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Item type Presentation
Title Global Connections: Integrating Theory and Practice inProfessional Nursing: The Artinian Intersystem Model inEducational Settings
Authors Artinian, Barbara M.; Cone, Pamela H.
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Link to item http://hdl.handle.net/10755/201893
GLOBAL CONNECTIONS: INTEGRATING THEORY AND PRACTICE IN PROFESSIONAL NURSING USING THE ARTINIAN INTERSYSTEM MODEL Barbara M. Artinian, PhD, RN Katharine S West, MPH, MSN, RN, PHN Margaret M Conger, EdD, MSN, RN Pamela H Cone, PhD, MSN, RN
BARBARA M. ARTINIAN PHD, RN Professor Emeritus Azusa Pacific University
KATHARINE S WEST MPH, MSN, RN, PHN, CNS Kaiser Permanente, Nurse Clinical Systems Analyst University of Phoenix, Facilitator
MARGARET M CONGER EDD, MSN, RN Professor Emeritus Northern Arizona University
PAMELA H CONE PHD, MSN, RN Associate Professor Azusa Pacific University (APU)
OVERVIEW I. Introduction to the Artinian Intersystem Model
(AIM) II. Integrating theory & practice in professional
nursing III. Teaching healthcare interactional skills using the
AIM IV. Teaching the concepts of AIM in educational
settings V. Using the AIM to teach health promotion &
disease prevention in public health nursing VI. Applying the AIM in professional practice VII. Q&A
INTRODUCTION TO THE ARTINIAN INTERSYSTEM MODEL (AIM) Katharine S. West, MPH, MSN
SALZBURG STATEMENT ON SHARED DECISION MAKING - DECEMBER 2010 We call on clinicians to: • Recognise that they have an ethical imperative to share important
decisions with patients • Stimulate a two way flow of information and encourage patients to
ask questions, explain their circumstances, and express their personal preferences
• Provide accurate information about options and the uncertainties, benefits, and harms of treatment in line with best practice for risk communication
• Tailor information to individual patient needs and allow them sufficient time to consider their options
• Acknowledge that most decisions do not have to be taken immediately, and give patients and their families the resources and help to reach decisions
BMJ 2011; 342:d1745
SALZBURG STATEMENT ON SHARED DECISION MAKING - DECEMBER 2010 We call on clinicians, researchers, editors, journalists, and others to: • Ensure that the information they provide is clear, evidence based,
and up to date and that conflicts of interest are declared We call on patients to: • Speak up about their concerns, questions, and what’s important to
them • Recognise that they have a right to be equal participants in their
care • Seek and use high quality health information We call on policy makers to: • Adopt policies that encourage shared decision making, including
its measurement, as a stimulus for improvement • Amend informed consent laws to support the development of
skills and tools for shared decision making
BMJ 2011; 342:d1745
AIM M
OD
EL
DESCRIPTION OF THE ARTINIAN INTERSYSTEM MODEL
Guides the nurse or provider to incorporate patient/client values into the
Mutual Plan of Care
Assesses patient’s own knowledge, values, and
behaviors about the main concern before engaging in interaction to resolve the concern.
