Change is necessary in the healthcare systems. With the advancement in the operational processes, there is always the need to adjust some of the approaches used in the healthcare. Most organizations often implement changes to ensure efficiency in the healthcare processes and also to increase revenues. With the increased demands of quality in the healthcare delivery, most healthcare institutions are always involved in the continuous change processes to ensure that they meet the ever increasing demands from the clients. Given that healthcare institutions are faced with different challenges that need to be addressed, there is always the need to initiate change processes to address such challenges/problems (Arditi, Nayak, & Damci, 2017). Different healthcare institutions are associated with different issues that either require changes in people’s behaviors or the processes or approaches in the healthcare system. Some of the challenges may include medication errors, workplace conflicts, inadequate care delivery, high costs of healthcare services, and low nurse to patient ratios. These challenges/issues often require the implementation of appropriate changes in the service delivery to ensure effective operational processes. The purpose of this paper is to examine an issue that may lead to the implementation of change processes in the healthcare system.
My current unit holds monthly staff meetings. These meetings are offered both in person and via zoom which allows more participation of our very large staff of 200 nurses. The meetings are led by our department manager who follows a similar agenda each month. She covers hiring and staffing updates, introduces new staff, provides updates on current and future unit projects and provides updates on past issues. When covering each topic, there is opportunity for conversation and input from the staff. The last segment of the meeting is for staff conversation where questions and concerns are encouraged and discussed. Due to the large number of staff involved, our manager is the formal leader. I feel that this model works well for our unit because of our large size and the fact that we also have a culture where input from all nurses is encouraged and “the norm”. People speak up freely and are respected for their input during meetings. In this unit culture, I feel that there are many informal leaders who are involved in subcommittees, formal and informal mentorship and creating an inclusive and supportive work environment.
Executive Summary of the Issue Impacting Organization/Workplace
One of the main issues affecting my organization/workplace is workplace conflict. In most cases, conflicts among the employees and the management often impact effective operational processes. Usually, workplaces with a lot of issues experience delays in service delivery. Also, the quality of service delivery may go down. With the increasing conflicts within the work environment, people cannot reach consensus on various issues that impact healthcare processes. Workplaces with continuous conflicts often require constant changes to ensure that there is an overall improvement in the operational processes. Conflicts within the work environment may be caused by poor communication, lack of common understanding among the workforce, as well as the lack of respect among the employees and the management. Close-mindedness, misunderstandings, as well as passive aggressive behaviors are some the other causes of workplace conflicts in my organization. In my organization, the management has been involved in implementing different change processes to address the issue of workplace conflicts. However, the approaches that have been taken often appear ineffective. For instance, the management has tried to transform communication processes to enhance understandings among the employees and the management; however, the approaches that were taken failed to produce effective outcomes.
Description of Health Organization
My organization is a tertiary hospital that serves a diverse patient population. The organization’s specialized and general care services serve patients. The organization’s organizational culture is team-oriented. Employees collaborate in inter-professional teams to complete their assigned tasks. The organization is ready to implement change as a result of the increased use of inter-professional teams to complete organizational tasks. Furthermore, the organization has a culture of implementing best practices to drive performance and care quality excellence. The organization also recognizes the importance of continuous quality improvement. It reviews its effectiveness in achieving its goals on a regular basis in order to improve on areas of weakness and explore opportunities in its markets.
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The rising rate of adult obesity is the current issue confronting our institution. In recent years, the number of obese patients seen in the emergency department and admitted to the wards has steadily increased. Obesity has been linked to a number of health issues, including cancer, heart disease, hypertension, and diabetes. As their ability to engage in strenuous physical activities declines, obese adults lose social and occupational functioning. Nurses and physicians, for example, play critical roles in combating adult obesity. Nurses and physicians oversee the implementation of evidence-based practice interventions to reduce the prevalence and risks of obesity in the population. They also educate at-risk populations on the necessary lifestyle and behavioral interventions for obesity prevention.
My Healthcare Organization
My Healthcare business provides our clients with high-quality healthcare services.
My organization’s culture is founded on honesty, respect, acceptance of new employees, privacy, and regard for our patients.
The firm is prepared for any change since personnel are constantly trained to adapt to changes in the workplace.
The gathering of evidence is an activity that takes place with an end goal in mind. Law enforcement officers, for example, gather evidence to support a decision to charge persons accused of illegal action. Similarly, evidence-based healthcare practitioners gather data to support decisions aimed at achieving specified healthcare outcomes.
In this Assignment, you will identify a problem or opportunity for change within your healthcare organization and propose a practice change backed by an EBP methodology.
To Get Ready:
Consider the four peer-reviewed articles linked to your clinical area of interest and PICOT that you critically appraised in Module 4.
Reflect on your present healthcare organization and consider potential prospects for evidence-based reform, depending on your topic of interest and PICOT.
Consider the best way to communicate the outcomes of your presentation to an audience.
