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NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence

NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence

NUR 590 Topic 2 DQ 2

Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.

It is preferable, as with any project execution, to anticipate any potential problems before they occur. As a result, I am concerned about the proposed implementation of my project. Finances have been and will continue to be a major concern for me as I move forward with my evidence-based initiative implementation. One strategy I discovered to help alleviate budgetary issues was the involvement of senior leadership in the process. To gain the support of the senior leadership team, it is critical to be open and honest about the implementation plan’s costs and savings strategies. A team of subject matter experts and educators on the Physician Orders for Life-Sustaining Treatment (POLST) program using the system Respecting Choices Model could also be formed. The development of software within the system will reduce the need for external resources.

Secondly, a lack of physician support for the program and change management has been anticipated.

It is vital to use strategies such as education, participation, and communication to overcome this issue.

Continuing education, audits, and reviews will all be a part of the training.

As part of the engagement strategy, we want to make sure that employees have faith in their job, that processes are consistent, and that stakeholders are included in the process. The communication strategy includes regular updates on educational and engagement opportunities, events, current POLST material, and the production of a newsletter.

Third, the POLST method and order sets need to be improved.

The quality of the work depends greatly on the first two difficulties that were mentioned.

“The quality of POLST documentation is only as good as the prior discussions” (Abbott, 2019, p. 297). POLST quality will suffer as a result if there is a lack of financial support or physician acceptance.

Research on POLST implementation is actively being reviewed and updated therefore in order to  ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.

NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence

Reference

Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021

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The only issue I see with the proposed implementation of my project is allowing time for both nurses and patients to adjust to the new process. Most organizational change initiatives fail because we use strategies that are inappropriate for the structure of the organization in question. I work at the VA in Lancaster, and our organization is in good shape. It takes trust, clarity, and integrity to change a healthy structure. Employees are held accountable for their actions. If they lack skills, they can be trained or seek assistance from their managers. “When will you be ready?” or “Have you tested the quality of your realization?” are likely to be asked by anyone in the organization, not just managers. Everyone is responsible to their coworkers. Here are the steps to take in order to determine the best change strategy. It breaks down the transition from the current state to the future state into five steps. (Cavarec, 2014):

  • Formulate change
  • Plan change
  • Implement change
  • Manage transition
  • Sustain change

Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles (Silver et al., 2016).

Investments in new clinical practices do not stop with their developers; enormous effort and resources are directed to introducing new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the establishment of knowledge brokers, evidence-based practice committees or teams and identifying opinion leaders and champions who will support the practice excellence (Virani et al., 2009).

Reference

Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.

Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2016). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology : CJASN11(5), 916–924. https://doi.org/10.2215/CJN.11501015

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Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly, 12(1), pp 89- 96

I do foresee issues with the proposed implementation of my project, including financial difficulties. My project focuses on the importance of continuous CPR during defibrillation. For many decades the focus of CPR was identified in order of importance; airway, breathing, circulation. Recently the American Heart Association announced that circulation would overtake as the number one

NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence

NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence

priority during cardiopulmonary resuscitation  (American Heart Association., n.d.). This means that early and continuous high quality compressions are seen to improve circulation and perfusion during CPR to help increase patient outcomes.

According to Clark et al., 2019, interruptions in chest compressions lasting more than 10 seconds are associated with poor outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting not only nurses but also physicians on board with the new evidence-based practice is a major impediment to implementation. It is extremely difficult to change people’s practices, especially if they have been practicing for a long time. To encourage staff buy-in to this new practice, a significant amount of education and support from leadership and clinical education will be required. Furthermore, the research I gathered revealed that in simulation studies, ECG devices and the LUCUS device were found to be the most beneficial for performing continuous compressions during defibrillation. These devices are extremely expensive and may be out of reach for small rural community hospitals. In this case, small community hospitals will be unable to provide patients with the most up-to-date evidence-based practice care due to a lack of funding. This is not only a barrier to implementation, but it is also a barrier to providing the best possible care to the patient.

To assess the organization’s readiness, capacity, and strength to change and implement this project, I would use The Organizational Readiness to Change Assessment (ORCA) tool. For a project of this size, I believe this tool would be capable of assessing all areas of change in order to determine whether the organization is a good fit for the project and vice versa.

American Heart Association . (n.d.). CPR Facts and Stats. cpr.heart.org. https://cpr.heart.org/en/resources/cpr-facts-and-stats.

 

Clark, L. R., McDannold, R., Mullins, M., & Bobrow, B. (2019). Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA. Circulation140(Suppl_2), A458-A458.

