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Benchmark – Evidence-Based Practice Project Proposal Final Paper

NUR-590 Benchmark – Evidence-Based Practice Project Proposal Final Paper

Alcohol use disorder is a critical problem that affects a significant proportion of the population in the US. The statistics estimates shows that 25.8% of the adults aged 18 years and above in the US were victims of alcohol use disorder. Alcohol use disorder is recognized a mental disorder that contributes to premature mortality and loss of productivity. Nurses have a critical role to play in ensuring that appropriate care that addresses the needs of patients with alcohol use disorder is offered. Therefore, the purpose of this evidence-based practice project is to propose the use of behaviors strategies with care coordination to improve the withdrawal symptoms and alcohol use among patients with alcohol use disorder.

Research articles and research is extremely significant in the nursing field and practice as a whole. Nurses work directly with patients on a daily basis and because of this, they are the most aware of the needs of the patient. They are also the most informed about what procedures and policies favor the quality of patient care given and what needs to be adjusted to better cater to their needs. Rigorous research is extremely important for nursing students and nurses to keep up with at every stage of their career. This is because it advances nursing practice like aiding in the shaping of healthcare policy which leads to overall advancements in health all around the globe not just within the United States. For example, the National Institute of Nursing Research is dedicated to finding new knowledge on disease prevention, disability, illness symptom management, and improvement of end-of-life care (“Importance of research in Nursing: UNCW online,” 2016). In terms of the application of research in the modern world, the importance of research can be seen with the occurrence of the pandemic of COVID-19. The world experienced a complete lockdown and incredible spike of deaths in the past two years due to a virus that has no cure and still does not hold a cure rather than a vaccine that aims to slow and decrease the spread and prevalence of the disease. It is due to research that a vaccine could be created and that nurses and other med

Benchmark  Evidence Based Practice Project Proposal Final Paper
Benchmark  Evidence Based Practice Project Proposal Final Paper

ical professionals found out what treatment methods and care plans work best to treat this disease.

Problem Statement

As noted above, alcohol use disorder is a critical problem with high prevalence and incidence rate in the US. Approximately 25.8% of adults aged above 18 years old in America suffer from alcohol use disorder. The prevalence of the problem is reported to be high in men (29.7%) when compared to women (22.2%). The rate of visits to the emergency department due to the disorder increased 47% between the years 2006 and 2014. The mortality rates attributed to alcohol overdose is estimated to be 22.1%. The number of people that die due to alcohol-related causes is estimated to be 95000. The economic burden due to binge consumption of alcohol is enormous as seen from the fact that the US incurred losses of $249 billion in 2010 due to alcohol misuse (NIAA.NIH, 2020).

Most victims of alcohol use disorder often express the intent to abandon their binge consumption of alcohol (Garofalo & Wright, 2017). However, the effects of withdrawal symptoms often makes it difficult for them to achieve the objective. Behavioral treatments have been shown to be effective in helping patients with alcohol abuse disorder manage their withdrawal symptoms and reduce binge intake of alcohol. Behavioral treatments enable patients to develop effective coping knowledge and skills that enable them to overcoming the cravings for alcohol (Carroll & Kiluk, 2017). The effectiveness of the treatments are long-lasting, and provide an effective approach to enhancing the effectiveness of pharmacological interventions utilized for the problem (Carroll & Weiss, 2017). Despite the existence of evidence support the use of behavioral treatments, their use in treating patients with alcohol abuse disorder has not been explored in my organization.

Organizational Culture and Readiness

The successful implementation of the interventions targeting individuals with alcohol abuse disorder will largely depend on the support from the organization. Organizational support in forms such as human and financial support will be needed to promote the effective implementation of interventions. The culture should also facilitate the change process in the organization.

Description of the Organization’s Culture

The use of teamwork in undertaking tasks characterizes the culture of the organization. Inter-professional teamwork contributes to enhanced care outcomes that include safety, quality and efficiency. The culture is also characterized by the use of transformational leadership styles. Transformational leadership aims at promoting the development of the desired competencies by the staffs. Healthcare providers are motivated to play an active role in exploring effective interventions to optimize the care outcomes. The organization also encourages the implementation of new practices and approaches to care to improve patient outcomes. The use of new practices ensures continuous quality improvement in patient care, hence, safety and efficiency in the organization. Healthcare providers have the required knowledge and skills to implement the proposed intervention. The organization also has systems and processes that will enhance the adoption of the change.

Organizational Readiness

The organizational readiness tool by Barwick (2011) was used for this analysis. The tool examines the readiness of an organization to

Benchmark - Evidence-Based Practice Project Proposal Final Paper
Benchmark – Evidence-Based Practice Project Proposal Final Paper

embrace change by focusing on dimensions that include system and organizational capacity, functional considerations, organizational culture, senior leadership, implementation plan, and training. The organization scored highly in all the dimensions of organizational readiness assessment. It scored 19 in system capacity, 19 in organizational capacity, 20 in functional considerations, 18 in organizational culture, 19 in senior leadership, 18 in staff capacity, 19 in implementation plan, and 18 in training. The assessment tool showed that the organization is ready to implement and sustain change. The readiness could be seen in aspects such as readiness of the staff to engage in activities that will facilitate the change, existence of frameworks for implementing change, and senior leadership that is ready to implement and transform organizational processes. The strengths of the organization in relation to the implementation of the change include empowered staff, enabling leadership, and existence of systems that will facilitate the successful implementation of the change. Some of the weaknesses include staff shortage and inadequate financial resources that may hinder the implementation of the project. Potential barriers that may affect the project will include the lack of stakeholder support for the project and withdrawal of the participants in the project. The resources that will be utilized include nurses, counselors, and financial resources for the implementation of the interventions.

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Healthcare Systems and Processes

The human resources processes in the organization should be improved to ensure quality, safety and cost-effectiveness in the organization. The organization should consider hiring additional nurses to address the current shortage in being experienced in the firm. Shortage in staffing ratio affects quality and safety outcomes in healthcare due to the increase in workload and risk for adverse events due to issues such as medication errors. Therefore, adequate staffing in the organization is recommended.

Proposed Strategies to Facilitate the Readiness of the Organization

Needs analysis will be performed to identify knowledge and skill gap among the healthcare providers in relation to the project. Needs assessment will provide information that will guide the development of goals for training for the staffs. The objectives of the project will also be aligned with the organizational mission. Alignment will ensure the relevance and readiness of the organization to embrace the project. Staff training will be offered to ensure that they have the required knowledge and skills for the project implementation. Lastly, active stakeholder involvement will be adopted to ensure their empowerment and sustained use of the project intervention.