FOUNDATIONAL TO THE ARTINIAN INTERSYSTEM MODEL
Each person is an intrasystem biological self psychosocial self spiritual self
Mutuality of interaction between the patient/client
and nurse/provider intrasystems
Fosters mutual problem solving
APPLICATION OF THE ARTINIAN INTERSYSTEM MODEL
Applied to individual clients aggregate populations communities as clients or institutions as clients
Supports
Shared Decision Making in all aspects of health care
AIM CARE PLAN TEMPLATES
1. AIM Block Care Plan Template for Undergraduate Students
2. AIM Community Health Care Plan Template
3. AIM Standard Care Plan Template
4. AIM Narrative Care Plan Template for Graduate Students
INTEGRATING THEORY & PRACTICE IN PROFESSIONAL NURSING USING THE AIM Barbara M. Artinian, PhD
MODEL VS. THEORY
Represents the structure or concept of an object
Example: Ararat Resident-
Centered Care Program
Explains the “How” or “Why” of a phenomenon
Example: Theory of Identity
Preservation
MODEL THEORY
THE PROCESS OF THE AIM
Figure 1.8
THE THEORIES OF THE AIM
Developed by integrating and extending into the model Chin (1969) Kuhn (1974) Antonovsky (1987) Blumer (1969) Stallword & Stoll (1975) Hill (1949)
INNOVATIONS IN NURSING RESEARCH USING THE AIM: PRESERVING IDENTITY THEORY
Copyright © 2009 B.Artinian. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INNOVATIONS IN NURSING RESEARCH USING THE AIM: PREPARATIVE WAITING THEORY
Copyright © 2009 T. Giske. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INNOVATIONS IN NURSING RESEARCH USING THE AIM: LETTING GO THEORY
Copyright © 2009 L.Pash. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INNOVATIONS IN NURSING RESEARCH USING THE AIM: CONQUERING OPERATIONAL SPACE THEORY
Copyright © 2009 E. Hjälmhult. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INNOVATIONS IN NURSING RESEARCH USING THE AIM: CAREGIVING BEHAVIORS DESCRIPTIVE STUDY
Copyright © 2009 M.Friesen. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INNOVATIONS IN NURSING RESEARCH USING THE AIM: RECONNECTING THEORY
Copyright © 2009 P.Cone. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
TEACHING HEALTHCARE INTERACTIONAL SKILLS USING THE AIM Margaret M Conger, EdD, MSN, RN Professor Emeritus Northern Arizona University
EVIDENCE BASED PRACTICE (EBP)
IOM recommends all practice be based on research evidence
EBP must become part of all professional practice Needed to
Enhance quality care Lead to reduced costs
EBP APPLIED TO THE INDIVIDUAL
Identify best practice for a situation Must be research based Useful for the aggregate
Must be adapted to the individual This is where AIM is needed How does provider knowledge/ values fit with client
knowledge/values? What adaptations are needed?
INTERSYSTEM INTERACTION
INDIVIDUALIZING EBP USING THE AIM
Use available evidence from research
Consider client concerns / abilities
Adapt interventions to meet specific client needs
Developmental environment Collect client data
Situational environment Score on SSOC Adapt interventions to
specific client need/ values
EBP AIM
CRITICAL THINKING
Important component of nursing practice
Critical thinking skills used in the AIM
• Inquisitiveness - exercise intellectual curiosity • Systematicity – use orderly process • Analyticity – use research to find answers to
questions • Open mindedness – be tolerant to divergent views
CLINICAL REASONING
Clinical reasoning needed to • Frame • Juxtapose • Test match client’s
present state and desired outcome state”
Assess client present state Score on SSOC
Requires clinical reasoning Work mutually with client to develop plan for interventions
Puset & Herman( 1999)
AIM
USE OF AIM IN DELEGATION DECISIONS
Delegation to assistive personnel (AP) is needed skill in today’s health care environment
Most tools developed to teach delegation focus on tasks
Tool needed that also includes needs of the individual client
Nursing Assessment Decision Grid (NADG) developed
NURSING ASSESSMENT DECISION GRID (NADG)
Assess client subsystems Score on SSOC Delegate care based on
Tasks Client needs Knowledge of AP
Assess client subsystems Analyze information Evaluate client/provider
Knowledge Values Behaviors
NADG AIM
NURSING ASSESSMENT DECISION GRID
Source: Conger, M (1993). Delegation decision making: Development of a teaching strategy. Journal of Nursing Staff Development, 9(3). 131-135.
NURSING ASSESSMENT DECISION GRID
Source: Conger, M (1993). Delegation decision making: Development of a teaching strategy. Journal of Nursing Staff Development, 9(3). 131-135.
USE OF AIM IN INSTITUTIONS
Institution - “two or more partners engaged in intersystem interaction” (Kuhn, 1974)
Leadership styles changing
INSTITUTIONAL SUBSYSTEM ASSESSMENT
Biological Health policies Work schedules Gender issues
Spiritual
Religious affiliations Use of chaplains
Psychosocial Unwritten rules Employee groups Leadership styles Organizational ethics/
values
SITUATIONAL ENVIRONMENT
Knowledge How is information communicated?