The first issue with any proposed project implementation is that people avoid change because they are afraid of failing to adapt to the new system, losing their comfort zone and losing confidence in their choice, or possibly having a previous bad experience when workflow changes. A lack of communication is another issue that could lead to the project failing. To ensure that all stakeholders are involved in the process, I should be more vigilant in dealing with this issue through effective communication, timely communication, and transparent communication methods ( (Project.2021). Another issue is a lack of available labor. Assessing the available workforce to determine whether additional staff and skill sets are required to complete the project is critical for project success. As the project leader, you must ensure that all project stakeholders are on the same page and have a clear vision by inviting them to actively shape and provide feedback on the project plan.

An evidence-based approach entails a continuous, critical review of research literature to determine what information is credible and which policies and practices, based on the best available evidence, would be most effective. It also necessitates rigorous quality assurance and evaluation to ensure that evidence-based practices are faithfully replicated and that new practices are evaluated to determine their effectiveness ( nicic.gov).

Projects: (2021). 9 Project management Challenges and How to Overcome them. https://kissflow.com/project/project-management-challenges.

National Institute of Corrections. (n.d). Evidence-based Practices (EBP). https://nicic.gov/projects/evidence-based-practice-ebp.

From an institutional standpoint, I do not anticipate any problems with implementing my EBP Project because the nurses are already involved in patient education and have the resources to do so. However, patient compliance and adherence may be an issue. According to Pan et al (2019), noncompliance with treatment regimens is the primary cause of uncontrolled blood pressure in hypertensive patients.

Organizations must assess their readiness for change before implementing change.

As a result, when conducting change readiness assessments, organizations must examine systems, processes, and, most importantly, people.

According to Borges and Camila (2020), 70% of organizational changes fail due to a lack of employee adoption.

Change readiness assessments can help to facilitate change by gathering quantitative and qualitative data measurements about potential readiness gaps.

Change can be initiated after the change readiness assessment has been completed, data has been summarized and reviewed, and issues have been addressed.

Because it involves establishing, maintaining, and sustaining change, John Kotter’s 8 Step Change Model would be most appropriate.

According to Kotter’s model, organizational change is essential for success (Kuo & Chen, 2019).

In Kotter’s model, the eight steps of change are: create urgency, organize a guiding team, develop a clear and concise vision and strategy, communicate the vision, use empowerment to remove obstacles or barriers, create short-term victories, build on the change, and cement cultural changes (Kuo & Chen, 2019).

References

Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach. Journal of Organizational Change Management, 33(5), 667-681. doi: http://dx.doi.org.lopes.idm.oclc.org/10.1108/JOCM-09-2019-0279

 

Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4). https://doi.org/10.1371/journal.pone.0213496

 

Pan, J., Wu, L., Wang, H., Lei, T., Hu, B., Xue, X., & Li, Q. (2019). Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine98(27), e16116. https://doi.org/10.1097/MD.0000000000016116

As with any change there is stress on an organization or staff in the process of the change, even good change causes stress to staff as their process is changed moving them out of their comfort zone (Ost et al., 2020). In every population from nursing to the janitor, change has moments of unacceptance, In my project of teaching a new practice change from EBL to QBL I foresee change stress and pushback, due to lack of trust in this new process.  Utilizing assessment tools such as a SWOT analysis to address readiness is the first step to understand where the population of a EBP project is ready to accept(Renalt, 2021).  Once barriers are identified one can start to formulate a plan to address those barriers and to navigate around them by removing barriers, acceptance of a change is made easier.

Transformation or change is a large problem area in an organization, Implementing or using a change management tool such as ADKAR also will help in the success of a project. ADKAR is an acronym with the following meanings,  A= starting with awareness, presenting the issue, why it is a problem or why they should be a change.  D= creating desire or want to become engaged in the process, creating a desire of the how this will improve practice and outcomes.  K= giving knowledge or improving knowledge in the process, through providing the research for staff to understand. A= abilities, or assessment of abilities of the nurse involved, do they have the tools, understanding, equipment needed. Finally, R= reinforcement or circling back to address issues that arose in the process after development and re-enforcement of usage of a practice(Pawl & Anderson, 2017).

As the leader of a project understanding there may be pushback, self-awareness is another area needed for assessment and creating a support system around oneself when “hiccoughs” happen, a process has a lot of push back.  Assessing or understanding your emotions and the intellectual intelligence of those you are leading, or teaching will help you to stay focused and look for solutions.

Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse40(3), 59–63. https://doi.org/10.4037/ccn2020963

Pawl, J. D., PhD, RN, OCN, CNE, & Anderson, L. S., PhD, RN. (2017). The use of change theory to facilitate the consolidation of two diverse Bachelors of science in Nursing programs. Nursing Outlook, (65), 233–239. Retrieved May 4, 2021, from

 

Renalt, V. (Ed.). (2021). SWOT analysis: Strengths, Weakness, Opportunities and Threats. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main

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