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Theory Selection and Evaluation

Theory Selection and Evaluation

Phenomenon and Concepts, Intervention and Outcomes Summary

The hand hygiene of healthcare workers is important within any setting as it helps in the prevention of pathogens to patients as well as staff. As Amtz (2016) pointed out that hand hygiene is vital in ensuring that nosocomial infection within the healthcare setting. Hand hygiene is particularly important within the emergency department given that the nature of the emergency department differs from other inpatient units in ways that might considerably contribute to reduced compliance to hand hygiene. The emergency department is usually characterized with limited space, patients who are in close complexity with others, wide variations in patient acuity, and high or unpredictable patient volumes (Muller, Carter, Siddiqui, & Larson, 2015). The presence of these factors makes it difficult for professionals within this setting to comply with hand hygiene. Given that the ED department is a portal of entry for pathogens into the hospital system and so it is critical to ensure that proper interventions have been implemented to ensure highest levels of compliance with hand hygiene.

Although there is a recognition that appropriate and effective hand hygiene strategies have the potential to significantly reduce associated infections within the healthcare setting, multiple studies have established that hand hygiene is one of the most overlooked and poorly-performed infection control interventions (Wiles, Roberts, & Schmidt, 2014). To improve hand hygiene within the ED department, there are certain approaches that hospitals can utilize. Some important strategies that can be used to improve hand hygiene is by increasing emergency department staffing, reducing employee workload, and reducing the time required to perform hand hygiene (Muller, Carter, Siddiqui, & Larson, 2015). Another important strategy that can be utilized is to utilized is to provide adequate staff education (Gould, Navaie, Pursell, Drey, Creedon, 2018) and also empower the patients to enquire whether healthcare professionals have performed hand hygiene. In addition to implementing intensive educational programs, hand hygiene within the ED can also be promoted through cost-effective monitoring and reminders (Neo, Zadeh, Vielemeyer, & Franklin, 2016).

Search Strategies for Theories

            In order to identify the appropriate theories that can be utilized to facilitate the implementation of proper strategies to improve compliance with hand hygiene within the emergency department, it was vital that a comprehensive literature search was conducted. The search was carried out online using a Boolean search. The key words “middle range theory”, “hand hygiene” and “improve” were used to carry out the search. The search was conducted via credible and reputable search engines and nursing databases including PubMed, CINAHL, Healthline, EBSCO, Nursing reference Center Plus, and Medline. Initial results for the search realized many articles detailing a wide variety of theories. The articles were then read extensively, analyzed, evaluated, and summarized. After extensively assessing the various theories, two theories that were deemed to be most relevant and appropriate were selected. A furthers search was conducted on the two theories to yield further evidence-based articles on the selected theories. The two selected theories are Bandura’s self-efficacy and Vroom’s Expectancy theory.

Selection Criteria/ Theory Support

            The first theory that was selected is Albert Bandura’s self-efficacy theory. The central theme of the theory is that among all the mechanisms that influence human actions and compliance, there is none that is none that is more pervasive and influential than the belief that people have in their own efficacy and ability to influence the events that affects their lives (Maddux, 2013). One of the foundations of human motivation, performance, accomplishment, inspiration, and emotional well-being is the core belief that they have in themselves. Therefore, unless individuals believe in their abilities to produce the desired effects, then they will have minimal incentives to undertake activities and actions that promote the desired outcomes. This directly applies to the issue of hand hygiene within the ED department as nurses and other healthcare professionals should believe in their ability to effectively promote hand hygiene before they can adopt appropriate approaches to do so.

            The second theory that was selected was Vroom’s expectancy theory. Vroom’s expectancy theory is another important motivational theory that can be utilized to promote improved compliance with hand hygiene within the emergency department. The primary premise for the theory is that behavior is a consequence of processes that entail the making of conscious choices among alternatives in a bid to maximize pleasure and minimize pain (Schweiki et al, 2015). The performance of individuals is based on a number of factors including skills, knowledge, personality, abilities, and experiences. The level of effort, performance, and motivation that individuals demonstrate is dependent on the level of motivation. Motivation can be improved if the individuals believe that effort and performance are positively correlated, favorable performances results in desirable rewards, the resultant reward will satisfy particular needs which are important, and the desire to satisfy the need is strong enough to make the effort worthwhile.