Stakeholders and Team Members

The stakeholders for the project will comprise of nurse managers and leaders, registered nurses, counselors, and psychiatric mental health nurse practitioners. Nurse leaders and managers will play the role of supervision and coordination of the project interventions. They will also ensure the effective use of resources to ensure the realization of the goals of the project. Registered nurses will recruit, implement and monitor the participants with withdrawal symptoms. Counselors will provide health education to the participants on the use of behavioral interventions. Psychiatric mental health nurse practitioners will assess the response of the participants to the selected treatments. The stakeholders will work as a team to ensure the realization of the desired outcomes in the project.

Information and Communication Technologies

Computers will be used in the project for data storage. The healthcare providers will also use them in accessing the sources of evidence-based data that they need to inform their practice. Projectors will also be needed in the project for patient education and presentation of results and training the providers of care and patients. Short messaging services will be used as sources of reminders to the patients on the need for the consistent utilization of the required behavioral interventions. The importance of the above technologies to nursing is that they will promote safety, efficiency, quality, and patient-centeredness in project implementation.

Literature Review

The articles that were used in this review of literature were obtained from various databases. A search was performed on databases that included MEDLINE/PubMed, CINAHL, and Cochrane Library for clinical trial and observation studies. Embase and ScienceDirect were also considered. Keywords used included alcohol use disorder (AUD), behavioral treatments, coordinated care, and alcohol withdrawal symptoms. Articles used have been published in the last five years and centered on translational research. The project was guided by the following PICOT question:

In individuals suffering from alcohol use disorder (AUD) (P), does the use of behavioral      treatments and coordinated care with other providers (I) compared to non-interventions (C) lead to improvement in handling of alcohol withdrawal symptoms and treatment of alcohol use disorder (0) within 12 months (T)?

Synthesis of Literature

Ray et al. (2021) deployed a qualitative review of treatment interventions for AUD and the current development. After discussing how to use translational research in developing AUD treatment, Ray et al. (2021) found that transitional research models can help stakeholders develop new AUD treatment interventions and translate the knowledge to patient care. Accordingly, stakeholders are advised to consider translational research in developing AUD treatment interventions. The article supports the EBP practice project proposal by showing the significance of translational research in developing treatment interventions.

Hass-Koffler and Schank (2020) evaluated the present translational research into neurobiological targets in alcohol and substance use disorder treatment. The study was qualitative research (systematic literature review) where the scholars integrated preclinical and clinical neuroscience research to reduce the knowledge gap, identify and describe new treatment models and enhance translational efforts in advancing downstream recovery pathways for those suffering from AUD. Hass-Koffler and Schank (2020) found a need to develop more personalized treatment approaches and increased research on effective interventions for alcohol and substance use disorder treatment. The article supports the EBP project proposal by showing the need for stakeholders to work together and apply translational science findings to develop better interventions.

Louise et al. (2020) synthesized and evaluated the effectiveness of implementing programs to treat individuals with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR) approach. The study was a systematic review implying that it evaluated the current existing evidence from previous study articles on alcohol use disorder (AUD). Louise et al. (2020) found that it is important to have a more insightful understanding of the effective interventions in helping individuals with AUD. The article supports the EBP project by shedding more light on barriers that practitioners face even when using EBP interventions in treating individuals with AUD in their clinical settings and offer divergent perspectives on what practitioners can do to enhance the efficacy of the existing integrated models.

Heilig et al. (2019) hypothesized that few medications exist to treat alcohol addiction, making the problem a medical condition. The primary method in the study is the use of neuroscience studies on alcohol addiction. The authors are keen on the development of neuroscience interventions to help treat these individuals. Key outcomes include the identification of different approaches that clinicians can deploy to treat the condition. The article supports the EBP project proposal by showing the various approaches/interventions that clinicians can deploy to ensure that they understand how to tackle AUD.

De Beaurepaire et al. (2019) examined the use of Baclofen as a treatment intervention for alcohol use disorder (AUD). They qualitatively reviewed information and integrated it to show the efficacy of Baclofen and its potential side effects.  De Beaurepaire et al. (2019) analyzed data from different settings where Baclofen has been used among patients with the condition. The key findings include the acceptable use of Baclofen, the ensuing side effects of the drug for individuals suffering from AUD, and recommended cautious use of Baclofen in treating AUD because of its safety reasons. The article offers an insightful analysis of one of the treatment interventions for the issue of AUD.

Wood et al. (2020) examined the role and efficacy of clinical champions in drug and alcohol and mental health practices. In this systematic review search (13 different studies), Wood et al. (2020) majored in different settings based on the need to get information on the role and efficacy of clinical champions in mental health settings. The main finding was that clinical champions are essential in facilitating practice changes and facilitate overcoming system barriers, and improved staff engagement and motivation. The article is relevant and highlights the need for stakeholders to understand the role and efficacy of clinical champions in treating different mental health challenges associated with alcohol use disorder (AUD).

Slade et al. (2021) used a case study approach to demonstrate how preclinical data and evidence from studies can be transitioned to help health populations with substance use disorder problems. They used hypotheses generated from the preclinical rodent studies to prove their efficacy in clinical settings and if they have a public health impact. Slade et al. (2021) found that clinicians and other stakeholders can leverage big data to make critical decisions and translate findings from preclinical studies to have effects in public health situations. The article is essential in underscoring the importance of different types of translational research in knowing AUD treatment barriers.

Thompson et al. (2017) evaluated drug therapy for alcohol dependence 12 months after initial diagnosis in primary care settings. They collected data from 39,980 participants with incidence diagnosis of alcohol dependence for 13 years. Thompson et al. (2017) found that treatment for alcohol dependence is haphazard. There is no demonstrated efficacy of the different approaches using drugs on alcohol dependence. The article is important and sheds more insight into the barriers that many individuals with alcohol dependence face in their efforts to get better clinical management of their condition.

Comparison of Articles

Broadly, all articles are translational research expanding knowledge on interventions for AUD and treatment barriers, among other focus areas. The primary theme is the need to increase the use of translational research types’ findings in public health situations to help individuals with substance use disorders. Concerning methods, qualitative and quantitative approaches differentiate the articles. Slade et al. (2021) and Thompson et al. (2017) are qualitative articles since they use a case study model and quantitative model with open cohort, respectively. Other studies are qualitative and mainly systematic literature reviews. De Beaurepaire et al. (2019), Heilig et al. (2019), Louise et al. (2020), Ray et al. (2021), and Chen et al. (2020) conducted a systematic literature review. Hass-Koffler and Schank (2020) performed a literature review of scientific literature in the specific areas of research about AUD.