The task at hand: (Evidence-Based Project)
Also Read:
NURS 6052 Post a Description of the Healthcare Organization Website you Reviewed
NURS 6052 Post a Brief Description of your Clinical Issue of Interest
NURS 6052 Identify and Briefly Describe your Chosen Clinical Issue of Interest
NURS 6052 Critical Appraisal Tool Worksheet Template
NURS 6052 Change Implementation and Management Plan
NURS 6052 Discussion Workplace Environment Assessment
NURS 6052 Assignment Personal Leadership Philosophies
NURS 6052 Discussion Leadership Theories in Practice
NURS 6052 Organizational Policies and Practices to Support Healthcare Issues
NURS 6052 Developing Organizational Policies and Practices
NURS 6052 Analysis of a Pertinent Healthcare Issue
Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052
NURS 6052 Change is necessary in the healthcare systems
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uA tertiary organization
uProvides a wide range of care services
uHas culture of teamwork, openness in communication, transformational leadership, and recognition of employee contributions
uIts ready to implement change
I work with a tertiary hospital. The hospital has been providing its services for the last 50 years. The hospital provides a wide range of services to its populations. The services include inpatient, outpatient, surgeries, maternity, and psychiatric care services. The organization has an effective culture that promotes excellence. The culture of the organization is characterized by teamwork in the provision of patient care. The leadership and management encourages open communication to ensure that the needs of the healthcare providers are prioritized in patient care. The organization also utilizes transformation leadership styles to ensure that employees develop the competencies that they need in addressing the actual and potential needs of their populations. There is also the provision of rewards and incentives to motivate the employees engage in activities that contribute to the optimum care outcomes in the organization. Based on the above, the organization is ready to implement change that addresses the issue of the increasing prevalence of CLABSI .
Part 4: Recommending an Evidence-Based Practice Change
Create a narrated PowerPoint presentation with 8 to 9 slides that includes the following:
Briefly describe your healthcare organization’s culture and willingness to change. (You may choose to keep a variety of
This anonymous, for example, your firm name.)
Describe the current issue or change opportunity. Include the circumstances around the need for change, the breadth of the problem, the stakeholders involved, and the risks associated with change implementation in general in this description.
Propose an evidence-based idea for a change in practice utilizing an EBP decision-making process. It should be noted that if sufficient proof is not discovered, additional study may be required.
Describe your strategy for this change’s knowledge transfer, including knowledge development, distribution, and organizational adoption and execution.
Explain how you plan to present your project’s findings to an audience. Give an explanation for why you chose this distribution approach.
Describe the measurable results you aim to obtain as a result of implementing this evidence-based change.
Make sure to include APA citations for any evidence-based peer-reviewed literature you used to back up your points.
Include the following in your lessons learnt section:
A synopsis of the critical evaluations of the peer-reviewed publications you previously contributed
An explanation of what you discovered when filling out the Evaluation Table on the Critical Appraisal Tool Worksheet Template (1-3 slides)
By Week 10’s seventh day
Part 4 of your Evidence-Based Project must be submitted.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
- Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 10 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment Draft for Authenticity
Submit your Week 10 Assignment Draft and review the originality report
Submit Your Assignment by Day 7 of Week 10
To participate in this Assignment:
Week 10 Assignment
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Module 6: Changing the World Through Evidence-Based Practice (Weeks 10-11)
Laureate Education (Producer). (2018). Evidence-based Practice and Outcomes [Video file]. Baltimore, MD: Author.
| Due By | Assignment |
| Week 10, Days 1-3 | Read the Learning Resources. Begin to compose your assignment. |
| Week 10, Days 4-6 | Continue to compose your Assignment. |
| Week 10, Day 7 | Deadline to submit your Assignment. |
| Week 11, Days 1-2 | Read the Learning Resources.
Compose your initial Discussion post. |
| Week 11, Day 3 | Post your initial Discussion post. |
| Week 11, Days 4-5 | Review your Discussion posts.
Compose your peer Discussion responses. |
| Week 11, Day 6 | Post two peer Discussion responses. |
| Week 11, Day 7 | Wrap up Discussion |
Learning Objectives
Students will:
- Analyze opportunities for change within healthcare organizations
- Recommend evidence-based organizational changes using an evidence-based practice approach to decision making
- Identify measurable outcomes addressed by evidence-based changes
- Justify dissemination strategies
- Analyze the impact of patient preferences on clinical decision making
- Analyze decision aids
Learning Resources
Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 7, “Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice” (pp. 219–232)
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
Note: You will access this article from the Walden Library databases.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Note: You will access this article from the Walden Library databases.
Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483
Note: You will access this article from the Walden Library databases.
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x
Note: You will access this article from the Walden Library databases.
Sample Answer 3 for NURS 6052 EBP Part 4 Recommending An Evidence-Based Practice Change
Culture and change readiness
My successful strategic shift requires consideration of crucial factors.
Ecologic tension
Consistency and quality of policy
my responsibility as a significant player in change leadership
A positive institutional culture is present.
clinical and administrative relations
the compatibility between the regional setting and the change agenda
the straightforwardness of institutional intentions
aspirations are one among these elements.
Possibility of change
I propose adopting N95 masks for healthcare professionals in conjunction with current hygiene, distance, and contact tracking techniques as a viable method to source management.
I urge the institution’s administration and officials to support the widespread use of this sort of face mask when caring for patients, including the application of appropriate laws.
After collecting factual resources, the investigation on the public’s use of masks to prevent COVID-19 infection is advancing rapidly.
In order to prevent the COVID-19 pandemic, healthcare professionals need guidance on which sorts of masks to use when treating the general public.
Evidence-based Concept
First, healthcare practitioners must limit infected individuals’ contact with each other through physical contact tracing and separation with effective quarantine. Second, they must reduce the likelihood of transmission per contact by, among other things, wearing the safest type of masks in healthcare institutions.
N95 Respirator
Protects against infectious particles or droplets that cause respiratory diseases.
Provides fifty times the protection of a fabric mask and twenty-five times that of a surgical mask.