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Evaluation Tool Selected

            The evaluation tool that was selected was Fawcett’s evaluation criteria which proposes comprehensive recommendations that can be utilized to foster an effective evaluation of nursing theories. Fawcett’s criteria for the evaluation of nursing theories includes a number of significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy (Peterson, & Bredow, 2009). Fawcett proposed that the evaluation of nursing theories requires that effective judgements be made regarding the degree to which a given theory satisfies the proposed criteria.  

Theory Evaluation

            It is critical to evaluate theories to ensure that they are relevant and effective before they can be utilized to drive interventions and programs. This section of the paper provides a comprehensive evaluation of the two selected theories. Both Albert Bandura’s self-efficacy theory and Vroom’s expectancy theory will be fully evaluated using the criteria for theory evaluation proposed Fawcett.

Albert Bandura’s theory of self-efficacy

            As earlier mentioned, the core premise of this theory is that self-efficacy, or rather the belief that people have regarding their capabilities to produce certain levels of performance, determines how people think, feel, behave, and stay motivated. Through cognitive, affective, motivational, and selection processes, these beliefs that people have produces diverse effects. Individuals who have a strong of efficacy usually attain higher levels of personal well-being and accomplishment as they hold high levels of assurance and therefore approach tasks as challenges that are to be mastered rather than as threats that should be avoided. On the other hand, individuals with low self-efficacy shy away from tasks as they feel as though they are personal threats while they doubt their abilities to be successful. This theory can be evaluated using Fawcett’s criteria for the evaluation of theories.

The first criterion in the evaluation tool is significance which focuses on justifying the importance of the theory for the nursing discipline (Zaccara, Costa, Nobrega, Franca, Morais, & Fernandes, 2017). The significance of the theory is evaluated based on the explicitness of the metaparadigms that are inherent in nursing practice including the person, environment, health, and nursing (Zaccara, Costa, Nobrega, Franca, Morais, & Fernandes, 2017). Applying the concepts of metaparadigms as proposed by Fawcett to Bandura’s self-efficacy theory, it is observed that all the four concepts of human being, health, environment, and nursing are explicit. The second criterion is consistency which requires that the concepts of a given theory present clarity and coherence.

Albert Bandura’s theory of self-efficacy excels on this criterion as the author uses the same definition of self-efficacy in all discussions within the theory. In addition, the structural consistency is also present as the concepts of the theory are interrelated, coherent, and advance a unique vision. The third criterion is parsimony which requires that statements within the theory be clarify rather than obscure the phenomenon of interest. The theory is parsimonious as it is stated clearly and concisely. The theory is also empirically adequate as its theoretical assumptions are congruent with empirical evidence, it can foster positive influences and outcomes in health, and is cost-effective. It also meets the last criterion, pragmatic adequacy, as it has been applied in real-world nursing practice and does not require special skills training before application.

Vroom’s expectancy theory

            Vroom’s expectancy theory is a process motivational theory that assumes motivated behavior is goal-oriented. The theory assumes that behavior arises out of a process of conscious choices among alternatives so as to minimize pain and maximize pleasure. People tend to act in a hedonistic manner as they prefer to undertake actions that will bring the highest possible utility (Sucio, Mortan, & Lazar, 2013). Fawcett’s criteria for theory evaluation can be applied to evaluate Vroom’s expectancy theory. Concerning significance, the concepts of the theory are explicit but the author’s antecedent knowledge from nursing and adjunctive disciplines has not bene acknowledged. The theory is internally consistent as all the elements of the theory are congruent. Also, the theory is stated clearly and concisely and so it meets the third criteria of parsimony. The theory and its concepts can be empirically tested while empirical adequacy is met as the assertions of the theory are congruent with empirical evidence.

