic
2. Explain the rationale used for choosing the theory and model including:
a. background and significance of the theory/model to advanced practice nursing
using
1. citations from the literature (including EBP) in which the theory/model
has been used
Evaluation Criteria:
A. Identification of one middle range theory and one EBP model (clarity and logic):
10 points
B. Accuracy and detail in chosen models: 40 points
1.author(s)
2. purpose of the model
3. relevant assumptions of the theory/model that relate to your topic/practice area
4. major concepts/constructs in the theory/model that relate to your topic/practice
area
C. Rationale for chosen theory/model: 40 points
1. Review of evidence-based literature that utilizes the chosen theory and model.
2. Discussion of relevance and applicability of the chosen theory and model to
advanced practice and specific DNP project.
D. Scholarly writing and use of APA format: 10 points
Total: 100 points
Hints:
In part C, ‘review of evidence-based literature’ means is there anything in literature that
provides rationale for choosing this model? What other studies have used the
theory/model?
See Blackboard for more information
1
Purpose
The purpose of this project was to examine the effect of AAT on self-reported
anxiety among hospital employees such as physicians, pharmacists, nursing managers,
nurses, patient care technicians, and hospital secretaries.
Models/Theories
Workplace anxiety is a common theme in the occupation of nursing and other
healthcare disciplines. Holistic interventions to reduce anxiety in the work environment
are needed to achieve an appropriate level of patient care quality (Markwell et al., 2015).
Animal-assisted therapy using a dog has been shown to provide a calming effect to
reduce anxiety. For example, Sigmund Freud often had his dog, Jofi, present in his office
for his comfort during psychotherapy sessions (Silcox et al., 2014). The study hypothesis
was that animal-assisted therapy could produce a comforting effect on hospital staff,
which may reduce their workplace anxiety. The theory of comfort and Iowa model of
evidence-based practice (EBP) to promote quality of care were used to guide this study.
Middle-range Nursing Theory
The theory of comfort was created by Kolcaba in 1991 to provide a holistic
understanding of an individual’s needs for comfort. Kolcaba’s concept of comfort is
simple. Comfort is an experience felt by recipients resulting from comfort interventions.
Kolcaba defines comfort as an immediate feeling and sense of being reinforced by the
holistic experience when needs are met by three categories of comfort. These types of
comfort include relief, ease, and transcendence. The recipients’ need for comfort arises
from stressful health care situations that do not diminish by traditional support (Alligood,
2014; Kolcaba, 1991). According to Kolcaba (1991), this need for comfort may be
physical, psychospiritual, sociocultural, and environmental. Animal-assisted therapy is
thought to fit into Kolcaba’s definition of a comforting intervention (Fenstermaker,
McKendree, & Swope, 2015). Comforting interventions are intended to focus on specific
comfort needs of recipients, including environmental and physical needs. Kolcaba also
suggested these interventions need to be evidence-based to produce best possible client
outcomes (Alligood, 2014). A few aspects of the comfort theory were utilized for the
purpose of this study, which include assumptions and concepts.
The goal of utilizing this theory was to assure holistic comfort is provided to
reduce the presence of anxiety. A few studies recently have utilized this theory
successfully. Vianney (2016) used Kolcaba’s theory to aid in the exploration of patient
perceptions, experiences, and feelings associated with postoperative pain. The comfort
theory was used by Vianney (2016) because it points out important nursing actions to
take care of each specific comfort need within the study. All of Kolcaba’s concepts,
definitions, and assumptions were used to guide Vianney’s (2016) study. Vianney’s
(2016) gave a positive example of how the theory of comfort could be used to guide
practice.
Another study by Craig (2015) applied the theory to examine nursing knowledge
and attitudes toward patient pain management. Craig (2015) explains Kolcaba’s theory in
detail during the conceptual framework within the study, which included all concepts,
assumptions, and definitions. Craig (2015) reviewed other studies which used Kolcaba’s
theory of comfort to investigate nurses’ perceptions of comfort as they relate to pain. The
application of the comfort theory was shown in Craig’s study (2015) as a way to guide
nursing decisions regarding the concepts of comfort towards patient care.
Fenstermaker et al. (2015) used the comfort theory to help guide a study in testing
pet therapy as a way to decrease signs and symptoms of depression, and lower heart rate,
and blood pressure among long-term facility residents. Again, all the theory’s concepts,
definitions, and assumptions were explained. However, Fenstermaker et al. (2015) only
applied two types of comfort within only two contexts of Kolcaba’s theory. For example,
relief and ease were observed within the context of the physical and psychospiritual
senses (Fenstermarker et al., 2015).