Plan for knowledge transfer factors are included while creating an effective knowledge transfer strategy.
That are the notable audience members who are educated about this topic?
How much data must be documented? What information is indispensable, and what may be gained by other means?
How will crucial information be collected and distributed to those who need it?
Adoption by the company
I explain six crucial steps that I want to implement for an effective organizational transformation.
Clearly defining the change and connecting it to the goals of my institution.
Identifying the consequences and those who will be affected.
Creating a communication strategy.
Recommend training that is beneficial.
Developing a support network.
Assessing the change procedure.
Measurable Outcomes
N95 adoption consequences
COVID-19 control
Physical and behavioral intervention.
Health organizations operate with the aim of optimizing outcomes such as safety, quality, and efficiency in addressing the needs of their organizations. Often, health organizations operate in highly dynamic and challenging environments. They experience issues such as competition from other organizations, changing consumer needs and preferences, and emerging health problems. These challenges imply that health organizations must embrace change to respond to their current and emerging needs in their markets. Change initiatives provide organizations competitive edge over others involved in the same market niche. Healthcare providers, including nurses play a crucial role in the implementation of change initiatives that address organizational needs. They select evidence-based practice interventions to ensure efficiency in the adopted strategies and realization of optimum safety and quality outcomes in service delivery. Therefore, this presentation examines an organizational issue and proposed change to address it.
The organization I work with is a tertiary hospital. The hospital leads in the region in the provision of specialized and general care to its diverse populations. The hospital has a culture that supports change. First, healthcare providers utilize teamwork in the provision of patient care services. Teamwork aims at ensuring collectivism in the realization of the organizational outcome. The organization also strives to support safety culture. This is achieved by the adoption of evidence-based interventions in the implementation of organizational strategies. Evidence-based strategies optimize outcomes such as safety, quality, and efficiency. There is also the use of open communication among different stakeholders. Open communication ensures the prioritization of the stakeholder needs, views, and concerns. Open communication has strengthened openness and trust among the organizational employees, hence, enhanced teamwork in the provision of patient care. The organization also recognizes the vital role that rewarding performance plays in contributing to employee productivity. As a result, it undertakes biannual performance appraisals and uses them to reward employees and motivate them to explore additional ways of achieving the desired outcomes. These aspects of the organizational culture make it ready to embrace change.
The selected nursing problem in my organization is nursing shortage. The hospital currently experiences an acute shortage of nurses, which has affected the provision of patient care services to the patients. Several circumstances surround the issue of nurses shortage in the hospital. One of them is high rate of nurses’ turnover. The rate of nurses leaving their jobs intentionally has risen significantly over the past years. The rise is attributed to organizational issues such as high workload because of the few nurses, burnout, and occupational stressors associated with the challenge of balancing professional and family life demands. The other factor is unhealthy workplaces. This can be seen from violence targeted at nurses by other nurses and other healthcare providers. Most nurses report experiencing either physical or verbal violence from others, which affect their psychological and physical health, hence, their intention to leave their jobs. The other factor is the low number of nursing students being trained among the American universities. This is attributed to the shortage of faculty staff to train a high number of nurses to address the current shortage. Lastly, more than one million nurses will be retiring in the next decade. This implies that the problem of nursing shortage will persist if no intervention is embraced (Yahya Muabbar & Zayyan Alsharqi, 2020). The affected stakeholders by the problem include nurses and patients. Nurses suffer from high workload while patients are affected by low quality nursing care being given to them. The risks of implementing change include resistance to change from the adopters, inadequate support from health organizations, and disruption of the existing systems and processes by change.
The proposed idea to address the issue of nurses shortage in the hospital is empowering them. The hospital should implement nurse-centered interventions that address their actual and potential needs. The interventions should align with the needs and expectations of the nurses. One of the empowerment strategies that the hospital should consider is rewarding their performance. The hospital should ensure that the remuneration for the nurses aligns with the role and contributions of nurses to its success. The hospital should also implement reward schemes regularly to motivate nurses to engage in additional ways to meet the needs of their patients and theirs too. The other strategy is ensuring health and safe working environment (Challinor et al., 2020). The hospital should ensure the adoption of strict policies that condone behaviors such as violence targeted at nurses. In addition, workplace stressors such as high workload should be addressed to prevent more nurses from leaving their jobs in the hospital. The other empowerment strategy is ensuring flexibility in the nurses’ schedules. The leadership and management should ensure that nurses have flexible schedules that help them to balance between work and family demands. There should also be programs such as counseling for nurses to help them be resilient and develop effective coping skills for managing the workplace demands. These empowerment strategies should be incorporated into the organization’s culture to ensure sustainable change (Farid et al., 2020; Gensimore et al., 2020; Lester et al., 2020; Seren Intepeler et al., 2019).
The plan for knowledge transfer will comprise several interventions. One of them will be training nurses about the selected empowerment strategies. For example, nurses will be enrolled into training sessions where they will be informed about their role in creating safe work environments and advocating for sustainable change. Training will equip them with the competencies they need to drive excellence in nursing practice and protection of nurses’ needs and interests. The second strategy is creating discussion forums for nurses. The forums will enables them to share their issues and potential strategies that should be adopted in the organization. The third strategy for knowledge transfer will be involving nurses in assessing, planning, implementing, and evaluating the selected empowerment strategies. Their involvement will ensure the adoption of interventions that align with nurses’ expectations, hence, their sustainability (Dang et al., 2021). Lastly, best strategies will be incorporated into the organization’s culture. The incorporation will ensure the organization supports evidence-based strategies that contribute to nurses’ retention in the organization.
