Professional Paradigm


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My journey toward the DNP role that I hope to define.

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  • Hello everyone, but those who, I am excited to share with you my professional paradigm. Before I do that, Id like to quote Alvin Toffler: “ The illiterate of the 21 st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn. That quote reflects my journey.
  • I will read my outline for this presentation.
  • My professional growth chart reflects my education in red. I am a learning learner so I believe that my survival in this profession is through enriching myself with knowledge and sharing them. I go to school not for the degree nut my unquench thirst for learning. After graduation I went through a stage where I questioned myself whether Nursing is the right profession for me. I got my MSN in Medical Surgical Nursing on a scholarship from my nursing school, providing that I teach. I have been keeping the promise. I believe that in whatever stage you are in life, one has the responsibility to share the truth. My focus has transitioned from the individual patient to the community and ultimately, I hope, globally. My experience is hampered by the fact that I was not always the first choice for a job.
  • When I first took a class in nursing theory, I fell in love with Rosemarie Parse’s Theory on Human Becoming. For clinical practice King, Orem, Newman is frequently used. As my knowledge grew, I began to see the relevance of theory and its role in guiding practice. Read…definitions…
  • What are paradigms…
  • After some reflection, these are the factors that influenced my paradigm shifts. Yes, it has changed and I believe it will keep on changing depending on the situation that I am in. One could be as limited as viewing nursing as a source of income or can be in depth as looking at nursing as an art and science, a way of life. That is how I see nursing, a way of life. Maslow comes to mind…I will only be actualized in this profession if I can give something back.
  • We exist in an ever changing environment. The turbulence that nursing exists in should be viewed as a call for change to the old values and beliefs. We need to be more creative an look at nursing as a discipline that needs to be involved in leadership processes to assist in a more effective delivery of healthcare. It is crucial that we keep up with the trend of generating new ideas and adapt technological changes yet keep the very essence of nursing, caring.
  • As the world changes, nurses and Nursing should look at other theories: Chaos theory talks about dissolution of old patterns and development of new. Change theory tells us that unsettled at a time, s form of unfreezing old patterns, is to be looked at as an era of opportunity.
  • I will be doing my residency this last 2 semesters. I hope to spend them with professionals who can look at the needs of the future and are willing to share their expertise with me.
  • According to Van Sell in her editorial on Receding and Evolving paradigms: Nursing went through a revolutionary change from the mechanical paradigm, where the human body is a machine and nurses are the agents that could help fix that machine; she quotes Libster “ the mechanical paradigm is based on reductionism. Reductionism is the concept that an illness including all of its cultural, social, physical, and emotional components can be reduced or explained by a biological problem. Van Sell continues to explain that this led to the “doing” role of nursing.
  • Holistic Paradigm is being practiced by a large number of nurses. Holism, according to Van Sell views the world as an integrated whole rather than a collection of dissociated parts. My experience in Public health, in my case, made me that there is more to a patient than his/his disease. Van Sell states that holism helped nurses focus on assisting the client achieve a higher degree within the mind, body and soul: patient centered care.
  • The deep ecology paradigm, according to Van Sell, recognizes the fundamental interdependence of all phenomena and the fact that individuals and societies are embedded in the cyclical process of nature. The changes that nursing is going through is brought about by chaos and complexities requiring integrative thinking-being intuitive, be able to synthesize, holistic and non linear. The paradigm suggests integrative values of conservation, cooperation, quality and partnership; social organizations as networks; ethics as exocentric values thus resulting in scientists in being responsible for their research not only intellectually but also ethically and morally; and finally a shift from physics as the center of life to nursing at being in the center with emphasis on life sciences.
  • I was lucky enough to meet Dr Van Sell. She taught at UNLV for a semester and I happen to be one of her students. She is dynamic and asks you open ended questions. She now teaches at North Carolina. She developed the Complexity Integration Theory with a Greek colleague I Kalofissudis. This theory reflect the actual need for a paradigm change in nursing. She mentions chaos theory and the goal is to consistently adjust to change. To me she is a visionary.