Values What are the organizational cultural values ?
Behaviors What is the power structure? How is power shared?
SSOC
Institutions can be scored using the SSOC
Problems identified
Mutually develop plans for changed behavior
Institute changes
Can result in organizational improvement
ARARAT EXAMPLE
Ararat Nursing Facility – long term care residential facility
Staff assessed problems Leadership style – autocratic, crisis focused Client care – not individualized Staff morale – very low
SSOC – very low
ARARAT EXAMPLE
Situational Environment Knowledge
Primary staff – CNA Little knowledge of client care needs
Values Little pride in work
Behavior Fragmented client care Noisy uncaring environment Power applied from top down
ARARAT EXAMPLE Management/Staff negotiated for changed environment Power shared among staff/ management Results
Unprofessional behaviors eliminated Communication with client/families improved Staff appearance looked more professional Increased satisfaction of staff, clients, & families
Client care changed Reduced client falls Improved documentation
Education encouraged All staff had opportunity to increase level of education
CONCLUSIONS
AIM can be applied in a variety of situations Not limited to nurse/client interactions Nurse student education
Enhance application of EBP to individuals Enhance critical thinking/clinical reasoning skills
Institutional change Refine delegation decision making Promote institutional leadership change
USE OF THE AIM IN EDUCATIONAL SETTINGS Pamela H Cone, PhD, MSN, RN
AIM IN NURSING EDUCATION
Congruence with school mission & philosophy
Usefulness in curriculum development
Sense of Community & Mutuality
Centrality of Language
Curriculum with Coherence
Development of Care Plans
Climate for Creative Learning
(Boyer, 1996)
AIM IN UNDERGRADUATE (UG) NURSING PROGRAMS
Early work on AIM focus – UG care plans
Adoption of AIM at APU
Care plans leveled across four years from simple to complex Definition of Person (Stallwood & Stoll, 1975)
Sense of Coherence (Antonovsky, 1987)
Nurse-Patient interaction (Kuhn, 1974)
Mutual Negotiation of Plan
Case Study Vignette
BLOCK CARE PLAN FOR UG STUDENTS
AIM IN GRADUATE NURSING PROGRAMS
Introduction of Theories & Models
Focused discussion of AIM
Student Sample Philosophies
Congruence with the AIM
LESSON PLAN FOR INTRODUCING MODELS AND THEORIES
Discuss student experiences in providing nursing care
Introduce use of models in practice
Selected models, including the AIM
Acquaint students with the concepts of the AIM
Use the AIM diagram
Demonstrate the narrative care plan
LESSON PLAN FOR INTRODUCING MODELS AND THEORIES
Discuss examples of care plans written in varying formats Truncated
Full text
Annotated
Referenced
Group care plans
Care plans based on Glaserian Grounded Theory Research (Artinian, Giske, & Cone, 2009)
NARRATIVE CARE PLAN FOR GRAD STUDENTS
Copyright © 2011 B. Artinian, PhD. From The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing. May use with permission.
NARRATIVE CARE PLAN FOR GRAD STUDENTS, CONTD.
Copyright © 2011 B. Artinian, PhD. From The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing. May use with permission.
NARRATIVE CARE PLAN FOR GRAD STUDENTS, CONTD.
Copyright © 2011 B. Artinian, PhD. From The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing. May use with permission.