Animal-assisted therapy has been shown as a comforting intervention to reduce
anxiety and produce a positive emotional effect on a variety of individuals, including
patients, family, students, and healthcare staff (Abrahamson et al., 2016; Bibbo, 2013;
Edwards et al., 2014; Gonzalez-Ramirez et al., 2013; Lynch et al., 2014, Marcus et al.,
2013; Stewart et al., 2014; Wright et al., 2015). Incorporating Kolcaba’s definition of
institutional integrity, the hospital may benefit from AAT for employees in providing a
comfortable workplace environment. Institutional integrity is important for the
organization because it produces evidence for best practice and best policies. According
to Kolcaba, healthcare staff may be recipients of enhanced workplace comfort when the
institution or organization are trying to improve the working environment. Kolcaba also
expressed that the environment is any aspect of the institutional setting that can be
manipulated by the institution to enhance comfort. Placing AAT in the hospital setting
may enhance employee comfort and improve stressful working conditions (Alligood,
2014).
The four assumptions of Kolcaba’s (1994) theory of comfort was applied to the
current DNP project. Healthcare workers may have a holistic experience with AAT. This
statement is based on Kolcaba’s (1994) assumption that human beings have a whole
person response to complex stimuli. American workers, including those in healthcare,
attempt to achieve their comfort needs within the workplace and provide quality work
when in a supportive work environment (APA, 2014). This can be based on Kolcaba’s
(1994) assumption that human beings consistently strive to meet their basic comfort
needs. Workplace comfort is a necessary holistic outcome for healthcare organizations
following The Magnet Recognition Program (Karadzinska-Bislimovska et al., 2013).
Kolcaba’s (1994) assumption that comfort is a desirable holistic outcome to the discipline
of nursing is shown by the Magnet Program initiatives on a systems level. Furthermore,
Kolcaba also assumed that institutional integrity is based on a value system focused on
providing a health promoting, holistic setting for providers of care (Alligood, 2014).
Although all the parts of Kolcaba’s (1991) theory of comfort are important, this
DNP project focused on two categories of comfort: relief and transcendence; and also
focused on two contexts: physical and environmental. In the comfort theory, relief occurs
when a specific need is met. This type of comfort associates the most with nursing
because relief is felt due to a prior existing discomfort. Transcendence is achieved when
an individual can rise above a difficult situation because of the state of comfort. Kolcaba
(1991) further called this type of comfort the renewal or inspiration sense. Kolcaba
describes transcendence as an extraordinary or potential performance thus resulting from
ease and relief. Extraordinary performance requires concentrated effort and a detaching
of one’s concern of difficulty, such as a stressor. Kolcaba’s comfort themes are signifying
that some comfort needs can be related to physical sensations or environmental factors or
activities. The physical context of the comfort theory pertains to bodily sensations, while
the environmental context pertains to the external surroundings, conditions, or influences
(Kolcaba, 1991).
For this project, animal-assisted therapy was presented in the hospital setting.
Self-reported anxiety levels were collected from participating healthcare employees
before and after a brief AAT intervention using a measurement tool. AAT did provide a
reduction in self- reported stress in healthcare employees who were experiencing high
levels of workplace anxiety (Abrahamson, et al., 2016; Bibbo, 2013). The study’s
participants may have also experienced improved work assurance and motivation after an
AAT activity mirroring Kolcaba’s definition of transcendence (O’Connor, 2014; Silcox
et al., 2014). The act of petting the dog’s fur helps to create a comforting effect and the
repetitive motion helps with relaxation (O’Connor, 2014; Silcox et al., 2014). This type
of comforting effect relates to the context of physical sensation when the participant has a
chance to touch and receive affection from the therapy dog (Kolcaba, 1991). The sole
presence of the dog in the environment has the potential to increase physical and mental
functioning, provide a positive emotional response, and foster personal growth and
empathy (Silcox et al., 2014). AAT within the working environment has been shown to
create a warm and friendly work setting (O’Connor, 2014). The participant’s workplace
can improve by implementing AAT within the environment, hopefully influencing a
reduction in anxiety and provide a comfortable place to work (Goddard & Gilmer, 2015;
Swanson, 2014).
Evidence-Based Practice Model
The Iowa model of EBP to promote quality care was used to help guide evidencebased literature about AAT reducing anxiety into clinical practice. The Iowa model is
general and easy to apply to typical practice issues (Mann-Salinas et al., 2013). This EBP
model helps in selecting a way to solve a practice problem by the availability of evidence.
In a healthcare setting, this model provides a pathway on how to take a clinical problem
and match it with an evidence-based intervention to make an organizational or
departmental change in practice. Because of the general effectiveness of the Iowa model,
it was chosen as the guide for implementation of AAT into the work environment. Two
recent articles were found as examples in how to use the Iowa model in practice. MannSalinas et al. (2013) used the Iowa model to gain a foundation of an evidence-based
nursing preceptor program for skilled nurses who lack specific experience of caring for
burn patients in a hospital burn unit. The authors extensively used the first few steps in
the Iowa model to determine a problem, form a team of experts, and systematically
evaluate the evidence to support the nursing preceptor program. In this particular burn
unit, the Iowa model was used for all EBP projects, so the staff and team members were
familiar with the concepts and systematic approach to implementing EBP practice change
prior to the study (Mann-Salinas et al., 2013). Mann-Salinas et al. (2013) reported that
they will continue to use the Iowa model in the final steps, including to pilot the change,
determine appropriateness for full adoption, and if so, sustaining the change, monitoring
outcomes, and disseminating results. Also noteworthy is a study by Brown (2014), in
which the Iowa model was used for oncology nursing to implement a change to reduce
patient falls. During Brown’s (2014) study, all the steps of the Iowa model were used and
explained in detail. Brown (2014) displayed how the Iowa model can be used in a
hospital setting and provided a detailed guideline on how to make the change for a
healthcare environment.