  • This table shows how my paradigms has evolved from the inclusive to a more global view of health. The theories that has grounded my practice is totally different from when I started practicing nursing. In time I will develop my own theory of how to best perform the practice that I hope to share with the world.
  • As a DNP in a leadership role, I believe that I have the responsibility to be maintain my professionalism and to continuously learn and create new ideas.
  • I believe that I have a responsibility to myself as well. My integrity, wellness and time to myself is essential for me reflect on how I can be a better person, educator and teacher.
  • I love to do research. The use of evidence to improve practice is essential in enriching the profession’s core knowledge. I love to share my ideas to whomever wants to listen as long as we agree to disagree. Unfortunately, where I work, I best keep my ideas to myself. 
  • I have a passion for figuring out the most efficient way to do things to help nurses. DNP’s have the responsibility to provide the best possible care for their patients and at the same time as a leader, give nurses the tools to use evidence in their practice. Teach them to be more assertive and creative in their practice.
  • I am still growing in this arena. I chose leadership because it is more challenging. Organizational leadership is a thankless job but I chose it because I know I am good at it. However, I am not quite ready yet. I am in the process of learning this role.
  • What made me decide to pursue the organizational leadership role? Well, as a clinician for the past 20 years, I have seen resources wasted and irresponsible decisions made by management. I believe that being in touch with the individual employees needs is a must.
  • Here are my professional goals. I believe that I can effect more change if I trigger culture change, where people share a common vision. Having a common vision for all in an organization and providing employees tools to achieve this vision fosters empowerment and quality outcomes will follow. Often, healthcare providers are expected to perform more than they are capable of doing-staffing inadequacies does not result in quality outcomes. New leadership in the healthcare industry is needed. Nurses, physicians and other healthcare disciplines should take the responsibility to lead the industry. We should not leave the leading to those who are not familiar with human services and healthcare. I believe that new leadership is not selfish, it empowers, it does not focus on mistakes but on potentials for growth, it is an environment where everyone takes credit for success and accountability for failure.
  • Silos currently exists in healthcare delivery system. Community service organizations should closely work with health care organizations to allow for continuity of care from the community to hospitals and then back to the community. This can only be achieved through collaboration among healthcare providers. I would like to eventually participate in global health policy planning especially in Asia.
  • Why did I decide to pursue the DNP role? Because I feel that AACN has created the potential to solve not only the issue on nursing shortage but also on the needs of a complex society by preparing health care professionals to deal with the crisis.
  • I was able to make sense of my professional path. I had always been asking about a better way of doing things at the bedside and how nurses can affect change. The DNP program has helped me make sense of it all.
  • I have most of the component that I believe will make me an effective health care professional…I plan to pursue a fellowship that will provide competencies in systems management, fiscal administration and program evaluation. I didn’t include teaching as a goal because I believe that each professional has the responsibility to teach and share what they know. So I will always teach and I will always study and learn.
  • The DNP professional that I hope to become is one who maintains a passion for patient care and sensitive to the frontline workers. The job that I will be doing will involve the competencies on the next slide. I know that what I envision may not be existing yet but I believe that it is for us to explore the DNP role.
  • Here are the competencies that I agree should be that of a DNP in the organizational leadership role. One has to show competence in nursing practice to gain respect.
  • I still need to develop conceptual competencies.As a bedside nurse, this is what I lacked. I chose the leadership role because I know the role will help me in developing these competencies that my culture and background did not provide for me. Leadership and interpersonal competencies is something that I think is innate to me.
  • This is my theory…it is a work in progress. I would like to look at business models, human resource management, finance and economics in healthcare organizations. The use of public empowerment, education and health policy is essential I believe to affect change in our current health care.