Three dissemination strategies will be adopted. The first one is publishing an article about the results of empowering nurses on the hospital’s nursing staffing levels. Publishing an article will be an effective approach to reaching a large nursing audience. It will also be used in other organization as an evidence-based intervention to address nurses’ shortages. The second dissemination strategy will be presenting results in nursing conferences. The conferences will provide opportunities to share knowledge with other nurses on the effectiveness of the intervention and how to improve it further. The last strategy will be developing new guidelines in the hospital to guide employee management (Dang et al., 2021). The empowerment strategies that prove effective will be incorporated into human resource policies, hence, sustainability in the use of best practices in the hospital.
Several outcomes will be used to assess the effectiveness of nurses’ empowerment in addressing the issue of nursing shortage in the organization. One of them will be the rate of nurses’ turnover. The rates will be compared before the intervention and after it to determine its impact on nursing workforce. The other measure will be nurses’ level of job satisfaction. Surveys, interviews and questionnaires will be administered to determine the satisfaction of nurses with the adopted empowerment interventions. An increase in their level of satisfaction will translate into the success of the intervention. Information about nurses’ intent to leave their jobs will also be obtained before and after the empowerment interventions. A reduction in their intention to leave their jobs will translate into project success. The costs incurred by the organization in hiring, training, and retaining nurses will also be compared before and after empowerment interventions to obtain a true picture of its impacts (Blouin & Podjasek, 2019; Cao et al., 2019).
I learned several things from conducting the evaluation table using the peer-reviewed articles. One of them is the importance of evidence-based data in nursing practice. I learned that nurses should make their decisions based on the best available evidence. The use of evidence-based data ensures optimum outcomes such as safety, quality, and efficiency. The other lesson learnt is the need for nurses to be competent in article critique. This will help them to determine the level of evidence in each article and relevance to their practice. I also learnt that evidence-based data is important in improving patient and nursing outcomes. This could be seen from the enhanced outcomes in the articles included in the review. Organizations influence the use of evidence-based data in their process. Therefore, they should ensure that their culture supports new practices to enhance performance and care outcomes in addressing the needs of different populations.
References
Blouin, A. S., & Podjasek, K. (2019). The Continuing Saga of Nurse Staffing: Historical and Emerging Challenges. JONA: The Journal of Nursing Administration, 49(4), 221. https://doi.org/10.1097/NNA.0000000000000741
Cao, Y., Liu, J., Liu, K., Yang, M., & Liu, Y. (2019). The mediating role of organizational commitment between calling and work engagement of nurses: A cross-sectional study. International Journal of Nursing Sciences, 6(3), 309–314. https://doi.org/10.1016/j.ijnss.2019.05.004
Challinor, J. M., Alqudimat, M. R., Teixeira, T. O. A., & Oldenmenger, W. H. (2020). Oncology nursing workforce: Challenges, solutions, and future strategies. The Lancet Oncology, 21(12), e564–e574. https://doi.org/10.1016/S1470-2045(20)30605-7
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines, Fourth Edition. Sigma Theta Tau.
Farid, M., Purdy, N., & Neumann, W. P. (2020). Using system dynamics modelling to show the effect of nurse workload on nurses’ health and quality of care. Ergonomics, 63(8), 952–964. https://doi.org/10.1080/00140139.2019.1690674
Gensimore, M. M., Maduro, R. S., Morgan, M. K., McGee, G. W., & Zimbro, K. S. (2020). The Effect of Nurse Practice Environment on Retention and Quality of Care via Burnout, Work Characteristics, and Resilience: A Moderated Mediation Model. JONA: The Journal of Nursing Administration, 50(10), 546. https://doi.org/10.1097/NNA.0000000000000932
Lester, P. E., Dharmarajan, T. S., & Weinstein, E. (2020). The Looming Geriatrician Shortage: Ramifications and Solutions. Journal of Aging and Health, 32(9), 1052–1062. https://doi.org/10.1177/0898264319879325
Seren Intepeler, S., Esrefgil, G., Yilmazmis, F., Bengu, N., Gunes Dinc, N., Ileri, S., Ataman, Z., & Dirik, H. F. (2019). Role of job satisfaction and work environment on the organizational commitment of nurses: A cross-sectional study. Contemporary Nurse, 55(4–5), 380–390. https://doi.org/10.1080/10376178.2019.1673668
Yahya Muabbar, H., & Zayyan Alsharqi, O. (2020). The Impact of Short-Term Solutions of Nursing Shortage on Nursing Outcome, Nurse Perceived Quality of Care, and Patient Safety. American Journal of Nursing Research, 9(2), 35–44. https://doi.org/10.12691/ajnr-9-2-1
Sample Answer 4 for NURS 6052 EBP Part 4 Recommending An Evidence-Based Practice Change
Introduction
This presentation will describe my healthcare organization, including the organizational culture and readiness for change. I will also identify an opportunity for change in the organization and discuss the circumstances surrounding the need for change and the scope of the issue. Besides, I will propose an evidence-based intervention to promote a change in practice that will help address the opportunity for change. In addition, I will describe the plan for knowledge transfer of the proposed change and dissemination strategies for the project’s results. Lastly, I will discuss the lessons learned from the appraisal of the peer-reviewed articles in the previous assignment.
