Topic 13: Implementation

Topic 13 DQ 1

The leadership practicum project entails implementing a team-building activity to enhance communication and relationship building among staff. The project’s goal is to improve and create a positive, healthy environment, which will increase staff motivation and productivity as well as decrease burnout and staff turnover. A model usually involves a purposeful simplification of a phenomenon or a specific element of a phenomenon. On the other hand, a framework generally represents an overview, structure, outline, system, or plan and their connections that justify a phenomenon (Esmail et al., 2020).

Implementation of the practicum project can benefit from action models, which are process models that promote implementation by providing practical guidance in the planning and execution of the project’s strategies. The Knowledge to Action (KTA) Framework is one of the action models that will be valuable in implementing the practicum project. KTA is a conceptual frame

work to assist projects focused on knowledge translation to deliver sustainable, evidence-based interventions (Esmail et al., 2020). The KTA framework has two components: Knowledge Creation and an Action Cycle, each encompassing multiple phases.

Process models describe and guide the process of translating research into practice. The Iowa model is one of the process models that will guide the implementation of the practicum project. The model is an application-oriented guide for the EBP process. Besides, the Iowa model guides the steps that help identify issues, research solutions, and implement changes (Indriani et al., 2020). In addition, Situated Change Theory will be useful in executing the project. The theory suggests that change occurs in an evolving context, in which people adapt or metamorphosis as a result. Given its strong association with the environment, change is gradual and significant rather than planned and deliberate (Indriani et al., 2020). The Situated Change Theory can thus be used to guide the project’s implementation, which will bring change in the communication and relationships among staff.

Leadership strategies that are critical and effective to the implementation of the project include defining and communicating the project’s vision to all the stakeholders involved. Communicating the vision will be crucial in bringing the team together under a common goal and ensuring that we are working together towards achieving the vision (Ali et al., 2021). Another crucial leadership strategy is empowering the team members through delegation of duties, which will engage them in the project’s implementation (Ali et al., 2021). In addition, appreciation of team members will be critical in implementing the project because it instills a sense of commitment and engagement among the members resulting in more outstanding results.

References

Ali, H., Chuanmin, S., Ahmed, M., Mahmood, A., Khayyam, M., & Tikhomirova, A. (2021). Transformational Leadership and Project Success: Serial Mediation of Team-Building and Teamwork. Frontiers in psychology, 12, 689311. https://doi.org/10.3389/fpsyg.2021.689311

Esmail, R., Hanson, H. M., Holroyd-Leduc, J., Brown, S., Strifler, L., Straus, S. E., … & Clement, F. M. (2020). A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implementation Science, 15(1), 1-14. https://doi.org/10.1186/s13012-020-0964-5

Indriani, M. N., Thanaya, I. N. A., Astana, N. Y., & Yana, A. A. G. A. (2020). Conceptual framework of knowledge sharing and project team performance relationship in design and build project. In IOP Conference Series: Earth and Environmental Science (Vol. 419, No. 1, p. 012012). IOP Publishing. https://doi.org/10.1088/1755-1315/419/1/012012

Implementation into Practice

Regardless of their sizes, missions, and health care programs, health care facilities have a professional mandate to provide timely, safe, and quality care. The standard obligation requires health care facilities to apply multi-dimensional interventions to address patient needs. Research translation into clinical practice promotes evidence-based care and is instrumental in reducing adverse health outcomes through creative problem-solving (Wensing & Grol, 2019). Its significance obliges health care practitioners and organizational leaders to implement programs that reduce gaps between research findings and clinical practice. Accordingly, health care facilities should be open to change and support evidence-based practice (EBP) adequately. The purpose of this paper is to discuss a topic where a gap exists between research findings and their implementation into practice.

Topic, Supporting Research, and Desired Outcomes

The Agency for Healthcare Research and Quality (AHRQ) explores many health topics relevant to current nursing practice. A topic related to the direct practice improvement (DPI) project is hospital readmissions, represented as a priority for payers, providers, and policymakers striving to improve health outcomes and reduce costs (AHRQ, n.d.). Hospital readmissions connect with the DPI project since their occurrence hampers care quality in the practicum site. Besides, pressure ulcers are a leading cause of hospital readmissions, hospitalizations, and high costs (Wassel et al., 2020). Accordingly, any significant rise in pressure ulcers leads to a proportional increment in hospital readmissions, reducing care quality.

Hospital readmissions adversely affect health outcomes and require evidence-based, sustainable, and relevant solutions. Recent health data shows that over $52.4 billion is spent annually on readmitted patients (Beauvais et al., 2022). Unless health care organizations implement lasting programs, the cost will increase as time advances. Upadhyay et al. (2019) noted that readmission penalties exceed over half a billion dollars annually. Such penalties are detrimental to the growth of organizations and their ability to sustain safe and quality care. Furthermore, crucial aspects of quality sustainability, like organizational reputation and partnerships, become dysfunctional when readmission rates are high in hospitals. Patient-provider relationships are also broken due to reduced patients’ trust in health care professionals.

Pressure ulcers increase the risk of readmissions, and their prevention should be a priority for all hospitals. Research translation into practice implies implementing interventions supported by scientific evidence. Veith et al. (2019) emphasized high attention to wound care, patient education, and modifying risk factors to prevent pressure ulcers. Wound care strategies include preventive dressing, patient repositioning, and wound cleaning for the admitted patients. These strategies are among the core components of a preventive pressure bundle that is highly effective in reducing the incidence of pressure ulcers in critical care settings (Darvall et al., 2018; Hahnel et al., 2020). Implementing such a bundle would be pivotal in reducing readmission rates in the current setting.