The current DNP study was used as an example in describing how the Iowa model
could be used effectively in implementing AAT among healthcare employee at the unit
level. The first step of the model illustrates the problem or knowledge triggers that
initiate the EBP process. A problem trigger originates from a clinical problem, while a
knowledge trigger surface when new research findings exist or when new practice
guidelines are needed. The second step in the Iowa model is to determine if the clinical
problem is a priority for the organization, department, or unit where the trigger is taking
place (Brown, 2014). Healthcare employees, especially those in high-intensity areas of a
hospital, experience workplace stress frequently (Kreitzer, 2015; Oyeleye et al., 2013;
Rushton et al., 2015). As a result, hospital administrations often see high nursing turnover
and signs of burnout, decreased staff satisfaction, and reduced quality of patient care
(Markwell et al., 2015). The outcomes of workplace anxiety in healthcare are all
significant and of high priority within the organization. Each issue resulting from
workplace anxiety in the hospital employee can have an important effect in the way
patients and their families receive care, whether it be directly or indirectly (Bibbo, 2013;
Kreitzer, 2015; Markwell et al., 2015). A reduction in the quality of patient care due to
workplace anxiety in the hospital setting is the most important problem trigger identified
in the current study. The implementation of an evidence-based intervention to reduce
workplace anxiety is necessary to the hospital organization and patient care. For the
current project, AAT was used as a holistic approach to reduce workplace anxiety in
healthcare employees in a high-intensity unit.
A team will need to be formed for the next step in the Iowa model. This team is
essential in helping to develop, evaluate, and implement the EBP change into practice.
The members of the team should include nursing and non-nursing specialties (Brown,
2014). The DNP project team consisted of the DNP student leader, unit manager, head of
the volunteer services, and the dog handler supervisor from Therapy Dogs International
(TDI). The unit manager helped with the implementation of the AAT activity within the
unit, provided pertinent information about the number of staff, and granted needed access
to staff meetings. The head of volunteer services provided relevant data on the existing
animal-assisted activities throughout the hospital, including a protocol and previously
developed guideline. The scheduling and details of the dog visits were arranged ahead of
time by the supervisor of TDI. Once the team was formed, the next step in the Iowa
model was to gather and critique the evidence related to the implementation of AAT.
This step involved creating a PICOT (population, intervention, comparison, outcomes,
and time) question, conducting a literature search, and then critiquing each recent study
(Brown, 2014; Mann-Salinas et al., 2013).
Advanced practice nurses and doctorally prepared nurses are ideal team members
to assist with the critique of the literature (Brown, 2014; Mann-Salinas et al., 2013). All
the aspects in the evidence search step were conducted in the current study by the DNP
student and critiqued literature can be found in the included evidence table. A sufficient
amount of current evidence was found showing AAT reduced anxiety (Abrahamson et
al., 2016; Bibbo, 2013; Edwards et al., 2014; Gonzalez-Ramirez et al., 2013; Lynch et al.,
2014, Marcus et al., 2013; Stewart et al., 2014; Wright et al., 2015). Furthermore, there
was evidence to suggest that the use of AAT with nursing staff and other healthcare
workers benefits their emotional state (Abrahamson et al., 2016; Bibbo, 2013; Edwards et
al., 2014). There are findings from the literature that workplace anxiety exists in hospital
settings, that AAT is effective in reducing anxiety, and AAT can be used among
healthcare staff.
The next step in the Iowa model, and for this project, was to implement AAT into
a pilot practice change. In the Iowa model, it is important to implement a practice change
in a small unit or department first before conducting a full study for the entire
organization. This step exists to ensure the change is feasible and will result in improved
outcomes before full-scale implementation (Brown, 2014). AAT was implemented on an
oncology unit where high anxiety among the floor staff is usually seen relating to the
types of patients occupying the unit (Oyeleye et al., 2013; Rushton et al., 2015). The
study showed significance in demonstrating a perception of reduced workplace anxiety
among the oncology floor staff using AAT, therefore; the organization may consider
implementing the EBP change within the hospital system for all employees (Brown,
2014).
The current study implemented animal-assisted therapy in a hospital setting where
workplace anxiety was an issue. A middle-range theory and evidence-based model for
nursing are being used to help guide the DNP project structure. Only two types of
comfort and comfort contexts will be used from Kolcaba’s (1991) theory of comfort
within this project. AAT may provide relief and transcendence for the hospital staff to
reduce stress in the physical and environment sense. The project also used the Iowa
model of EBP to promote the quality of patient care to help guide AAT within the
hospital setting to improve workplace anxiety among healthcare employees. Both the
theory and model were used to promote the success of the DNP study.

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