Module 6 Discussion: Initial Post
Intentions at the Sink: What the Theory of Planned Behavior Explains About Hand Hygiene, and What It Misses
Nursing borrows many theories from other disciplines, and some fit better than others. The one I want to examine is the theory of planned behavior, borrowed from social psychology and widely used to explain health behaviors, including nurses' hand hygiene. Ajzen (1991) proposed that behavior is predicted by intention, and intention by three factors: attitude toward the behavior, subjective norms, meaning perceived social pressure, and perceived behavioral control, the sense that one can perform the behavior. The theory is appealing for infection prevention because each factor suggests an intervention: education to shape attitudes, role modeling to shape norms, and more accessible sinks and sanitizer to increase control.
The limits appear when the theory meets a busy unit. O'Boyle et al. (2001) applied the theory to nurses' hand hygiene and observed 1,248 opportunities. The theory's variables predicted nurses' intention to wash their hands, and intention was related to self-reported hand hygiene. But self-reported and observed adherence were only weakly correlated, and observed adherence was predicted by the intensity of activity on the unit rather than by the theory's variables. The theory explained what nurses meant to do; the workload explained what they actually did.
This finding reflects a broader critique. Sniehotta et al. (2014) argued that the theory of planned behavior should be retired, pointing out that it focuses on conscious, rational processes and leaves out habits, emotions, and environmental cues, that many people with strong intentions do not act on them, and that interventions based on the theory have produced limited behavior change. Hand hygiene is a clear example: it is performed dozens of times a shift, often automatically, in moments of competing demands, which is exactly where a model based on deliberate intention is weakest.
For a DNP project, the lesson is not to reject borrowed theory but to check whether its assumptions fit the nursing situation. A theory built on deliberate decisions may explain a patient's choice to start an exercise program better than a nurse's split-second action between two call lights. For hand hygiene, frameworks that address the environment and workflow, such as placing sanitizer at the point of care and reducing interruptions, may matter more than changing intentions nurses already hold.
Has anyone used a borrowed theory in a project and found that the setting changed how well it worked?
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
O'Boyle, C. A., Henly, S. J., & Larson, E. (2001). Understanding adherence to hand hygiene recommendations: The theory of planned behavior. American Journal of Infection Control, 29(6), 352-360. https://doi.org/10.1067/mic.2001.18405
Sniehotta, F. F., Presseau, J., & Araújo-Soares, V. (2014). Time to retire the theory of planned behaviour. Health Psychology Review, 8(1), 1-7. https://doi.org/10.1080/17437199.2013.869710
How this DNP 845 Module 6 example is structured
DNP845 Module 6 discussions often turn to borrowed theory and its limits in nursing. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example explains one borrowed theory from its source, tests it against a nursing study, adds a published critique and ends with a principle for using borrowed theory and a question for peers.
DNP845 Module 6 questions, answered
What does DNP845 Module 6 usually ask for?
The module's discussion often asks you to examine a theory borrowed from another discipline and consider its usefulness and limits in nursing. Aspen does not publish module deliverables, so your classroom's instructions govern.
What are the components of the theory of planned behavior?
Attitude toward the behavior, subjective norms and perceived behavioral control, which together predict intention, and intention, which predicts behavior.
Why might borrowed theories fit nursing poorly?
They may rest on assumptions, such as deliberate decision-making, that do not match nursing situations like rapid, repeated actions under competing demands. Checking those assumptions against the setting is part of choosing a theory.
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