Healthcare Organization and Culture
Our healthcare organization is an outpatient psychiatric facility. It offers extensive mental health and psychiatric services in child, adolescent, and adult behavioral health. Services offered include treatment and psychotherapy for psychiatric disorders, substance abuse disorders, addiction, sexuality issues, life transitions, and family issues.
The organization has a clan culture characterized by collaborative teamwork, and all employees feel like equals. Since there are few employees (10 medical and 7 non-medical staff), the organization is non-hierarchical. There is a strong focus on mentorship, and employees are encouraged to give honest and open feedback.
The organization has a high level of readiness to change. Employees have a high individual and shared commitment to implement changes in the organization and ensure change is effective. In addition, employees have a strong belief in their shared ability to execute change.
Current Opportunity for Change
Healthcare providers attend to numerous patients with Alzheimer’s disease (AD). The AD patients usually present with cognitive decline caused by the disease process as demonstrated by increasing memory loss, shortened attention span, difficulty with language, difficulty organizing thoughts and thinking logically, inability to learn new things, poor judgment, and impaired reasoning ability (Bradfield & Ames, 2020). Although patients are prescribed medications to slow the progression of the disease, the medications do not reverse the cognitive decline. Improving AD patients’ cognitive functioning is an opportunity for change. We need to identify new evidence-based approaches to improve cognitive function in AD patients, particularly in the early stages of the disease. This would help lower the disease morbidity caused by cognitive decline and improve their quality of life.
Stakeholders involved include patients, who are the most affected by the cognitive decline, and the mental healthcare providers responsible for providing the best available interventions in helping patients live a near to normal life. No potential risks will be associated with change interventions in the organization.
EBP Best Practice Recommendation
Cognitive training is my recommended EBP best practice approach to address the cognitive decline in AD patients. Bahar‐Fuchs et al. (2019) define cognitive training as a non-pharmacological treatment approach that centers on guided practice on tasks targeting specific cognitive functions, such as attention, memory, and problem-solving. It entails guided cognitive exercises to improve various cognitive functions and improve performance in untrained cognitive tasks.
Various studies have established that cognitive training improves working memory, global cognition, learning, attention, and memory. It also improves psychosocial functioning, depressive symptoms, and visuospatial skills (Kallio et al., 2017).
Butler et al. (2018) showed that cognitive training enhanced cognitive performance in healthy older adults. Thus, it should be included in the preventative care of elderly persons to lower their risk of declined cognitive function.
Plan for Knowledge Transfer
Knowledge transfer of the change will adopt the integrated knowledge transfer approach. The steps in knowledge transfer will include:
i.Integrate stakeholders (nurses and mental health providers) into the research process.
ii.Shape the research questions
iii.Determine the research methods to use (Prihodova et al., 2019).
iv.Take part in data collection and tool development.
v.Support the process and outcome evaluation.
vi.Interpret the study findings
vii.Create the message and disseminate the research results (Prihodova et al., 2019).
viii.Generate research findings that will likely be relevant to and used by the end-users.
Dissemination Strategy
Dissemination refers to the purposed distribution of information and intervention materials to a target clinical practice or public health audience. It aims at spreading knowledge and related evidence-based interventions (Brownson et al., 2018). The results of the EBP project on using cognitive training to improve cognitive function in AD patients will be disseminated through conference presentations and seminars (Brownson et al., 2018). I can present the results in conferences held by professional nursing organizations such as the American Association of Nurse Practitioners (AANP), American Psychiatric Nurses Association (APNA), and American Nurses Association (ANA). Nursing professional organizations offer a platform to their members to disseminate research findings from their projects. I chose this strategy because I will reach a large target audience, including registered nurses, APRNs, and PMHNPs. Besides, I will interact with providers from other organizations and share knowledge on the interventions they take to improve cognitive functioning in AD patients.
Measurable Outcomes
The measurable outcomes I hope to achieve with implementing the EBP project on cognitive training include improved: cognition, memory, attention, learning ability, and visuospatial skills.
Besides, I hope to achieve improved psychosocial functioning and reduced depressive symptoms in AD patients with comorbid depression.
I also seek to improve patients’ executive function and their ability to perform ADLs through executive function.
Another outcome will be a decreased number of patients who develop AD morbidities secondary to a decline in cognitive function.
Summary of Lessons Learned
The peer-reviewed articles evaluated the impact of cognitive training in enhancing cognitive function in AD patients with cognitive decline.
I learned that cognitive training (CT) significantly improves executive function, memory, and performance of ADLs. It can be integrated as part of health promotion interventions in healthy older adults to improve their cognitive test performance (Butler et al., 2018). Besides, cognitive training can be provided in a computerized cognitive training (CCT) program. The computerized cognitive training approach is a practical intervention to improve cognition in patients with mild cognitive impairment (Hill et al., 2017). In addition, cognitive training can enhance working memory in geriatric patients with declined cognitive function and thus can be effectively implemented in AD patients. I further learned that cognitive training could enhance patients’ initiative and stabilize memory in mild to moderate AD (Giovagnoli et al., 2017).
References
Bahar‐Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., & Clare, L. (2019). Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (3).