Health care professionals implement research into clinical practice to improve health outcomes. The primary goal of implementing research on wound care is to reduce pressure ulcers which will lead to a proportional reduction in hospital readmissions. Reducing readmissions will reduce health care costs and improve the organization’s ability to invest in quality care programs. As Rasiah et al. (2020) mentioned, patients’ trust in health care professionals depends on the care quality and health care experiences. Consequently, implementing a care bundle and other wound care programs will improve patient-provider relationships and patients’ trust in health care professionals. High hospital readmissions hamper organizational reputation (Upadhyay et al., 2019). Implementing research will improve the organization’s reputation and accelerate its growth.

The Extent of Research Implementation

Organizations implement different wound care practices depending on the patients’ type and severity of health conditions. As an established health care institution, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in numerous programs to optimize patient outcomes. They include patient education, telehealth, follow-up care, and testing new treatments and care models (ProMedica, 2021). Despite these programs, the facility primarily relies on routine pressure ulcer prevention care. Overreliance on this care program depicts a huge gap between research findings and implementation into practice, and substantive improvement is essential. More evidence-based interventions should be implemented to reduce the incidence of pressure ulcers among high-risk groups such as the elderly and debilitated patients. Their implementation will reduce the incidence of pressure ulcers and associated adverse outcomes, including hospital readmissions, mortality, and hospitalization.

Possible Barriers to Implementation

Research translation faces multiple barriers depending on the intensity of work required, resources, and the project’s type. Potential barriers to implementing a preventive bundle to prevent pressure ulcers and hospital readmission in the facility include resource facilitation, availability of implementation team members, and patients’ reluctance to participate in the project. Resource inadequacy is a significant barrier since effective research implementation of a care bundle for pressure ulcers requires technologies like patient monitors and alert systems to optimize patient turns. Research also recommends silicone dressing as the most effective preventive dressing for wound care for pressure ulcers (Hahnel et al., 2020). Combining such resources makes the project expensive and inconvenient for timely implementation. The implementation requires teamwork, where the change leader works together with organizational leaders and support nursing staff. However, the intensity of nursing care in the facility would affect their availability and successful research implementation.

Possible Ways to Overcome the Barriers

Success in research translation depends on how change implementers overcome present and emerging barriers. A suitable strategy to overcome the identified barriers is stakeholder engagement. As Haynes et al. (2018) underlined, active stakeholder engagement is crucial to successful change since it influences them positively to support change. The engagement process involves providing stakeholders with adequate information about the research translation and its potential benefits while engaging them throughout the implementation. The other potential intervention is implementing the affordable components of a preventive bundle. For instance, patient repositioning and optimizing turns are affordable and would improve outcomes. Importantly, intensive patient education is crucial to improve health literacy, increase patients’ confidence in the project, and ensure participation and compliance.

Resources Available on the Site

As a modern facility and an affiliate of the extensive ProMedica Health System, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has multiple resources vital in informing the transition from research into practice. They include an equipped health workforce, modality-based equipment, comfortable surroundings, and essentials like the internet (ProMedica Health System, 2022). An equipped and educated health workforce is open to change and readily supports research translation into practice to achieve positive change. Modern equipment and comfortable surroundings are also vital in successful research translation to ensure that research subjects are protected from harm and are comfortable with the process.

Conclusion

Health care facilities should be committed to continuous quality improvement. Such a commitment necessitates continuous research translation into practice and progressive outcomes assessment. Although ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in massive programs to improve care quality, more interventions are needed to reduce hospital readmissions. Reducing pressure ulcers will be instrumental in achieving this goal hence implementing research on interventions for pressure ulcer prevention like wound care, patient education, and risk assessment.

References

AHRQ. (n.d.) Hospital readmissions. https://www.ahrq.gov/topics/hospital-readmissions.html

Beauvais, B., Whitaker, Z., Kim, F., & Anderson, B. (2022). Is the hospital value-based purchasing program associated with reduced hospital readmissions?. Journal of Multidisciplinary Healthcare, 15, 1089–1099. https://doi.org/10.2147/JMDH.S358733

Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784

Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621

Haynes, S. C., Rudov, L., Nauman, E., Hendryx, L., Angove, R. S., & Carton, T. (2018). Engaging stakeholders to develop a patient-centered research agenda: Lessons learned from the research action for health network (REACHnet). Medical Care, 56(10 Suppl 1), S27-S32. doi: 10.1097/MLR.0000000000000785

ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#

ProMedica Health System. (2022). ProMedica Skilled Nursing and Rehabilitation. https://www.promedicaskillednursing.org/locations/promedica-skilled-nursing-and-rehabilitation-wheaton/?contentIdString=14063

Rasiah, S., Jaafar, S., Yusof, S., Ponnudurai, G., Chung, K. P. Y., & Amirthalingam, S. D. (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: A scoping review protocol. BMJ Open, 10(1), e028061. http://dx.doi.org/10.1136/bmjopen-2018-028061

Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission rates and their impact on hospital financial performance: A study of Washington Hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386

Veith, J. P., Collier, W., Kim, J., Agarwal, J., & Kwok, A. (2019). A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database. The American Journal of Surgery, 217(4), 658-663. https://doi.org/10.1016/j.amjsurg.2018.12.013

Wassel, C. L., Delhougne, G., Gayle, J. A., Dreyfus, J., & Larson, B. (2020). Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. International Wound Journal, 17(6), 1924-1934. https://doi.org/10.1111/iwj.13482

Wensing, M., & Grol, R. (2019). Knowledge translation in health: How implementation science could contribute more. BMC Medicine, 17(1), 1-6. https://doi.org/10.1186/s12916-019-1322-9

Grid View

	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

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Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource