On October 23rd, 2014, we updated our
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BSN, RN Awakening (Nightingale) MSN Confusion (Neuman, King, Orem) FNP Credits Period of Disillusionment ( Parse, Rogers and Pender) MEd Period of Rapid Intellectual Growth ( Psycho-socio-cultural and economic models, Wellness and Holistic Theories, Behavior Change, Deming, Life Skills, Empowerment, Social Behavior, Diffusion of Innovation etc) DNP Leadership and Personal Growth Complexity, Caring, Systems, Organizational Theories, Culture Change, Shared Governance Knowledge Focus Global Organization Community Patient and family Patient Role as a Nurse 1987 1990 1995 2002 2009 Future Organization Education Research and Teaching Critical Care Clinical Critical Care Clinical Clinical Application Professional Growth Chart Learning Process: Infinite
“ A creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomenon.” (Chinn & Kramer, 1995)
“ Learning a new discipline is guided by theories, use of language, identification of concepts, definition of relationships, structured ideas, and facilitation of disciplined inquiry, practice and communication, as well as predicting outcomes of practice.. “ (VanSell & Kalofissudis, 2003)
Professional PARADIGM CONSRUCTION
sets of beliefs and practice
shared by communities of professionals
regulate inquiry, education & practice within disciplines
contributes towards disciplinary knowledge construction
requires assessment of personal, spiritual, cultural, social, intellectual and emotional concepts
weaver k. & olson j.k. (2006) Journal of Advanced Nursing 53 (4), 459–469
Philosophy in Life
Culture, values and
Desire to Learn
Personal Life and support system
Change in professional roles
Availability of mentors
Current State of Nursing
Chaos and Complex environment
Rapid changes in technological innovation
Globalization of the healthcare industry
Lack of training in adaptation to change
Revolutionary changes in medical care
Sky rocketing cost of medical care
Pay for performance
Nursing Shortage(educators, clinicians and leaders)
“ Thomas Kuhn defines a paradigm as a constellation of achievement, values and techniques, shared by a discipline to define legitimate problems & solutions,” (Kuhn, 1970).
Paradigm shift is the result of a revolutionary break from the usual practice and way of thinking to a new vision of reality, a new, bigger perspective of the world.
Leadership development through theory, mentorship, & clinical residency
Clinical residency/mentor experiences
(Dartmouth Hitchcock Med. Center & MD Anderson)
Karlene Kerfoot (1998):
“ Management can be taught—leadership must be experienced to be learned…”
Nursing Paradigm Shift
The world is made up of building blocks & man’s illness is influenced only by the biological problem; medical model; nurses “DO”
Nurses focus on helping patients achieve balance and harmony within the mind, body & soul; pt. Centered
The world is embedded in the cyclical pattern of nature; science allowed simulation, modelling & thinking from quantity to quality
( VanSell, 1995 )
` Holistic Paradigm Views the entire individual in his or her physical, social, esthetic and moral realms instead of just certain aspect of human behavior or physiology. “ Harmony, balance, synergy, yin and yang comes to mind.”
Deep Ecology Paradigm
interdependence of all phenomena
individuals and societies are embedded in the cyclical process of nature
changes that nursing is going through is brought about by chaos & complexities requiring integrative thinking-being intuitive, be able to synthesize, holistic and non linear
(Van Sell, 2002)
The only difference between revolution and evolution is the time it takes to make sustainable change.
The over time waves of change
Star’s Paradigm Shifts Nurses lead, teach, create new knowledge and change the world; work in collaboration with other disciplines; no limits; application of knowledge; learning learner Systems improvement; quality health care; Technology/super computer Fellowship Nurses play a bigger role in introducing positive changes in the environment; code of ethics DNP; professional/social responsibility; health policy, active participation in creating new knowledge; spread of knowledge; innovations; service in a larger scale; research; theory development Complexity theory, leadership, diffusion of innovation, systems management; Philosophy DNP Man is complex, has a choice & illness can be prevented through empowerment & education; behavior change is possible; nurses as members of the healthcare team; nurses can contribute to global knowledge; nurses can be autonomous practitioners; resource issue is global Parse, Rogers, Pender; social science theories FNP-MEd Patient seek help because they are sick, maladaptation to disease and nurses help them survive in the continuum of wellness & disease; Medical model; nurses obey orders King, Orem, Neuman MSN Learn and apply basic nursing care and adherence to code of Ethics of Nursing Florence Nightingale BSN, RN Paradigm Shifts Theory Stages
Professionalism Leaders, after mastering the technical skills to do the job, must choose appropriate work processes, understand and intentionally manage relationships to achieve better outcomes. (O’Grady & Malloch, 2003)
Nurse leaders has the responsibility to self
Moral self respect
Professional growth & maintenance of competencies
Wholeness of character
Contribution to New Knowledge Encourage creativity and Innovation Nurse leaders are expected to use evidence in clinical practice and encourage the use of EBP among the staff. Nurse leaders are responsible for creating research of discovery. They have the responsibility to test new knowledge; disseminate reliable and valid information to the public. Engage in scholarly activities. Nurse leaders are expected to teach nursing students, clinical staff and future nursing leaders. (Code of Ethics for Nurses, 2008)
Contribution to Healthcare Quality, Outcomes and healthcare delivery
Collaborate with other health professionals and the public in promoting community, national & international efforts to improve healthcare.