  • I took a philosophy course in college and I loved it. It was a little to difficult to comprehend and find it difficult to apply when I am assisting a patient to a bedpan. But as I grew as a learner, I get it. Philosophers were merely telling us the truth…only in difficult terms. “Change” gives us hope for possibilities unseen. I love the challenge of change and innovation. I have several shifts in my professional paradigm. Id like to share this quote by Goethe, that Van Sell included in her editorial: Read Quote. Constant adaptation to complexity, sustainability and its application to an organization is the truth that I will be seeking. During my journey I have the following to thank: Dr Dick Pappenfuss who validated my belief that life can be better for all. Dr. by far the best teacher in the world. Dr. Dale Carrison who believed in me Drs. Ross Berkeley, Thomas Matz and Charlie Bloom, Dr Ollie Thienhaus who wrote me the letters of recommendation Vicky Huber who allowed me to do my projects at UMC Mary Bondmass who told me that I was not alone. NCEMNA who allowed me to meet so many great leaders who inspired me to keep on trudging along.(Rochelle Carr whose call is going to be welcomed from now on), Dr Betty Williams, thank you. Belen Gabato and the PNA of Nevada who supported me. AACN who saw the potential in me and supported me financially. (Deb Latimer for being so helpful) Dr Robyn Nelson who agreed to mentor me and who finally became a friend to me. Dr Doug Turner who challenged my understanding of EBP and in turn ignited my passion for EBP. Dr Mitchell Levy who opened the doors for me and recognized my potential to be a leader, speaker and educator. Dr Susan Ullrich who opened my eyes that leadership is something that I am capable of doing. Dr Donna Emmanuel whose fire and passion I admire. She is my idol. My DNP classmates, the world is ours to conquer. My friends Mitch H., Delia U., Marilou T. Camille Lombardo, Marichu M. and the ED staff, secretaries who supported my research projects and helped me cope with my issues. They will always be friends to me. Alice the spin class instructor who just don’t know how her classes gave me the best stress release. Mel Talbott and Evelyn McGuckin for adopting me when I needed work. Ali, Tosh and Trizza and our lunch dates, it was fun. Dr Libby Amos who discovered me among the rubble and encouraged me to be me. IHI, who took a chance in me and made me believe that anybody is worthy of Harvard. Thanks Joelle. Last but not least my family, Steve, Ben, my brothers and sisters, Nini and Bob and Jean. You were all the wind beneath my wings. Nanay and Tatay, I know you both will always be around. I wont hesitate to say that whatever my success is, I alone do not deserve the accolade. It is all for ours to share.
  • Professional Paradigm

    1. 1. Professional Paradigm Estrella Evangelista-Hoffman BSN, RN, MEd, CNL
    2. 2. Outline <ul><li>Professional Growth Chart </li></ul><ul><li>Paradigm construction </li></ul><ul><li>Professionalism </li></ul><ul><li>Leadership </li></ul><ul><li>Advanced practice nursing </li></ul><ul><li>Paradigm of Constant Adaptation in Complexity </li></ul>
    3. 3. 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
    4. 4. Nursing Theory <ul><li>“ A creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomenon.” (Chinn & Kramer, 1995) </li></ul><ul><li>“ 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) </li></ul>
    5. 5. Professional PARADIGM CONSRUCTION <ul><li>sets of beliefs and practice </li></ul><ul><li>shared by communities of professionals </li></ul><ul><li>regulate inquiry, education & practice within disciplines </li></ul><ul><li>contributes towards disciplinary knowledge construction </li></ul><ul><li>requires assessment of personal, spiritual, cultural, social, intellectual and emotional concepts </li></ul>weaver k. & olson j.k. (2006)  Journal of Advanced Nursing 53 (4), 459–469
    6. 6. Paradigms <ul><li>Personal </li></ul><ul><li>Philosophy in Life </li></ul><ul><li>Culture, values and </li></ul><ul><li>Mores </li></ul><ul><li>Professional Goals </li></ul><ul><li>Desire to Learn </li></ul><ul><li>Personal Life and support system </li></ul><ul><li>Emotional Maturity </li></ul><ul><li>Basic Education </li></ul><ul><li>Resilience </li></ul><ul><li>Environment </li></ul><ul><li>Change in professional roles </li></ul><ul><li>Availability of mentors </li></ul><ul><li>Professional rewards </li></ul><ul><li>Technology </li></ul><ul><li>Work environment </li></ul><ul><li>Organizational culture </li></ul><ul><li>Opportunities </li></ul>