AIM IN STAFF NURSING PROGRAMS
Budding RN Program – staff education Designed for current ancillary nursing who have not
completed boards Assist with other mentoring programs
Develop Care Plan using AIM Provider = RN Staff Developer Client = RN board-eligible staff members
INSTITUTIONAL CARE PLAN
Developmental Environment Validation of Main Concern
Need for more RN staff Unsuccessful attempts of board-eligible staff to pass RN
boards Situational Environment
Score on SSOC = 1, 2, 1
Intersystem Interaction to Resolve Main Concern Negotiate, develop, implement, evaluate Re-score on SSOC = 3, 3, 3
AIM IN STAFF NURSING PROGRAMS
Ararat Nursing Facility Participatory
Leadership Reinforce Identity of
Staff Continuous Quality
Improvement Building Positive
Relationships with Families
EMBRACING HEALTH: USING THE AIM FOR HEALTH PROMOTION AND DISEASE PREVENTION EDUCATIONAL PROJECTS IN RN-TO-BSN PUBLIC HEALTH NURSING COURSES Katharine S West, MSN, MPH, RN, PHN, CNS
ADVANTAGES OF USING AIM IN PUBLIC HEALTH NURSING PRACTICE Process-oriented Content-free Use in any health care setting with any client Focuses on interplay of various systems Participation of community client in decision-
making process
USING MODELS TO GUIDE COMMUNITY & PUBLIC HEALTH NURSING PRACTICE
Assessment Assurance Advocacy
Community joint goals & strategies
Definitions & knowledge of health (comprehensibility)
Values regarding health (meaningfulness)
Behaviors carried out to promote health (manageability)
Core Functions of Public Health AIM
HIERARCHY OF INTRASYSTEMS BY COMMUNITY CLIENT
Copyright © 2011, K.West. In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INTRASYSTEM FUNCTIONS OF COMMUNITY HEALTH CLIENTS
In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INTRASYSTEM FUNCTIONS OF PUBLIC HEALTH CLIENTS
In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
INTRASYSTEM FUNCTIONS OF PUBLIC HEALTH CLIENTS, CONTD.
In The Artinian Intersystem Model: Integrating Theory and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing.
POPULATION-FOCUSED PLAN OF CARE
CASE STUDIES ILLUSTRATING USE OF THE AIM IN PUBLIC HEALTH NURSING
DATING SAFETY EDUCATION FOR A CATHOLIC YOUTH GROUP ABIGAIL EVANGELISTA, BSN, RN
Negotiating Values with a community client and adapting the educational objectives of the nurse to match those of the client.
Needs Assessment:
Catholic youth group, ages 12–16
Main concern of sex and sex safety
DATING SAFETY EDUCATION FOR A CATHOLIC YOUTH GROUP ABIGAIL EVANGELISTA, BSN, RN
Church was diametrically opposed to approving a topic that violated the church’s values of celibacy before marriage
Nurse met with Youth Leaders to negotiate values for an appropriate topic that would nonetheless satisfy the identified main concern. Not birth control or safe sex practices Could teach about date rape, date abuse, and physical
violence against women
DATING SAFETY EDUCATION FOR A CATHOLIC YOUTH GROUP ABIGAIL EVANGELISTA, BSN, RN
Joint goals were developed for a mutual educational plan of care on the topic of safe dating
Positive rescoring on SSOC One teen acknowledged an abusive relationship &
requested help.
“It felt so restrictive at first. But then I realized that the PHN needs to be creative and inventive and honor the client’s preferences that I could say this but not that.”
ADVOCACY FOR FOOD SECURITY: THE WIC PROGRAM IN A FARMER’S MARKET KATERINA PEREZ, BSN, RN
Use of the AIM in facilitating the PHN Core Competency of Advocacy Healthy People 2010 Objective 19–5: Increase the proportion of persons
aged 2 years and older who consume at least two daily servings of fruit
Objective 19–18: Increase food security among US households and in so doing reduce hunger
ADVOCACY FOR FOOD SECURITY: THE WIC PROGRAM IN A FARMER’S MARKET KATERINA PEREZ, BSN, RN
Community assessment revealed 4 of 5 health food stores & local farmer’s market,
did not accept the California Electronic Benefit Transfer (EBT) debit cards for the Women, Infants, Children (WIC) food supplement program.