Recommendations for Future Research

To maximize the application of translational research, there is a need for more research from high-quality randomized control studies to demonstrate the efficacy of combining interventions like drug interventions and psychosocial approaches to enhance treatment of alcohol dependency. It is also important to explore more strategies and approaches among stakeholders to enhance clinical management of the patient population diagnosed with AUD. Cautious use of Baclofen in treating AUD because of its safety reasons. Further research on making patients understand the current use of the drug and others approved for AUD is crucial.

Change Model

The successful implementation of the project aiming at meeting the care needs of patients with alcohol use disorder is a change initiative in itself. The stakeholders involved in the process should utilize a change model to guide the implementation process of the change initiatives. Change models provide insights into the practices that should be utilized to ensure the desired outcomes are achieved.

Selected Model

The implementation of the proposed project will be guided by the trans-theoretical model of change. The trans-theoretical model of change explores the ways in which people make decisions to change their behaviors. The model provides systematic approaches that can be utilized in healthcare to achieve sustainable change. It provides insights into the critical determinants of change that influence organizational success and performance. The trans-theoretical model is applicable to the proposed project because it provides insights into the ways in which the desired behavioral change to support the initiative can be introduced in the organization. It also provides information on the ways in which the stakeholders can assess the effectiveness of the project in achieving its objectives.

Stages of the Model and Application to the Project

The trans-theoretical model of behavioral change shows that change occurs in a series of phases. The different phases of change as seen in the model include pre-contemplation, contemplation, preparation, action, maintenance and termination. The stages of change are applicable to the proposed project. The pre-contemplation phase is the first stage where the adopters of a proposed change do not intent to take any change to improve their performance or change their current situation. They are not informed about the ways in which their current behaviors are harmful to others and them. The applicability of this stage to the project is that nurses and other healthcare providers will not be aware of the need for behavioral approaches for patients with alcohol use disorder. As a result, they do not show any intentions to change their behaviors to ensure that they can improve the health outcomes of the patients affected by the disorder.

The second stage in the trans-theoretical model is contemplation. The adopters become aware of the need for change in their routines in this step. They demonstrate willingness to embrace change by exploring the ways in which their status quo can be improved. Contemplation stage is applicable to the model, as the nurses are willing to adopt interventions that will improve the health outcomes of patients with alcohol use disorder. Nurses explore the ways in which behavioral interventions and car coordination will improve the withdrawal symptoms in patients with alcohol use disorder.

Preparation is the third step in the trans-theoretical model. Preparation is characterized by the individuals targeted by the change being ready to implement actions that would lead to a change in their behaviors. They engage in activities that would enable them to achieve the ultimate aim of behavioral change. The applicability of this step to the proposed project is that the nurses will be ready to provide behavioral interventions to improve withdrawal symptoms in patients with alcohol use disorder. They implement the initiatives that are needed to ensure the desired change in treatment outcomes among patients with substance use disorder.

The fourth step in the trans-theoretical model is action. Action is the process whereby the adopters of the change have begun adopting interventions that would ensure behavioral change. As a result, they have the motivation to continue improving their behaviors by incorporating behaviors that will contribute to further improved outcomes. The applicability of this stage to the project is that nurses would have determined the benefits of care coordination and the use of behavioral interventions in improving withdrawal symptoms and those associated with alcohol use disorder. Nurses are therefore motivated to explore the different ways in which the behavioral change can be sustained.

Maintenance is the other stage in the trans-theoretical model. The individuals targeted by change in this step have incorporated the new changes into their daily routines. The focus is now placed on ensuring that relapse to earlier behaviors is prevented. They also work towards ensuring that their organization supports the change initiatives that were implemented to improve the care outcomes. The applicability of this stage to the project is that nurses would have incorporated the new behavioral interventions and care coordination into their daily routines in caring patients with alcohol use disorder. The focus is on ensuring that the use of earlier interventions of patient care are not utilized anymore in the institution. Termination is the last stage where the desired behavioral change has been achieved. Nurses working in the psychiatric unit have embraced change interventions into their organizational culture. Therefore, the focus is on exploring new ways in which the change can be improved further.

Implementation Plan

Setting and Access to Potential Subjects

The setting for the proposed project will be the psychiatric unit in a tertiary hospital. The psychiatric unit addresses the care needs of different patients suffering from mental health problems that include alcohol use disorder. The potential subjects for the project will comprise mainly of patients diagnosed with alcohol use disorder. The patients should be undergoing treatment in the unit for the disorder. The participation of the subjects will be voluntary. As a result, informed consent will be obtained from them prior to their initiation in the project. Approval to undertake the project will also be sought from the institution.

Timeline

The proposed timeline for the project is 12 months. It is expected that the timeline will be adequate to enable the undertaking of the entire project activities. The draft for timeline as well as the different activities that will be undertaken is included in the Appendix section.

Budget and Resources

The project will require adequate supply of resources for its implementation. Human, financial and material resources will be needed for the project. Human resources will comprise of healthcare providers that will educate the selected participants about the use of behavioral interventions in minimizing withdrawal symptoms and symptoms of alcohol use disorder. The healthcare providers will also be involved in care coordination to ensure that the optimum outcomes of care for the subjects are met. The other human resource is trainers for trainees. Trainers will be hired to educate the staffs on the use of behavioral interventions and care coordination in the management of alcohol use disorder. The project will also require financial resources. Money will be needed for use in the purchase of the needed resources as well as remuneration of the healthcare providers who will be involved in the implementation of the project. Material resources will also be needed for the successful implementation of the project. The materials needed will include reading materials, booklets for patients, and projectors for the training. The successful implementation of the project will require a budget of $68,000. The budget will be used for purchasing and undertaking the different activities of the project. They will include needs analysis, data collection, analysis, and presentation, remuneration for staffs and trainers, purchase of materials, and follow up of patients. The budget for the project is attached in the appendix section.

Clinical Processes or Tools

There will be a need for a change in clinical processes for the successful implementation of the project. Healthcare providers will be required to incorporate behavioral strategies into the interventions that they will utilize in caring patients with alcohol use disorder. They will have to educate the patients about the behavioral interventions and ways of sustaining their use in minimizing withdrawal symptoms and improving treatment outcomes. Through it, sustained change will be achieved in the organization.