    7. 7. Current State of Nursing <ul><li>Chaos and Complex environment </li></ul><ul><li>Rapid changes in technological innovation </li></ul><ul><li>Globalization of the healthcare industry </li></ul><ul><li>Lack of training in adaptation to change </li></ul><ul><li>Revolutionary changes in medical care </li></ul><ul><li>Sky rocketing cost of medical care </li></ul><ul><li>Sicker patients </li></ul><ul><li>Pay for performance </li></ul><ul><li>Nursing Shortage(educators, clinicians and leaders) </li></ul><ul><li>Shifting Paradigms </li></ul>
    8. 8. <ul><li>“ Thomas Kuhn defines a paradigm as a constellation of achievement, values and techniques, shared by a discipline to define legitimate problems & solutions,” (Kuhn, 1970). </li></ul><ul><li>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. </li></ul>Dynamic World
    9. 9. <ul><li>Why DNP… </li></ul><ul><li>Leadership development through theory, mentorship, & clinical residency </li></ul><ul><li>Clinical residency/mentor experiences </li></ul><ul><li>(Dartmouth Hitchcock Med. Center & MD Anderson) </li></ul><ul><li>Karlene Kerfoot (1998): </li></ul><ul><li>“ Management can be taught—leadership must be experienced to be learned…” </li></ul>
    10. 10. Nursing Paradigm Shift <ul><li>Mechanical paradigm </li></ul><ul><li>The world is made up of building blocks & man’s illness is influenced only by the biological problem; medical model; nurses “DO” </li></ul><ul><li>Holistic Paradigm </li></ul><ul><li>Nurses focus on helping patients achieve balance and harmony within the mind, body & soul; pt. Centered </li></ul><ul><li>Ecological Paradigm </li></ul><ul><li>The world is embedded in the cyclical pattern of nature; science allowed simulation, modelling & thinking from quantity to quality </li></ul>( VanSell, 1995 )
    11. 11. ` 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.”
    12. 12. Deep Ecology Paradigm <ul><li>interdependence of all phenomena </li></ul><ul><li>individuals and societies are embedded in the cyclical process of nature </li></ul><ul><li>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 </li></ul><ul><li>(Van Sell, 2002) </li></ul>
    13. 13. <ul><li>The only difference between revolution and evolution is the time it takes to make sustainable change. </li></ul>The over time waves of change
    14. 14. 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
    15. 15. 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)
    16. 16. <ul><li>Nurse leaders has the responsibility to self </li></ul><ul><li>Moral self respect </li></ul><ul><li>Professional growth & maintenance of competencies </li></ul><ul><li>Wholeness of character </li></ul><ul><li>Integrity </li></ul>
    17. 17. 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)
    18. 18. Contribution to Healthcare Quality, Outcomes and healthcare delivery <ul><li>Collaborate with other health professionals and the public in promoting community, national & international efforts to improve healthcare. </li></ul><ul><li>Responsibility for articulating nursing values, maintain integrity of the profession and practice. </li></ul><ul><li>Nursing leaders should actively participate in social reform and health policies that address health disparities and healthcare quality in necessary. </li></ul><ul><li>Encourage organizational transparency so that outcomes can be easily measured. </li></ul><ul><li>Be an advocate for patients and resource for colleagues. </li></ul><ul><li>(Code of Ethics for Nursing, 2008) </li></ul>
    19. 19. Contribution to Advance Nursing Practice-Leadership Role <ul><li>DNP is the highest level of education for the clinical doctorate in Nursing. </li></ul><ul><li>It has a focus on health policy, administration, information technology and management in advanced practice. </li></ul><ul><li>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. </li></ul>
    20. 20. <ul><li>Personal Motivating Factors </li></ul><ul><li>Desire to enhance leadership repertoire </li></ul><ul><li>To develop administrative skill sets (financial management/dev. of healthcare programs) </li></ul><ul><li>To better understand & integrate clinical expertise & administrative skills to impact pt outcomes </li></ul>
    21. 21. 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/; 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;
    22. 22. 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.
