NURS 715 Week 1 Discussion Board Forum 1 on Theory and the DNP Example

Discussion Board Forum 1: The Place of Theory in Doctor of Nursing Practice

NURS 715 Theoretical Application for Advanced Practice Nursing, Discussion Board Forum 1

Thread by [Student Name]

The practice examples and the classmates replied to are composites written for a model discussion.

Two years ago, the cardiac rehabilitation program at my hospital had a problem that everyone could see: about half of the patients we referred after a heart attack or a stent never came to a single session. We tried the obvious fixes. We moved the referral to the day of discharge, printed a brighter brochure and added an automated reminder call. Attendance barely moved. Only when a rehabilitation nurse began asking non-attenders why they stayed away did a pattern emerge. Many said they did not know whether exercise was safe for them, could not tell what their chest sensations meant, and were afraid of setting off another event. Their problem was not information in the abstract; it was uncertainty about their own bodies.

That experience is my argument for theory in a practice doctorate. Our first fixes were guesses about logistics, and they failed because no one had an explanation of why patients behaved as they did. Smith and Liehr (2014) describe middle range theory as sitting on the ladder of abstraction between grand theories, which address all of nursing in broad terms, and practice-level protocols, which tell clinicians what to do in a specific situation. Such theories work with only a handful of concepts, focuses on a recognizable phenomenon such as uncertainty, comfort or self-efficacy, and is concrete enough to suggest interventions and measures. For our program, Mishel's uncertainty in illness theory would have pointed straight at what the nurse eventually discovered, and it would have suggested specific remedies: clearer explanation of symptoms, consistent providers and structured early sessions that build trust.

This matters for the DNP role in particular. Chism (2016) describes the practice doctorate as preparation to translate evidence into practice and lead system-level change. Translation without theory tends to copy interventions from one setting to another without understanding why they worked, so they fail when conditions change. Research on how DNP-prepared nurses are seen in practice supports the link between theory and lasting change. Manderscheid et al. (2026) interviewed 21 people who hire or work with DNP-prepared nurses and found that these nurses were valued for leadership, advanced clinical reasoning and systems thinking, while unclear roles and weak organizational support limited their impact. Systems thinking is, in part, theoretical thinking: seeing the mechanism beneath a pattern.

Theory also clarifies what nursing is, which matters for a degree whose graduates often work alongside physicians and administrators who may see nursing only as task completion. An analysis of nine caring theories found that caring worked as a principle that reorganized the metaparadigm concepts of person, health, environment and nursing into distinct models of practice (Muñoz Devesa & Rico Becerra, 2026). Each theory, in other words, gives a different answer to what nursing is for, and that answer shapes what a nurse notices and does. A theory is not decoration on a DNP project; it is the explanation that lets a change be designed on purpose rather than by trial and error. Daniel and his companions were praised because God gave them learning and skill in all literature and wisdom (English Standard Version Bible, 2001/2016, Daniel 1:17), gifts they put to work in service. Theory is one of the gifts of learning that nurses can put to work for patients.

Reply to Jennifer

Jennifer, you wrote that theory helps you explain your practice decisions after the fact, which is a real use and one many clinicians never make. I would push that a step further: theory can design the intervention before the fact, and it can make an intervention measurably better. Zheng et al. (2026) randomized 139 older adults with coronary heart disease to usual care or a staged cardiac rehabilitation program built explicitly on the Health Belief Model. The theory shaped the content at each stage, addressing perceived barriers, benefits and self-efficacy. Compared with usual care, the theory-based program reduced fear of movement, improved independence in daily activities and raised exercise self-efficacy at one and three months after discharge, with no exercise-related adverse events. The trial does not prove that the Health Belief Model is the best theory for this population, but it shows what happens when a theory is used as a blueprint rather than a label. In your project on early mobility after surgery, a theory of fear or self-efficacy could tell you which barriers your nurses should target first. A theory would also give you something to measure besides the number of steps patients take, such as fear of movement or confidence, which could show whether your intervention works through the mechanism you intended. Which theory are you leaning toward, and would it change what your nurses say to patients on the first postoperative day?

Reply to Andre

Andre, you argued that theory is mostly a concern for PhD-prepared nurse scientists, while DNP-prepared nurses should focus on implementing evidence. I understand the division of labor, but I think it underestimates how often implementation fails for lack of an explanation. Vortman et al. (2026) describe how DNP-prepared perioperative nurses lead system-level improvement in quality and safety by using evidence-based practice, quality improvement and implementation science to translate research into sustainable change, and they link DNP scholarly projects to the AACN Essentials domain on quality and safety. Implementation science is itself a body of theory, including frameworks that explain why some changes take hold and others fade. A DNP who implements evidence without any theory of behavior or organizations is like a surgeon operating without anatomy. The PhD may build theory and the DNP may use it, but both need to understand it. Paul told Timothy to do his best to be a worker who rightly handles the word of truth (English Standard Version Bible, 2001/2016, 2 Timothy 2:15), and handling knowledge rightly includes understanding why it works. In my own hospital, a hand hygiene campaign that relied on posters and audits faded within a year, and an organizational theory about habits and social norms would have predicted that. Can you think of a project on your unit that was implemented faithfully but faded within a year, and does a theory help explain why?

References

Chism, L. A. (2016). The doctor of nursing practice: A guidebook for role development and professional issues (3rd ed.). Jones & Bartlett Learning.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Manderscheid, A., Kesten, K., Moran, K., Conrad, D., Corrigan, C., & Strouse, S. (2026). The lived experience of those who work with or hire Doctor of Nursing Practice-prepared nurses in practice: A phenomenological study. Journal of the American Association of Nurse Practitioners, 38(9), 727-738. https://doi.org/10.1097/JXX.0000000000001366

Muñoz Devesa, A., & Rico Becerra, J. I. (2026). Caring as a generative principle: Reconfiguring the metaparadigm and operative mechanisms in nursing theory. Journal of Advanced Nursing, 82(10), 9433-9447. https://doi.org/10.1111/jan.70544

Smith, M. J., & Liehr, P. R. (Eds.). (2014). Middle range theory for nursing (3rd ed.). Springer Publishing.

Vortman, R., Muyco, J. D., Peneza, D., & Talatala, R. B. (2026). Optimizing the role of Doctor of Nursing Practice-prepared perioperative nurses in quality and safety. AORN Journal, 124(4), 264-275. https://doi.org/10.1002/aorn.70157

Zheng, X., Tan, Y., Wang, X., Li, Q., Li, J., Lan, X., & Zhang, S. (2026). A randomized controlled trial of staged cardiac rehabilitation based on the Health Belief Model on kinesiophobia, self-efficacy and activities of daily living in elderly patients with coronary heart disease. Frontiers in Medicine, 13, Article 1857532. https://doi.org/10.3389/fmed.2026.1857532