Design

The project will utilize quantitative design. The project will aim at determining the effect of the intervention on observed clinical outcomes. The clinical outcomes will be measured in numbers, making quantitative design the most appropriate. The project will also provide insights into the relationship between variables such as exposure of the subjects to an intervention to influence outcomes. The project also does not generate theories about cause-effect relationship between variables. As a result, quantitative design will be the most appropriate for the intervention.

Methods and Instruments

Outcome and process measures will be used in monitoring the implementation of the proposed intervention. Outcome measures will focus on whether the desired goals and objectives are being achieved at every stage of the project. Periodic assessment will be done to determine the strengths, weaknesses, and opportunities for the project. Process measures will focus on the determination of the effectiveness of the interventions utilized to achieve the set outcomes. Questionnaires will be used for data collection. Questionnaires will provide both objective and subjective data about the project success and its effectiveness in enhancing the care outcomes for patients with alcohol use disorder. Questionnaires are also easy to administer, hence, their appropriateness for the project (Schmidt & Brown, 2021). The questionnaire that will be used in the project is attached in the Appendix section.

Process for Delivering the Intervention

The delivery of the intervention will require a number of interventions. The first one will be performing an organizational need assessment. The assessment will provide information about the knowledge and skills that the healthcare providers have in relation to the implementation of the project. The second step will be seeking approval from the organization. An approval will be obtained prior to the implementation process to ensure that the organizational rules and policies are followed in the process. The third step will be training of the healthcare providers. Healthcare providers will be trained about the delivery of the intervention. It will strengthen the knowledge and skills that the healthcare providers have in relation to the implementation of the project. Monitoring and evaluation will follow the implementation phase. Monitoring will aim at ensuring the correct implementation of the project. Evaluation will aim at determining whether the outcomes of the project were achieved or not.

Stakeholders Needed

Stakeholders will be needed for the successful implementation of the project. One of the stakeholders will be the healthcare providers. The healthcare providers will comprise mainly of the psychiatric mental health nurse practitioners and registered nurses working in the psychiatric department. The healthcare providers will be involved in the direct implementation of the project. They will provide health education and assistance to the patients about the use of behavioral interventions in managing withdrawal symptoms associated with alcohol abuse disorder. The other stakeholder will be nurse managers and leaders. Nurse leaders and managers will ensure the effective coordination of the activities of the project. The other stakeholders will include trainers of trainees. The trainers will ensure that the healthcare providers have the required knowledge and skills for the successful implementation of the project.

Potential Barriers

The potential barrier that may be experienced in the implementation of the project is the lack of interest in the project by patients with alcohol use disorder. The patients may not be willing to participate in the project due to low level of awareness, perceived lack of time, and fear of the unknown outcomes of the project. The barrier will be addressed by providing adequate information to the patients about the importance of the project. Adequate information will be needed to ensure that participants make informed decisions on their participation.

Feasibility

The project is highly feasible for implementation in the organization. The organization has supportive culture that will ensure its successful implementation. It also has supportive leadership that will ensure the effective implementation of the project. The organization also has ready resources that will be utilized for the successful implementation of the project. Therefore, it is anticipated that the implementation process will be successful.

Evaluation Plan

Expected Outcome

One of the expected outcomes in the project will be the improvement in the withdrawal symptoms that patients experience in the project. The reduction in the symptoms is attributed to the development of coping skills by the participants. The other anticipated outcome of the project is the improvement in the symptoms of alcohol use disorder. It is also anticipated that the project utilization in the organization will be sustained. The organization will adopt the use of the intervention, as part of its evidence-based interventions to promote safety, quality, and efficiency in patient care.

Data Collection Tool

The effective tool for data collection that will be used in the project is questionnaires. Patients with alcohol use disorder that participated in the project will be provided with self-administered questionnaires to provide information about their experiences with the project. Questionnaires will be appropriate for the project due to the ease in which data for the project will be obtained. It will also require minimal time to administer them for the participants. Questionnaires will provide the opportunity to obtain extensive data from the participants. In addition, the data will be easily ordered for analysis. The validity of the questionnaires will be maintained by asking objective and relevant questions to the participants. Reliability will be achieved by undertaking a pilot test among the participants. Applicability will be achieved by ensuring that scientific methods of inquiry and data analysis are utilized in the project.

Statistical Test

Mean will be calculated for the data obtained in this project. Mean will provide an accurate measure of the effectiveness of the intervention in addressing the care needs of patients with alcohol use disorder. Mean is also associated with the lowest value of error in a data set. Therefore, it is anticipated that highly accurate data will be obtained from the participants by calculating the mean.

Methods Applied to Data Collection

As noted above, a pilot test will be performed prior to the final collection of the data for the project. The data obtained in the pilot test will be used to determine the effectiveness of the tool. The tool will be refined and be used for the final data collection. Data cleaning will be done to ensure the accuracy of the obtained data. Data cleaning will also be done to ensure that errors from multiple sources are eliminated to increase the accuracy and reliability.

Strategies if Outcome do not Provide Positive Results

The first strategy that will be adopted if the results are not positive is revising the used interventions in the project. The lack of realization of the desired positive results will imply that the strategies that were used might have not aligned with the project outcomes. Revising the strategies may therefore improve the outcomes. The second strategy is examining the utilization of resources in the project. Efficient utilization of resources is likely to improve the project outcomes. Investigation of the manner in which the resources have been utilized may provide insights into the factors that might have led to poor outcomes. The other strategy will be extending the timeline of the project. Extending the timeline will enable the incorporation of new strategies and determination of their success in achieving the desired outcomes.

Plans to Maintain, Extend, Revise and Discontinue the Proposed Solution

The project will be maintained if it is found to have positive effects on patients with alcohol use disorder. It will also be maintained if found to be cost-effective ad highly feasible for use in the organization. The project will be extended if the results obtained within the stated period are inconclusive. The project will be revised if the adopted strategies are found to be ineffective in delivering the anticipated outcomes. The project will be discontinued if found to have harm or negative effects to the participants. The negative effects will imply that the project will not ensure that the safety and quality needs of care for the participants will not be met.

Therefore, the evaluation of the project will be important to inform its effectiveness in promoting safety, efficiency and quality in patient care. Evaluation will enable the determination of the effectiveness of the interventions that were utilized in the project. The proposed project will utilize carefully developed evaluation interventions. The outcomes of the project will inform the decisions that are made on whether it should be sustained or discontinued in the organization.