Bradfield, N. I., & Ames, D. (2020). Mild cognitive impairment: a narrative review of taxonomies and systematic review of their prediction of incident Alzheimer’s disease dementia. BJPsych Bulletin, 44(2), 67–74. https://doi.org/10.1192/bjb.2019.77
Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Research full report: getting the word out: new approaches for disseminating public health science. Journal of public health management and practice, 24(2), 102. https://doi.org/10.1097/PHH.0000000000000673
Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A., … & Kane, R. L. (2018). Does cognitive training prevent cognitive decline? A systematic review. Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531
Sample Answer 5 for NURS 6052 EBP Part 4 Recommending An Evidence-Based Practice Change
Organizational Description
I work with a tertiary hospital. The hospital has been providing its services for the last 50 years. The hospital provides a wide range of services to its populations. The services include inpatient, outpatient, surgeries, maternity, and psychiatric care services. The organization has an effective culture that promotes excellence. The culture of the organization is characterized by teamwork in the provision of patient care. The leadership and management encourages open communication to ensure that the needs of the healthcare providers are prioritized in patient care. The organization also utilizes transformation leadership styles to ensure that employees develop the competencies that they need in addressing the actual and potential needs of their populations. There is also the provision of rewards and incentives to motivate the employees engage in activities that contribute to the optimum care outcomes in the organization. Based on the above, the organization is ready to implement change that addresses the issue of the increasing prevalence of CLABSI .
Current Problem
The current problem in the organization is the high prevalence of CLABSI in patients admitted in the acute care settings. CLABSI rates have been rising over the past translating into low quality and safety of patient care. The high rate of CLABSI could be attributed to the low level of awareness among the healthcare providers on the interventions used in the prevention of CLABSI (Scheier et al., 2021). The low level of awareness and skills imply that evidence-based interventions may not be utilized in providing the needed patient care. CLABSI is associated with a number of adverse outcomes. The adverse outcomes include the increased risk of complications, increased care costs, hospital stay, and reduced quality of life. Evidence-based interventions exist for CLABSI (Reynolds et al., 2021). Therefore, the problem can be addressed to ensure high quality, safe and efficient care in the organization.
Scope of the Issue and Stakeholders
The scope of the proposed issue is the prevention of CLABSI in acute care patients. The aim is to reduce the prevalence of CLABSI among hospitalized patients. The healthcare providers will be involved in the implementation of the change. It is expected that the implementation of the change will reduce the negative effects of CLABSI and promote safety, quality and efficiency in patient care. The stakeholders will include nurses, physicians, managers and nurse leaders. Nurses will be involved in the implementation of the change. They will administer the chlorhexidine baths to reduce CLABSI (Zerr et al., 2021). Physicians and nurses will work together to implement the intervention. Managers and nurse leaders will coordinate the implementation process of the change. They will ensure that the implementation is done according to the developed plan. They will also oversee the use of the resources in the implementation of the change.
Risks Associated with Implementing Change
Implementation of change is associated with a number of risks. The first risk is resistance to change. There is an increased risk of the healthcare providers and other stakeholders declining to embrace the change. The resistance could be attributed to lack of knowledge or inadequate preparedness for the change. The other risk is the lack of support from the hospital. A lack of support will result in poor implementation due to scarcity in resources (Greenhalgh, 2017). The other risk is misuse of resources. Ineffective or poor implementation of change may lead to resource wastage. Lastly, it increases the risk of adverse patient outcomes. Poor implementation of the change may lead to patient harm due to safety issues with the adopted interventions (Chletsos & Saiti, 2020). Therefore, interventions should be implemented to enhance the adoption process of the change.
Evidence-Based Idea
The proposed evidence-based idea is the use of chlorhexidine bathing to reduce the risk and rate of CLABSI in acute care settings. The existing evidence shows that chlorhexidine is effective in reducing and destroying disease causing bacteria on the skin. The reduction implies that the risk of patients CLABSI is reduced significantly. There is also the improvement in the safety and quality of care that patients receive. The use of chlorhexidine in preventing CLABSI is feasible because it does not require the extensive use of organizational resources and skills (Zerr et al., 2021). The proposed intervention can produce sustainable outcomes, hence, the need for its adoption in the organization.
Knowledge Transfer Plan
The plans for knowledge transfer will be varied. One of them will be the promotion of the active involvement of the stakeholders in the change initiatives. Active stakeholder involvement will ensure that the stakeholders have developed the needed competencies for the implementation and sustainability of the change. The second strategy will be the promotion of open communication. Open communication will be used to foster trust and honesty among the stakeholders. Open communication will also enable the stakeholders to express their needs and ideas related to the change. The third strategy will be training. Training will be offered to the stakeholders to minimize resistance to change. Lastly, regular assessments will be offered to ensure that the stakeholders receive frequent feedback on their abilities, challenges and opportunities for achieving outcomes in the implementation of the intervention (Greenhalgh, 2017).
Dissemination Plan
Several dissemination plans will be used in the project. The first one will be the presentation of the results to the healthcare providers in the organization. Dissemination to the healthcare providers will create awareness among them and increase their understanding of the need for the change in promoting optimum outcomes of care. The second dissemination plan is publishing the results of the intervention in reputable journals of nursing and healthcare. Publishing will create an extensive reach and awareness of the other healthcare providers about the ways of promoting quality, safety and efficiency in patient care. The other strategy will be presenting the results in scientific conferences. This will create awareness and facilitate discussions about the ways in which the intervention can be improved further. The last dissemination approach will be implementing the use of the intervention across the organization (Wensing et al., 2020). This will ensure the uniform implementation of the change for improved outcomes in the organization.