Evaluation Summary Criteria

            An evaluation of the two theories using Fawcett’s criteria for theory evaluation showed that both theories are effective in helping foster proper implementation and sustenance of relevant and appropriate behaviors within the healthcare setting. The self-efficacy theory by Albert Bandura met all of the evaluation criteria and proved to be a relevant and appropriate theory. On the other hand, Vroom’s expectancy theory also performed well against Fawcett’s evaluation criteria but failed to meet one or two sub-criterions. However, all in all both theories performed well in the evaluation. Theories are important components within the healthcare system as programs and initiatives to improve health behaviors and promote health are more likely to be successful when they are guided by effective theories. Therefore, it is important for nurses and other healthcare professionals to incorporate theories in their interventions. However, before utilizing a particular theory, the said theory should be comprehensively evaluated to determine its effectiveness and appropriateness. The two theories evaluated have both proven to be relevant and appropriate.

critical appraisal

Theory Selection Rationale

            The theory that is selected for use with the current practice problem is Albert bandura’s self-efficacy theory because it is the most appropriate among the two. The theory of self-efficacy can be appropriately applied as a guide to help improve compliance with hand hygiene within the emergency department. Hand hygiene is an important component of the overall health process within the hospital setting and so full compliance will ensure improved healthcare outcomes and quality care delivery. In order to accomplish this, it is critical that staff members within the emergency department and in general be guided to adopt best practices in hand hygiene and believe in their ability to improve care outcomes through compliance with proper hand hygiene. Vroom’s expectancy theory was not selected because of its subjective nature and the fact that it is more appropriate in understanding phenomenon rather than in informing action. This theory cannot be used because the objective is not to help staff make better choices but rather to promote positive hand hygiene behaviors. This can be attained by improving the self-efficacy of those working within the emergency department. 

References

Amtz, P. R. et al. (2016). Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. American Journal of Infection Control. 44(11). 1203-1207. DOI: https://doi.org/10.1016/j.ajic.2016.03.017

Suciu, L., Mortan, M., & Lazar, L. (2013). Vroom’s Expectancy Theory. An Empirical Study: Civil Servant’s Performance Appraisal Influencing Expectancy. Transylvanian Review of Administrative Sciences 39(2013). 180-200.

Gould, D. J., Navaie, D., Purssell, E., Drey, N. S., & Creedon, S. (2018). Changing the paradigm: Messages for hand hygiene education and audit for cluster analysis. Journal of Hospital Infection, 98, 345-351. doi: 10.1016/j.jhin.2017.07.026

Maddux, J. E. (2013). Self-Efficacy, adaptation, and adjustment: Theory, research, and application. Boston, MA: Springer US

Muller, M. P., Carter, E., Siddiqui, N., and Larson, E. (2015). Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding. Wiley Online Library, 22(10). 1218-1221. https://doi.org/10.1111/acem.12754

Neo, J. R., Zadeh, R. S., Vielemeyer, O., & Franklin, E. (2016). Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. American Journal of Infection Control, 44(6). 691-704. DOI: https://doi.org/10.1016/j.ajic.2015.11.034

Peterson, S. J., & Bredow, T. S. (2009). Middle range theories: Application to nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Shweiki, E. et al. (2015). Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training. Advances in medical education and practice, 6, 339-46. doi:10.2147/AMEP.S76587

Wiles, L. L., Roberts, C., & Schmidt, K. (2014). Keep It Clean: A Visual Approach to Reinforce Hand Hygiene Compliance in the Emergency Department. Journal of Emergency Nursing, 41(2). 119-124. DOI: https://doi.org/10.1016/j.jen.2014.11.012

Zaccara, A. L., Costa, F. S., Nobrega, L. M., Franca, J. R., Morais, G. S., & Fernandes, A. M. (2017). Analysis and Assessment of the Peaceful End of Life Theory According to Fawcett’s Criteria. Scielo Journals, 26(4). 20-32. http://dx.doi.org/10.1590/0104-07072017002920017

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