References

Barwick, M. A. (2011). Checklist to Assess Organizational Readiness (CARI) for EIP Implementation. 5.

Carroll, K. M., & Kiluk, B. D. (2017). Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychology of Addictive Behaviors, 31(8), 847–861. https://doi.org/10.1037/adb0000311

Carroll, K. M., & Weiss, R. D. (2017). The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review. American Journal of Psychiatry, 174(8), 738–747. https://doi.org/10.1176/appi.ajp.2016.16070792

Garofalo, C., & Wright, A. G. C. (2017). Alcohol abuse, personality disorders, and aggression: The quest for a common underlying mechanism. Aggression and Violent Behavior, 34, 1–8. https://doi.org/10.1016/j.avb.2017.03.002

Cheng, H. Y., McGuinness, L. A., Elbers, R. G., MacArthur, G. J., Taylor, A., McAleenan, A., … & Kessler, D. (2020). Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis. BMJ371. https://doi.org/10.1136/bmj.m3934

De Beaurepaire, R., Sinclair, J., Heydtmann, M., Addolorato, G., Aubin, H. J., Beraha, E. M., … & Agabio, R. (2019). The use of baclofen as a treatment for alcohol use disorder: a clinical practice perspective. Frontiers in psychiatry9, 708. https://doi.org/10.3389/fpsyt.2018.00708

Haass-Koffler, C. L., & Schank, J. R. (2020). Translational Research in the Neurobiological Mechanisms of Alcohol and Substance Use Disorders. Neurotherapeutics17(1), 1-3. https://doi.org/10.1007/s13311-020-00833-6

Heilig, M., Augier, E., Pfarr, S., & Sommer, W. H. (2019). Developing neuroscience-based treatments for alcohol addiction: A matter of choice?. Translational Psychiatry9(1), 1-11. https://doi.org/10.1038/s41398-019-0591-6

Louie, E., Barrett, E. L., Baillie, A., Haber, P., & Morley, K. C. (2020). Implementation of evidence-based practice for alcohol and substance use disorders: protocol for systematic review. Systematic reviews9(1), 1-6. https://doi.org/10.1186/s13643-020-1285-0

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Alcohol Use Disorder. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-use-disorder

NIAA.NIH. (2020). Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

Ray, L. A., Grodin, E. N., Leggio, L., Bechtholt, A. J., Becker, H., Feldstein Ewing, S. W., … & Koob, G. F. (2021). The future of translational research on alcohol use disorder. Addiction biology26(2), e12903. doi:10.1111/adb.12903

Rombouts, S. A., Conigrave, J., Louie, E., Haber, P. & Morley, K. C. (2019). Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings: protocol for systematic review. Systematic Reviews, 8(275). https://doi.org/10.1186/s13643-019-1157-7

Slade, E., Dwoskin, L. P., Zhang, G. Q., Talbert, J. C., Chen, J., Freeman, P. R., … & Bush, H. M. (2021). Integrating data science into the translational science research spectrum: A substance use disorder case study. Journal of Clinical and Translational Science5(1).doi: https://doi.org/10.1017/cts.2020.521

Thompson, A., Ashcroft, D. M., Owens, L., van Staa, T. P., & Pirmohamed, M. (2017). Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study. PloS One12(3), e0173272. https://doi.org/10.1371/journal.pone.0173272

Wood, K., Giannopoulos, V., Louie, E., Baillie, A., Uribe, G., Lee, K. S., … & Morley, K. C. (2020). The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review. Implementation Research and Practice1, 2633489520959072. https://doi.org/10.1177/2633489520959072

Appendices

Appendix I: Informed Consent

Hello, I am undertaking a project that aims at improving the withdrawal symptoms and treatment outcomes in patients with alcohol use disorder. The project entails the provision of behavioral treatments alongside coordinated care. The proposed interventions have no known adverse effects. It has optimum benefits to the patients. We therefore request you to participate voluntarily in it. By agreeing to participate, you acknowledge that you understand the aims of the program, its implications and the fact that you will not receive any monetary or material rewards.

Signature                                             Date

 

 

 

 

Appendix II: Timeline

September-November December-January January-February February-May May-June June-July July-September
Needs assessment
Obtaining approval
Training
Implementation/Follow Up
Data Collection
Data Analysis
Presentation of findings

 

 

 

Appendix III: Budget

Item Cost ($)
Needs analysis 5000
Data collection 5000
Data analysis and presentation 8000
Remuneration for staffs and trainers 25000
Purchase of materials 10000
Follow up 5000
Extraneous 10000
68000

 

 Appendix IV: Questionnaire

Hello, kindly provide your responses by ticking on the statements that best describe your experience with the project.

  1. What is your gender? Male [ ] Female [       ]
  2. How old are you? 18-30 years [ ] 30-40 years [             ] 40 and above [                 ]
  3. What is your highest level of education? High school and below [ ] College [       ] University [   ] Post-graduate [         ]
  4. What is your overall experience with the program? Very satisfied [ ] satisfied [      ] Neutral [       ] unsatisfied [  ] very unsatisfied [    ]
  5. Which of the following statements best describes your experience with the project?
Strongly agree Agree Neutral Disagree Strongly disagree
Behavioral interventions and care coordination are important in alcohol use disorder
Behavioral interventions equip individuals with the needed skills for managing withdrawal symptoms
Healthcare organizations should incorporate behavioral interventions into their practices
The risk and rate of withdrawal symptoms improve with behavioral and care coordination in alcohol use disorder
Healthcare providers play critical roles in the implementation of behavioral interventions and care coordination for alcohol use disorder
  1. What are some of the strengths of the program based on your experience?

 

 

 

  1. What are some of the strengths of the program based on your experience?

 

 

 

 

  1. What recommendations can you give on the ways in which the program can be improved further in the future?

Appendix V: Concept Map

The healthcare sector, healthcare professionals, and other stakeholders have, in the past and present, focused on improving patient outcomes using various strategies. Such strategies aim at improving the efficiency of patient care and the safety of patients while in the patient care environment. The efforts and initiatives aimed at improving care outcomes are usually triggered by a host of incidences happening in the care settings, such as patient falls, patient injuries, pressure ulcers, and healthcare-acquired infections, among other incidences. (Jaul et al.,2018) Among the most common healthcare-acquired infections are catheter-associated urinary infections (CAUTIs). CAUTIs have been shown to cause various negative impacts, such as increased healthcare spending, longer hospital stays, and other adverse impacts, such as death. Therefore, this evidence-based practice project focuses on lowering the rates of CAUTI among patients in admission settings and using indwelling catheters(Shadle et al.,2021). As such, the purpose of this paper is to formulate aproposal for the EBP. Various aspects which will be explored include the problem statement, the organizational culture, the literature review, the change framework, and the implementation and evaluation plans.