Food stamps households had increased 25.8% between February 2009 and February 2010 (California Department of Social Services, 2010)
Participants limited in access to fresh food and farmer’s market using WIC funds
ADVOCACY FOR FOOD SECURITY: THE WIC PROGRAM IN A FARMER’S MARKET KATERINA PEREZ, BSN, RN
California provides a “token” economy for farmer’s markets to accept EBT cards
Booth set up at market WIC client swipes EBT card in exchange for tokens. Tokens used to purchase produce from the farmer
merchants.
At market close Farmers exchange tokens back into cash at the booth.
ADVOCACY FOR FOOD SECURITY: THE WIC PROGRAM IN A FARMER’S MARKET KATERINA PEREZ, BSN, RN
Unilateral community nurse goal to raise awareness about the lack of acceptance of food stamps/EBT cards by the local health food stores or local farmer’s market.
Solution proposed to the city council Adopt “token” exchange at the farmer’s market “First step” toward food accessibility. Supportive printed materials & references
ADVOCACY FOR FOOD SECURITY: THE WIC PROGRAM IN A FARMER’S MARKET KATERINA PEREZ, BSN, RN
City Council Response: Comprehensibility: credentials as an RN and as a
public health nursing student Manageability: State “token” booth Meaningfulness: Access to local produce, improved
access to healthy food “When I was presenting my EBT card idea in front of council members, I was little shy and felt that perhaps I did not have the authority or credentials to do so. But [advocacy] gives a voice to those in the community who cannot speak for themselves.”
USING THE AIM IN OTHER SETTINGS IN PROFESSIONAL NURSING Katharine S West, MPH, MSN, RN, PHN, CNS
TAYLOR’S RECOMMENDATIONS FOR DEVELOPING A SALUTOGENIC PROGRAM
RESIDENT-CENTERED CARE PROGRAM
POPULATION CARE MANAGEMENT: HEART FAILURE PROGRAM COORDINATOR MAKES CONNECTION
POPULATION CARE MANAGEMENT: CONNECTS TO FAMILY & SOCIAL NETWORK
POPULATION CARE MANAGEMENT: CONNECTS PATIENT TO AGENCY
POPULATION CARE MANAGEMENT: COORDINATOR AS CONNECTOR LESSENS
POPULATION CARE MANAGEMENT: COORDINATOR STAYS CONNECTED
COSMETIC SERVICES - AMBULATORY NP
Cosmetic Services Nurse Practitioner Non-covered service Not medically necessary
Patient’s views = Focus of care
AIM used for Negotiating values between client and NP Developing a mutual plan of care to enhance the sense
of coherence (SOC) of the client
IN CONCLUSION
AIM GUIDES SHARED DECISION MAKING
Even power distribution Attentive to
knowledge values behaviors
Patient & Nurse
Identify Main Concern Negotiate plan of care Quantify nursing effect
Score on SSOC Rescore on SSOC
THE PROCESS OF THE AIM
Figure 1.8
Q&A
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well. San Francisco, CA: Jossey-Bass. Artinian, B., & Conger, M. (1997). The intersystem model: Integrating theory and practice.
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and Practice for Professional Nursing, 2nd ed. New York, NY: Springer Publishing. Blumer, H. (1969). Symbolic interactionism. Englewood Cliffs, NJ: Prentice Hall. Boyer, E. L. (1996). 5 priorities for quality schools. Education Digest, 62(1), 4–8. Chin, R. (1969). The utility of system models and developmental models for practitioners. In W.
Bennis, K. Benne, & R. Chin, The planning of change (pp. 297–312). New York, NY: Holt, Rinehart and Winston, Inc.
Kuhn, A. (1974). The logic of social systems: A unified deductive, system-based approach to social science. San Francisco, CA: Jossey-Bass.
Hill, R. (1949). Families under stress. New York, NY: Harper & Row. Martin, & R. Matheney. Patient-centered approaches to nursing. New York, NY: The Macmillan
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J. Passos (Eds.), Clinical nursing (3rd ed., pp. 1086–1098). New York, NY: The Macmillan Company.
Taylor, D. (1997). The implications of sense of coherence for the early treatment of people who have had a traumatic spinal cord injury. Doctoral dissertation, University of Wollongong, Wollongong, Australia.