Measurable Outcomes
One of the measurable outcomes that will be associated with the proposed change is the reduction of the rate of CLABSI in the hospital. The reduction will be attributable to the use of chlorhexidine baths to eliminate disease causing bacteria on the skin. The other measurable outcome is the reduction in the hospital stay and costs by patients admitted in the acute care settings. The reduction will be attributed to the effectiveness of the intervention. The other outcome is the incorporation of the intervention into clinical policies of safety and quality. The incorporation will ensure sustained and consistent use of chlorhexidine baths in reducing CLABSI .
Lessons Learned
I learned a number of lessons from the critical appraisal of evidence and completing the evaluation table. One of the lessons learned is that CLABSI is a critical health concern in acute care settings. The risks of patients developing CLABSI are high. I also learned that CLABSI is associated with negative outcomes to patients and healthcare systems. They include increasing costs of care, complications, poor quality of life, and increased utilization of resources. I also learned that CLABSI are preventable. Healthcare providers have the essential role of exploring evidence-based interventions that can be used to prevent and reduce the risk of CLABSI . The experience also showed that the use of chlorhexidine baths is highly feasible in preventing and reducing CLABSI . Therefore, the implementation of the proposed change should aim at utilizing best practices to ensure the realization of optimum outcomes in the process.
References
Chletsos, M., & Saiti, A. (2020). Strategic Management and Economics in Health Care. Springer Nature.
Greenhalgh, T. (2017). How to Implement Evidence-Based Healthcare. John Wiley & Sons.
Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): A stepped wedge cluster randomized trial. Implementation Science, 16(1), 45. https://doi.org/10.1186/s13012-021-01112-4
Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M. R., Schüpbach, R., Falk, C., Sax, H., Kuster, S. P., & Schreiber, P. W. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26–32. https://doi.org/10.1016/j.jhin.2021.01.007
Wensing, M., Grol, R., & Grimshaw, J. (2020). Improving Patient Care: The Implementation of Change in Health Care. John Wiley & Sons.
Zerr, D. M., Milstone, A. M., Dvorak, C. C., Adler, A. L., Chen, L., Villaluna, D., Dang, H., Qin, X., Addetia, A., Yu, L. C., Keller, M. C., Esbenshade, A. J., August, K. J., Fisher, B. T., & Sung, L. (2021). Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children’s Oncology Group. Cancer, 127(1), 56–66. https://doi.org/10.1002/cncr.33271
Name: NURS_6052_Module06_Week10_Assignment_Rubric
| Excellent | Good | Fair | Poor | |
|---|---|---|---|---|
| Part 4: Disseminating Results
Create a, 8-9-slide narrated PowerPoint presentation of your Evidence-Based Project: Briefly describe the following: your healthcare organization and culture, current opportunity for change, scope of issue, and EBP best practice recommendation. Explain how you would plan knowledge transfer and dissemination. Describe measurable outcomes with the implementation of EBP best practice. Summarize lessons learned. |
Points Range: 81 (81%) – 90 (90%)
The narrated presentation accurately and completely summarizes the evidence-based project. The narrated presentation is professional in nature and thoroughly addresses all components of the evidence-based project. The narrated presentation accurately and clearly describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. The narrated presentation accurately and clearly describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. The narrated presentation clearly and accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned. The narrated presentation fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation. |
Points Range: 72 (72%) – 80 (80%)
The narrated presentation adequately summarizes the evidence-based project. The narrated presentation is professional in nature and adequately addresses the components of the evidence-based project. The narrated presentation accurately describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. The narrated presentation accurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. The narrated presentation accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned. The narrated presentation integrates at least one outside resource and two or three course-specific resources that may support the presentation. |
Points Range: 63 (63%) – 71 (71%)
The narrated presentation vaguely, inaccurately, or incompletely summarizes the evidence-based project. The narrated presentation may be professional in nature and somewhat addresses the components of the evidence-based project. The narrated presentation inaccurately or vaguely describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. The narrated presentation inaccurately or vaguely describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned. The narrated presentation minimally integrates resources that may support the presentation. |
Points Range: 0 (0%) – 62 (62%)
The narrated presentation vaguely and inaccurately summarizes the evidence-based project or is missing. The narrated presentation is not professional in nature and inaccurately and incompletely addresses the components of the evidence-based project or is missing. The narrated presentation vaguely and inaccurately describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation, no examples are provided, or it is missing. The narrated presentation vaguely and inaccurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing no specific and relevant examples. The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned. The narrated presentation fails to integrate any or presents minimal resources to support the presentation. |
| Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. |
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. |
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive. |
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. |
Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided. |
| Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation. |
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
|
Points Range: 4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors.
|
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) grammar, spelling, and punctuation errors.
|
Points Range: 0 (0%) – 3 (3%)
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
|
| Total Points: 100 |
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Introduction
This presentation will describe my healthcare organization, including the organizational culture and readiness for change. I will also identify an opportunity for change in the organization and discuss the circumstances surrounding the need for change and the scope of the issue. Besides, I will propose an evidence-based intervention to promote a change in practice that will help address the opportunity for change. In addition, I will describe the plan for knowledge transfer of the proposed change and dissemination strategies for the project’s results. Lastly, I will discuss the lessons learned from the appraisal of the peer-reviewed articles in the previous assignment.
Healthcare Organization and Culture
Our healthcare organization is an outpatient psychiatric facility. It offers extensive mental health and psychiatric services in child, adolescent, and adult behavioral health. Services offered include treatment and psychotherapy for psychiatric disorders, substance abuse disorders, addiction, sexuality issues, life transitions, and family issues.