Problem Statement

Hospital-acquired infections have been shown to be on the rise in the past and present. One of the most common types of such infections is catheter-acquired urinary tract infections caused by the use of urinary catheters, especially indwelling ones. According to Flores-Mireles.(2019), CAUTIs lead to various adverse impacts. Even though the condition is largely preventable, it continues to cause havoc as it leads to increased patient morbidity and mortality, longer hospital stay, and increased healthcare spending (Kranz et al.,2020). This problem can, however, be prevented by applying various nursing interventions. It is important to note that, while various nursing interventions have been implemented, especially single activity-based interventions, the problem still persists hence calling for the use of more robust approaches which can integrate various interventions such as the use of CAUTI bundle.

Organizational Culture and Readiness

The process of evidence-based practice is impacted by various aspects, some of which are organizational aspects. The implication is that the EBP implementers should take their time and assess the nature of the organization, such as its culture related to EBP implementation and the readiness of various staff. Such a step is key in determining how easy or difficult the process of implementing an EBP project can be since a positive culture is needed for a successful implementation to occur (Cleary‐Holdforth et al.,2021). The assessment revealed that the organization’s leaders support patient improvement initiatives such as the EBP process for better patient outcomes. The organization also focuses on gaining magnet status, which has made them support various change initiatives. The assessment of the organization’s aim and mission showed that it focuses on offering exemplary and excellent patient services by using the latest care strategies at affordable costs. In addition, it was also noted that the organization adores interprofessional collaborations and teams in the provision of care. Therefore, it is evident that the organization’s culture is ready for change and also supports EBP.

The organization’s culture and readiness were assessed using a chosen tool, the System-Wide Integration of the EBP survey tool. This tool has widely been applied, especially to assess an organization’s capacity to adapt to and cope with change (Melnyk et al.,2022). This tool was used to explore the staff’s and the leader’s understanding of the proposed change of application of the CAUTI bundle to control the CAUTI rates. The survey tools showed that up to 91% of the staff support the proposed change, which is a majority. In addition, the majority of the leaders also supported the initiative, as up to 80% indicated that they were ready for the change. Therefore, this tool also revealed that the organization’s culture could support and sustain the proposed change.

Even though the culture supports the proposed change, it is worth noting that there are potential barriers and weaknesses that may derail implementation. For example, lack of support by minority leaders as staff can be a major drawback. The assessment will also be key in exploring the staff knowledge in using the proposed CAUTI bundle, which will then help to formulate strategies for improving their knowledge. The leaders supporting the initiative will play an important role in availing the required resources and supporting the project through making effective decisions and formulating change champions who can then help on driving the change initiative as appropriate. It was also important to identify the relevant stakeholders (Melnyk et al.,2022). Therefore, various stakeholders were identified, stakeholders include physicians, nurses, unit leaders, nurse managers, patients, and their families

Literature Review

The identified problem which informed the formulation of this project is increased rates of CAUTI in patient care settings. Therefore, the use of CAUTI bundles has been proposed as a potential EBP intervention. As such, it was important to perform a literature review to explore the existing evidence on the use of CAUTI bundles to reduce the rates of CAUTIs among patients admitted to the hospital and using indwelling urinary catheters. A PICOT question formulated earlier was used in the literature search. The formulated PICOT was: Among patients using indwelling urinary catheters, what is the efficacy of using CAUTI bundle care as compared to no intervention in lowering the rates of CAUTI by at least 60% within six months?

An article search strategy was also used to access the most relevant articles and evidence as appropriate. The search was accomplished in various article databases such as PubMed, google scholar, CINHAL, and Cochrane databases. The search also focused on peer-reviewed articles published in the last five years. Various search terms were also used in the search for relevant articles, including CAUTI, CAUTI bundles, intervention, and prevalence. Even though the search yielded several articles, the most relevant was chosen, and the literature review of the ten articles was performed and presented in the next section.

Elkbuli et al.(2018) conducted a study on the prevention of CAUTI among the trauma population. This study aimed at determining the efficacy of using a 5-S CAUTI bundle in the reduction of CAUTI rates among trauma patients. In a quantitative study, the researchers recruited a total of 2926 trauma patients. The analysis of the data showed that the use of the 5-S bundle led to a significant reduction in CAUTI rates among trauma patients (p-value of 0.002).

Davies et al.(2018) also conducted a study to explore the impact of using a CAUTI bundle. In a pre-and-post-study design, the researchers recruited a total of 6236 patients to take part in the study. The analysis of the data compared the rates of infections before the application of the CAUTI bundle and after its implementation. The results showed that the rates of CAUTI after the implementation of the CAUTI bundle were significantly lower compare as compared to the rates before, showing the efficacy of the CAUTI bundle.

Recently, Reynolds et al. (2022) conducted research that aimed at exploring the impact and sustainability of a multifaceted intervention in lowering CAUTI rates. This study was conducted in three large adult intensive care units among patients using urinary catheters. The analysis of the data showed a significant impact of bundle care. For example, the researchers noted a drop in CAUTI rates and the use of indwelling catheters. The positive impacts were directly associated with the implementation of the CAUTI bundle care as a strategy.

In a similar study, Mundle et al. (2020) explored the effectiveness of implementing a CAUTI bundle in preventing CAUTI incidences. The researchers conducted the study in internal medicine units where every patient admitted during the study took part in the study. The analysis of the data showed significant results relevant to this study as the researchers observed a 79% reduction in the rates of CAUTI among the patients, showing that the implementation of the CAUTI bundle care positively impacted CAUTI rates.

Sultan et al. (2022) explored the effect of using a CAUTI bundle to help prevent CAUTI occurrence among critically ill patients. In a quantitative study, the researcher recruited a total of eighty patients admitted to the intensive care units. The analysis of the data showed that the implementation of the CAUTI bundle led to a significant reduction in CAUTI rates. For example, they noted that upon the implementation of the CAUTI bundle, the CAUTI rates among the ICU patients were reduced by 50%, showing the efficacy of the intervention.

Another relevant study was conducted by Tyson et al. (2020), which focused on implementing a nurse-driven protocol designed to support catheter removal approaches to help reduce CAUTI rates. The aim of the study was to compare the CAUTI rates and the use of indwelling urinary catheters before and after implementing a nurse-driven CAUTI bundle among patients admitted to the surgical trauma intensive care unit. The analysis of the collected data led to significant results. For example, upon the implementation of the protocol, the researchers noted a significant reduction in the rates of catheter use. In addition, they also found that the protocol led to a reduction in CAUTI rates.

