Assignment task:
Anaida S.
Nursing Theory and Theory of Change to be used for the development of the project Nurse-Led Educational Intervention to Improve Therapeutic Adherence in Patients with Ischemic Heart Disease in the Cardiac Care Unit at Mount Sinai Medical Center
The nursing process that guides nursing care to the present day was initiated in 1958 by Ida Jean Orlando. It is defined as a systematic approach to care that uses the fundamental principles of critical thinking, client-centered treatment approaches, goal-oriented tasks, evidence-based practice (EDP) recommendations, and nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate, quality-based care (Toney-Butler & Thayer, 2024). Practice guided by nursing theory allows nurses to articulate what they do for patients and why they do it (Younas & Quennell, 2019).
In this way, nursing theories provide a basis for clinical decision-making. These theoretical models in nursing shape nursing research and create useful conceptual blueprints for the interpretation of patient-nurse interaction processes (Watkins, 2020). Taking into account that the proposed project deals with an educational intervention led by nurses to improve Therapeutic Adherence in patients with Ischemic Heart Disease in the Cardiac Care Unit of Mount Sinai Medical Center, it is necessary to select a nursing theory that facilitates the implementation and evaluation of the planned educational intervention. On the other hand, a theory of change will also be selected to contextualize the behavior change strategies necessary to improve therapeutic adherence in patients with ischemic disease. The nursing theory selected for the project is Dorothea Orem's Self-Care Theory and the selected theory of change is Kurt Lewin's Theory. In this paper the theoretical foundations of both theories will be discussed and foundations will be provided that support the usefulness of their selection for the project under development.
Dorothea Orem's Self-Care Theory
Dorothea Orem's Self-Care Theory focuses on strengthening the patient's self-care capacity, which is an essential component for adherence to chronic treatments and lifestyle changes. This theory posits that individuals require knowledge, skills, and support to assume responsibilities in their own health care (Yip, 2021). These precepts align with the goals of the educational intervention that advocate educating and empowering patients with ischemic heart disease to maintain autonomous and consistent treatment. In the context of this project, Orem's model would allow structuring the educational intervention so that patients internalize their role in self-care, including both the appropriate use of medications and the adoption of healthy habits that minimize risks of relapse and hospital readmission. The theory emphasizes the identification of self-care deficits, which provides a structured methodology to evaluate individual barriers and determine the specific elements that each patient needs to develop to improve their therapeutic adherence (Yip, 2021). Scholars have discussed the relevance and important strengths within Orem's nursing theory and recommend theoretical refinement in the context of significant social and health transformation. The constructs of global care focused on people and population health, with related social determinants of health, are identified as critical areas for development if SCDNT is to have ongoing relevance to nursing practice (Hartweg & Metcalfe, 2022). Orem established person-to-person nursing as a science based on the existence of human beings as a central value of the theory. In addition, he emphasized that the human-human relationship necessarily precedes the nurse-patient interface (Tanaka, 2022). The educational intervention project will be led by nursing, so this foundation of relationships is conducive In addition to the fact that the theory highlights the role of the nurse as a facilitator, educator, and advocate, guiding the patient towards greater self-care abilities (Yip, 2021).
On the other hand, these foundations are useful for the project, taking into account the psychological, family, economic and social impact that ischemic heart disease has (Bahall et al., 2020). Orem's theory can provide a solid basis for developing the educational intervention that will take into account the individual peculiarities of the patient and the family and community environment to which the patient will return upon discharge and that may influence his or her therapeutic adherence. Evidence has demonstrated the usefulness of this theory in coronary patients. A study investigated the influence of Orem's self-management model on rehabilitation efficacy, disease cognition, self-management skills, and quality of life of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and its results supported the conclusion that Orem's self-management for ACS after PCI helps reduce postoperative complications and improves emotions negative patient outcomes and their rehabilitative efficacy, disease cognition, self-care skills, quality of life, and nursing satisfaction (Zhu et al., 2021).
Kurt Lewin's Theory of Change
Kurt Lewin's Theory of Change will be useful in guiding the phases of behavioral change of patients during the intervention. Lewin postulates a process of change in three stages: thawing, changing, and refreezing, where thawing is the initial phase in which inappropriate practices or lack of therapeutic adherence in patients are identified (Barrow &Annamaraju, 2024). Applying this concept to the educational intervention project to promote therapeutic adherence in patients with ischemic heart disease, the objective would be to prepare patients and nursing staff to accept the need for an educational intervention in therapeutic adherence and to focus awareness on the challenges and consequences of therapeutic non-compliance (Endrejat& Burnes, 2024). Nursing can, for example, organize introductory sessions where the impact of non-adherence on the progression of ischemic heart disease and on the increase in readmission rates is discussed. The ultimate goal would be to generate an understanding of the benefits that adherence education can bring from the point of view of cardiovascular stability and quality of life. Also in this phase, possible barriers faced by patients should be identified, such as knowledge deficit, negative perception of medication, personal fears, false beliefs or myths about medication, as well as personal attitudinal factors, which will pave the way for change (Barrow &Annamaraju, 2024).
The change stage focuses on the implementation of the educational intervention, through the introduction of a set of new practices and habits in patients. The nursing team is a facilitator and educator as it will provide practical information on how to adhere to treatment, from taking medication to lifestyle changes (Wang et al., 2023). Individual and group sessions can be scheduled to promote self-control and informed decision-making. This education process should be continuous hospitalization and should be reinforced through educational materials such as guides and reminders (ESC Education, n.d.). The use of technologies such as medication tracking apps is very useful as well as educational websites that provide educational support for patients with ischemic heart disease (New ACC, AHA, multi-society guideline addresses management of chronic coronary disease, n.d.). During this phase, the nursing team can continuously assess progress, adapt strategies to individual needs, and provide a supportive space to answer questions and address obstacles (Gupta & Wood, 2019).
Finally, the refreezing phase aims to consolidate new knowledge and behaviors, ensuring that they are lasting and beneficial even after the intervention is completed (Barrow &Annamaraju, 2024). Post-discharge follow-ups, where unit nurses make follow-up calls or even follow-up visits, can support continued adherence. Another strategy may be to develop support networks between patients, or to provide reference contacts in the nursing team to which patients have access in case of doubts or difficulties. This phase ensures that patients internalize the importance of adherence (Raihan & Cogburn, 2024) and can maintain their long-term cardiovascular stability, which decreases the likelihood of readmissions. In this way, Lewin's Theory facilitates the fulfillment of the objectives of the educational project not only through the instruction of patients, but also by encouraging internal changes in their perception, attitude and commitment to the treatment that guarantee the effectiveness of the intervention and promote a lasting impact on their health and quality of life.
By way of conclusions, the integration of Orem's Self-Care Theory and Lewin's Theory of Change in this nurse-led educational intervention project provides a solid basis for promoting therapeutic adherence in patients with ischemic heart disease. Orem's theory provides a methodological basis for the structuring of educational intervention focused on strengthening patients' self-care capacity, addressing individual needs and promoting autonomy in the management of their treatment. Lewin's Theory of Change guides the process of behavior modification through its three phases, facilitating a sustainable transition towards health habits that favor long-term therapeutic adherence. The theoretical approach supports an effective and lasting change in patients' attitudes and behavior regarding therapeutic adherence, improving their health outcomes and reducing the risk of hospital readmission.