The organization has a clan culture characterized by collaborative teamwork, and all employees feel like equals. Since there are few employees (10 medical and 7 non-medical staff), the organization is non-hierarchical. There is a strong focus on mentorship, and employees are encouraged to give honest and open feedback.
The organization has a high level of readiness to change. Employees have a high individual and shared commitment to implement changes in the organization and ensure change is effective. In addition, employees have a strong belief in their shared ability to execute change.
Current Opportunity for Change
Healthcare providers attend to numerous patients with Alzheimer’s disease (AD). The AD patients usually present with cognitive decline caused by the disease process as demonstrated by increasing memory loss, shortened attention span, difficulty with language, difficulty organizing thoughts and thinking logically, inability to learn new things, poor judgment, and impaired reasoning ability (Bradfield & Ames, 2020). Although patients are prescribed medications to slow the progression of the disease, the medications do not reverse the cognitive decline. Improving AD patients’ cognitive functioning is an opportunity for change. We need to identify new evidence-based approaches to improve cognitive function in AD patients, particularly in the early stages of the disease. This would help lower the disease morbidity caused by cognitive decline and improve their quality of life.
Stakeholders involved include patients, who are the most affected by the cognitive decline, and the mental healthcare providers responsible for providing the best available interventions in helping patients live a near to normal life. No potential risks will be associated with change interventions in the organization.
EBP Best Practice Recommendation
Cognitive training is my recommended EBP best practice approach to address the cognitive decline in AD patients. Bahar‐Fuchs et al. (2019) define cognitive training as a non-pharmacological treatment approach that centers on guided practice on tasks targeting specific cognitive functions, such as attention, memory, and problem-solving. It entails guided cognitive exercises to improve various cognitive functions and improve performance in untrained cognitive tasks.
Various studies have established that cognitive training improves working memory, global cognition, learning, attention, and memory. It also improves psychosocial functioning, depressive symptoms, and visuospatial skills (Kallio et al., 2017).
Butler et al. (2018) showed that cognitive training enhanced cognitive performance in healthy older adults. Thus, it should be included in the preventative care of elderly persons to lower their risk of declined cognitive function.
Plan for Knowledge Transfer
Knowledge transfer of the change will adopt the integrated knowledge transfer approach. The steps in knowledge transfer will include:
- Integrate stakeholders (nurses and mental health providers) into the research process.
- Shape the research questions
- Determine the research methods to use (Prihodova et al., 2019).
- Take part in data collection and tool development.
- Support the process and outcome evaluation.
- Interpret the study findings
- Create the message and disseminate the research results (Prihodova et al., 2019).
- Generate research findings that will likely be relevant to and used by the end-users.
Dissemination Strategy
Dissemination refers to the purposed distribution of information and intervention materials to a target clinical practice or public health audience. It aims at spreading knowledge and related evidence-based interventions (Brownson et al., 2018). The results of the EBP project on using cognitive training to improve cognitive function in AD patients will be disseminated through conference presentations and seminars (Brownson et al., 2018). I can present the results in conferences held by professional nursing organizations such as the American Association of Nurse Practitioners (AANP), American Psychiatric Nurses Association (APNA), and American Nurses Association (ANA). Nursing professional organizations offer a platform to their members to disseminate research findings from their projects. I chose this strategy because I will reach a large target audience, including registered nurses, APRNs, and PMHNPs. Besides, I will interact with providers from other organizations and share knowledge on the interventions they take to improve cognitive functioning in AD patients.
Measurable Outcomes
The measurable outcomes I hope to achieve with implementing the EBP project on cognitive training include improved: cognition, memory, attention, learning ability, and visuospatial skills.
Besides, I hope to achieve improved psychosocial functioning and reduced depressive symptoms in AD patients with comorbid depression.
I also seek to improve patients’ executive function and their ability to perform ADLs through executive function.
Another outcome will be a decreased number of patients who develop AD morbidities secondary to a decline in cognitive function.
Summary of Lessons Learned
The peer-reviewed articles evaluated the impact of cognitive training in enhancing cognitive function in AD patients with cognitive decline.
I learned that cognitive training (CT) significantly improves executive function, memory, and performance of ADLs. It can be integrated as part of health promotion interventions in healthy older adults to improve their cognitive test performance (Butler et al., 2018). Besides, cognitive training can be provided in a computerized cognitive training (CCT) program. The computerized cognitive training approach is a practical intervention to improve cognition in patients with mild cognitive impairment (Hill et al., 2017). In addition, cognitive training can enhance working memory in geriatric patients with declined cognitive function and thus can be effectively implemented in AD patients. I further learned that cognitive training could enhance patients’ initiative and stabilize memory in mild to moderate AD (Giovagnoli et al., 2017).
Conclusion
- The organization has a clan culture
- A high level of readiness
- Need to improve cognitive function in AD
- EBP intervention- cognitive training
- CT improves cognition & memory
- Improves executive & psychosocial functioning
References
Bahar‐Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., & Clare, L. (2019). Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (3).
Bradfield, N. I., & Ames, D. (2020). Mild cognitive impairment: a narrative review of taxonomies and systematic review of their prediction of incident Alzheimer’s disease dementia. BJPsych Bulletin, 44(2), 67–74. https://doi.org/10.1192/bjb.2019.77
Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Research full report: getting the word out: new approaches for disseminating public health science. Journal of public health management and practice, 24(2), 102. https://doi.org/10.1097/PHH.0000000000000673
Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A., … & Kane, R. L. (2018). Does cognitive training prevent cognitive decline? A systematic review. Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531