Shadle et al. (2021) also conducted a study to determine the impact of using a CAUTI bundle to reduce CAUTI rates. In a quantitative study design, the researchers collected data using electronic health records. The analysis of the collected data also showed relevant results. For example, the researchers realized that during the study, no CAUTI cases or incidences were reported showing that the CAUTI bundle implemented was highly effective in preventing and controlling the CAUTI rates.

More recently, Pajerski et al. (2022) carried out research that explored the impact of using CAUTI bundles in controlling the rates of CAUTI. This study was conducted in a trauma brain injury rehabilitation unit. Upon the analysis of the data, the researchers noted that there was a reduction in the CAUTI rates when the CAUTI bundle care approach was implemented. Soundaram et al. (2020) also carried out research with the aim of exploring the impact of implementing a CAUTI bundle in the control and prevention of CAUTI rates and incidence. The researchers carried out the study in adult intensive care units. The analysis of the data showed that upon the use of the CAUTI bundles, the cases of CAUTI were observed to reduce significantly by sixty percent. As such, this is another study that shows the efficacy of using a CAUTI bundle in controlling and preventing CAUTI incidences and rates.

Another study was conducted by Ravi and Joshi (2018). This study was conducted with the major aim of exploring the efficacy of a CAUTI care bundle in lowering CAUTI rates. The researchers used a bundle care approach which included training and educating the nursing staff on how to appropriately use and manage the indwelling catheters. Upon the analysis of the data, the researchers also noted a significant reduction in the rates of CAUTI among admitted patients. Therefore, this is another study that shows the efficacy of using CAUTI bundles in the prevention and control of CAUTI.

Change Model or Framework

Change models play a crucial role in the implementation of evidence-based practice projects since they offer foundations upon which the project is implemented (Jayatilleke & Lai, 2018). As such, the selected change model for this project is Kurt Lewin’s change model. According to Lewin change occurs in three distinct faces, and there are two major forces involved in a change process, the driving and restraining forces. The driving forces are known to enhance the change process, while the restraining forces oppose the change. As such, the driving forces have to overcome the restraining forces for the change process to occur successfully.

The three phases include unfreezing, change, and refreezing. In the first phase, which is refreezing, the major activity is creating an urgent need for change by pointing out the evidence of why the change should urgently be undertaken (Hussain et al.,2018). Letting the stakeholders know that there is a need for change requires effective communication.  The second phase, which is the change phase, is associated with the implementation of the proposed intervention, where the change implementers implement the initiatives to help solve the identified clinical issue. The third phase is known as refreezing. This stage entails using various efforts to ensure that the implemented change becomes part of the organization’s culture and supporting the staff to accept and sustain the change.

The stages of the model will be applied to implement the CAUTI bundles. In the unfreezing stage, the stakeholders will be alerted to the urgent need for change to help reduce the rates of CAUTI in the care setting. Appropriate communication channels will be used to inform the staff of the need to address the issue of rising CAUTI cases. The second phase, which is the change phase, will involve training the nursing staff on the proposed new bundle and how to use it. The process will then be followed by the implementation of the CAUTI bundle to help reduce the rates of CAUTI. Effective communication will also be key in this phase(Hussain et al.,2018). The last phase, which is the refreezing stage, will entail sustaining the implemented change and ensuring that the CAUTI bundle becomes part of the organization’s protocol for preventing CAUTI incidence.

Implementation Plan

Implementation is one of the most important phases of an EBP project cycle. Therefore, a conducive environment should be created to enhance the implementation process. It is also important to explore various aspects, such as the setting and how to access the potential subjects. As discussed earlier, this project involves using CAUTI bundles to reduce or lower the rates of CAUTI among patients using indwelling urinary catheters (Elkbuli et al.,2018). Therefore, the targeted setting for the project is the admission wards with patients who used indwelling urinary catheters. The patients to be considered are those who will be admitted to the admission units and using the indwelling catheters. The other targeted population is the nurses who offer nursing care to the patients in these settings. The data for evaluating the project will be obtained from electronic health records. Therefore, there will be no need to obtain informed consent. Nonetheless, the organization leaders will need to offer permission to allow the implementation process.

It is also important to consider a suitable timeline for the proposed project. A timeline acts as a guide to knowing when particular activities should be accomplished (Melnyk & Fineout-Overholt, 2019). Therefore, a period of six months has been proposed for the project. It is hoped that this duration will be sufficient to cover various project phases such as project, initiation, literature review, project implementation, monitoring, and evaluation. This duration will also be used in obtaining project feedback from the stakeholders, such as indications of carrying out corrective measures to help solve various identified problems.

The Budget and Resource List

The success of a project heavily depends on the availability of needed resources; therefore, it is important to procure the necessary resources in time. There will be a need to train the staff on the use of the new CAUTI bundle. Therefore, both material and financial resources will be required to support such an education and training process (Melnyk & Fineout-Overholt, 2019). Besides, additional resources will also be needed to help in the development of the CAUTI bundle protocol to be used in controlling and preventing the CAUTI rates. Human resources will also be required to help accomplish the project goals. The budget implication is that the project team will need to get sufficient resources that can help in training and educating the nursing staff, purchasing the training materials, hiring the educators, collecting data, data analysis, project monitoring, and well as outcome evaluation. It has been projected that the cost of the project will be $36,000, and the detailed budget and resource list have been included in the appendix.

The Study Design

A study design is important in guiding a project; therefore, it is important to choose various aspects of study design appropriately. As such, the design chosen for this project is the quantitative design which will be used in both data collection and analysis. This design has been chosen since the targeted project data is quantitative. Statistical tests will also be used as part of the project to analyze the project data, which further corroborates the use of the quantitative study design as compared to the qualitative study approach (Jolley, 2020). The quantitative study approach also supports easier data collection and analysis. The quantitative study approach is also relatively cheaper in comparison to the qualitative study design and approaches.

Methods and Instruments

            Instruments and methods are a crucial part of the implementation plan, and they are important for various activities such as data collection, data analysis, and data evaluation. One of the instruments to be used in this project is the questionnaire. Questionnaires will be applied to test the nurse’s knowledge of CAUTI prevention and management. The nurses’ knowledge will be assessed before and after the education (Gunawan et al.,2021). The rationale for choosing questionnaires is that they are easier to use in collecting data. Another instrument is electronic health records which will be used to obtain the baseline data on CAUTI rates. The same instrument will also be used to obtain data on CAUTI incidences after the implementation of the proposed CAUTI bundle care.