Responsibility for articulating nursing values, maintain integrity of the profession and practice.
Nursing leaders should actively participate in social reform and health policies that address health disparities and healthcare quality in necessary.
Encourage organizational transparency so that outcomes can be easily measured.
Be an advocate for patients and resource for colleagues.
(Code of Ethics for Nursing, 2008)
Contribution to Advance Nursing Practice-Leadership Role
DNP is the highest level of education for the clinical doctorate in Nursing.
It has a focus on health policy, administration, information technology and management in advanced practice.
Nurse leaders have the responsibility to maintain competencies in personnel management and to continuously educate oneself to obtain the necessary competencies to perform the job.
Personal Motivating Factors
Desire to enhance leadership repertoire
To develop administrative skill sets (financial management/dev. of healthcare programs)
To better understand & integrate clinical expertise & administrative skills to impact pt outcomes
Professional Goals 1. To serve in a leadership/executive level at a major healthcare organization; 2. To impact change that results in sustained quality improvement w/ pt.care/outcomes; 3. To influence pt outcomes by ensuring best practices based on evidence through research, policy making and collaboration; 4. To make a difference in healthcare by leading effectively through others;
5. To bridge the gap between health care delivery systems i.e. hospitals and community services to ensure public access to primary, secondary and tertiary care; 6. To empower nurses, develop nurse leaders, and to create a common vision for all nursing specialties (education and mentorship); 7. To extend the success of organizational and community projects to third world countries.
Why DNP… 1. Visionary program that prepares nurse leaders to be effective in today’s dynamic & chaotic healthcare milieu Jobes & Steinbinder (1996): “ The new executive leadership roles require astute financial skills as well as expert executive administrative skills.”
Why DNP… 2. New connection between ordinary events and theory 3. Continually & critically analyzing and questioning the efficiency of the status quo 4. Constantly asking, “What if?” Effective Leadership does not allow a fragmented view of health care delivery. (E. Hoffman)
5. Well rounded approach to education
Biostatistics, epidemiology, research critiques, literature review, strength of evidence
Identification of vulnerable populations & specific needs of population
Formative & summative evaluation of programs
Cognates with other colleges in the University
research clinical Identity devt & transformation leadership Teaching is a major Component of each competency
Political insight to healthcare & healthcare policy development
Maintained passion for pts/pt care & frontline care providers
Advanced Practice Leadership Role
Acclimatization to Chaos
Synthesis Continuous Learning
O’Grady & Wilson, 1995
Receptivity and similarity
Immediacy and equality
Theory of Constant Adaptation to Complex Systems
“ Chaos & loss of certainty provide and opportunity to let go of things that are inherently changing & passing.” (O’Grady & Malloch, 2003)
Nursing leaders can create theories that allows them to hypothesize, test, evaluate and disseminate new knowledge and concepts.
This theory will focus on organizational change using nursing theories and maintain organizational sustainability and stability.
Work in progress
“ Until one is committed there is hesitancy, the change to draw back, always ineffectiveness. Concerning all acts of initiative or creation there is one elementary truth, the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, then providence moves too. Whatever you think you can do or believe you can do, begin it. Action has magic and power in it.” Goethe
American Nurses Association (2008). Code of ethics for nursing. Accessed November 15, 2008 from http://www.nursingworld.org/mainmenuecategories/the practiceof professionalnurisng/ethics/standards/codeofethics.aspx
Chinn, P. & Kramer, M. (2003). Theory and nursing (4 th ed). St. Louis:Mosby.
Kuhn, T. (1962). The structure of scientific revolutions. Chicago:University of Chicago Press.
O’Grady, T. & Malloch, K. (2003). Quantum leadership: a textbook of new leadership. MA: Jones and Bartlett Publishers, Inc.
Van Sell, S. (2002). Receding and evolving paradigms. ICU and Nursing Web Journal. Accessed November 15, 2008 from http://www.nursing.gr/selleditorial.pdf
Van Sell, S. & Kalofissudis, I. (2001). The evolving essence of the science of nursing: the complexity integration nursing theory. ICU and Nursing Web Journal. Accessed November 15, 2008 from http://www.nursing.gr/complexitytheory.pff
Weaver, K. & Olson, J. (2006). Paradigm construction. Journal of Advanced Nursing. 53 (4), 459-469.