    23. 23. 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.”
    24. 24. 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)
    25. 25. <ul><li>Why DNP… </li></ul><ul><li>5. Well rounded approach to education </li></ul><ul><ul><li>Biostatistics, epidemiology, research critiques, literature review, strength of evidence </li></ul></ul><ul><ul><li>Identification of vulnerable populations & specific needs of population </li></ul></ul><ul><ul><li>Formative & summative evaluation of programs </li></ul></ul><ul><ul><li>Cognates with other colleges in the University </li></ul></ul>research clinical Identity devt & transformation leadership Teaching is a major Component of each competency
    26. 26. <ul><li>Why DNP… </li></ul><ul><li>Political insight to healthcare & healthcare policy development </li></ul><ul><li>Leadership philosophy </li></ul><ul><li>Maintained passion for pts/pt care & frontline care providers </li></ul>
    27. 27. Advanced Practice Leadership Role <ul><li>Conceptual Competencies </li></ul><ul><li>Systems thinking </li></ul><ul><li>Acclimatization to Chaos </li></ul><ul><li>Synthesis Continuous Learning </li></ul><ul><li>Participation Competencies </li></ul><ul><li>Involvement </li></ul><ul><li>Empowerment </li></ul><ul><li>Accountability </li></ul>O’Grady & Wilson, 1995
    28. 28. <ul><li>Interpersonal Competencies </li></ul><ul><li>Receptivity and similarity </li></ul><ul><li>Immediacy and equality </li></ul><ul><li>Facilitation </li></ul><ul><li>Coaching </li></ul><ul><li>Leadership Competencies </li></ul><ul><li>Technical Expertise </li></ul><ul><li>Transformational Style </li></ul><ul><li>Interactive Administering </li></ul>
    29. 29. Theory of Constant Adaptation to Complex Systems <ul><li>“ Chaos & loss of certainty provide and opportunity to let go of things that are inherently changing & passing.” (O’Grady & Malloch, 2003) </li></ul><ul><li>Nursing leaders can create theories that allows them to hypothesize, test, evaluate and disseminate new knowledge and concepts. </li></ul><ul><li>This theory will focus on organizational change using nursing theories and maintain organizational sustainability and stability. </li></ul>Work in progress
    30. 30. “ 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
    31. 31. References <ul><li>American Nurses Association (2008). Code of ethics for nursing. Accessed November 15, 2008 from practiceof professionalnurisng/ethics/standards/codeofethics.aspx </li></ul><ul><li>Chinn, P. & Kramer, M. (2003). Theory and nursing (4 th ed). St. Louis:Mosby. </li></ul><ul><li>Kuhn, T. (1962). The structure of scientific revolutions. Chicago:University of Chicago Press. </li></ul><ul><li>O’Grady, T. & Malloch, K. (2003). Quantum leadership: a textbook of new leadership. MA: Jones and Bartlett Publishers, Inc. </li></ul><ul><li>Van Sell, S. (2002). Receding and evolving paradigms. ICU and Nursing Web Journal. Accessed November 15, 2008 from </li></ul><ul><li>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 </li></ul><ul><li>Weaver, K. & Olson, J. (2006). Paradigm construction. Journal of Advanced Nursing. 53 (4), 459-469. </li></ul>