The Process of Delivering the Intervention

The success of the implementation process hinges on the process of delivering the intervention. As part of the plan, the intervention will be delivered in various phases. In the initial phase, an assessment of the clinical setting is to be undertaken through a needs assessment approach to explore the nature of the needs (Grove & Gray, 2018). The assessment involves studying the CAUTI statistics within the organization, including the impacts and trends among patients admitted to the facility. The assessment also involves assessing the nurses’ levels of knowledge and awareness regarding CAUTI and control of CAUTI using CAUTI bundles. The process will be key in coming up with relevant strategies to use in the project. The next step will entail educating and training the nurses on the use of the proposed CAUTI bundles to help reduce the rates of CAUTI. The next step will then involve the implementation of the intervention, where the efficacy of the intervention will be tested. As part of the plan, the staff will be closely supervised for a considerable duration to ensure that they are correctly and adequately implementing the bundle elements. The next part involves collecting the data associated with the intervention and analyzing the data to determine the efficacy of the intervention in reducing the CAUTI rates.

The Stakeholders Required to Complete the Project

Stakeholders form a crucial part of the project. As such, it is crucial that they be identified in time so that they can be involved from the onset of the project (Lehane et al.,2018). Early involvement of stakeholders helps in limiting the chances of resistance. The following stakeholders have been identified; the chief executive officer, the nurse manager, the unit managers, the hospital finance officer, the nursing staff working in the admission wards, and the physicians. The hospital’s chief executive officer will give permission to accomplish the project in the organization. The nurse manager will play a critical role in coordinating the unit activities related to the project implementation. The unit managers will discharge duties related to each unit. The finance officer will also help with feasibility assessment, financial viability, and the best ways to acquire the needed resources. The nurses are at the forefront of the project and will help in the active implementation of the intervention. The physicians also take part in the treatment of the patients admitted to the wards and, therefore, will support the nursing team in implementing the proposed CAUTI bundle.

Potential Barriers or Challenges to The Plan

Implementing an evidence-based practice project may face various challenges or barriers which may need to be mitigated if the project implementation process is to be a success. The implication is that appropriate strategies should be formulated in time to help overcome the challenges or barriers. Among the potential challenges are potential difficulties in obtaining the resources needed, especially financial resources (Lehane et al.,2018). Project failure may be the result if sufficient funds are not obtained. Therefore, a solution should be explored. One of the solutions is writing funding proposals to potential sponsors or financiers. The other expected barrier or challenge is resistance by the leadership or the nursing staff. The nursing staff may offer resistance to the use of the proposed bundle since it may need more time. The resistance can be reduced by training the nurses to help them have a better understanding of the proposed initiative to reduce the chances of resistance.

Evaluation Plan

Evaluation is one of the most important stages and the last stages of evidence-based practice project initiatives. As such, it is crucial to come up with an evaluation plan which can be applied in assessing the impact of the implemented intervention. This phase is also crucial in exploring how effective the strategies or methods used in the project have been (Dang et al.,2021). As part of the evaluation plan, it is important to explore the expected outcomes as far as the project is concerned. In the previous sections, it was indicated that the nursing staff would need training regarding the use of the proposed CAUTI bundle. Therefore, among the expected outcomes is improved nurse knowledge and skills in the use of CAUTI bundles to control the rates of CAUTI (Elkbuli et al.,2018). The next expected project outcome is the reduction in CAUTI rates. It is hoped that the implementation of the CAUTI bundle will lead to a reduction in CAUTI rates by at least 60%. Such a feat will be used as a reflection of the efficacy of the intervention. Another expected outcome is that the organization will adopt the CAUTI bundle protocol as a standard intervention for preventing and managing CAUTI in the organization. Such an expectation will be made easier by positive project outcomes.

The Data Collection Tools

Data collection tools are important in the project phases, especially the evaluation phase in obtaining project data to be used in evaluating the efficacy of the implemented intervention. One of the data collection tools is electronic health records. The electronic health records will be applied to obtain data on the rates of CAUTI after implementing the CAUTI bundle protocol. This data will then be compared with the baseline data which was obtained at the start of the project. Such a comparison will ventilate more on whether the intervention has been effective or not.

The next targeted tool is the questionnaires. The questionnaires will be used to assess the nurses’ skills and knowledge concerning the use of the CAUTI bundle to prevent and control CAUTI. The knowledge gained after education will be compared with the baseline knowledge to determine the efficacy of the education program. Questionnaires will also be used to assess the attitude of patients and nurses concerning the implementation of the new CAUTI bundle. Questionnaires will be appropriate as the project utilizes a quantitative design approach. The tool is also valid as they have been validated and shown to be effective in measuring knowledge (Yaddanapudi& Yaddanapudi, 2019). The tool is reliable since the same set of questions will be used

The Statistical Tests

Statistical tests are used in the data analysis process to help determine the efficacy of the intervention. The major thrust of this project is to compare the rates of CAUTI in the admission units before and after the implementation of a CAUTI bundle. Therefore, one of the most appropriate statistical tests to use in this case is paired t-test. The paired t-test has been chosen since it has been shown to be effective in measuring the variation between a set of paired samples. This project will focus on the pre and post-test rates scores and CAUTI rates. Therefore, the chosen statistical test will help in determining the significance of the considered set of scores. Mean will also be used, especially in the nurse knowledge scores regarding the use of CAUTI bundles to control the rates of CAUTI.

The Methods of Use and the Evaluation of the Outcomes

            Methods and strategies used in the project may impact project outcomes; hence it is important to explore them. The questionnaire to be applied in the project, as part of the plan, is expected to have scaling questions, multiple-choice questions, and dichotomous questions. It is important to use different formats and approaches to questions since the project should determine various changes associated with the implemented initiative. Various validated scales will be used in formulating the scaling questions and use scales, such as 1 to 5. On the other hand, the dichotomous questions require the research subjects to either answer a yes or a no. It is important to use these kinds of questions for a complete evaluation of the project (Melnyk & Fineout-Overholt, 2022).

Strategies to Be Taken If the Outcomes Do Not Provide Positive Results.        

Quality improvement projects and evidence-based practice projects are usually designed with the hope and aim of positive outcomes. Indeed, positive outcomes are usually achieved under normal circumstances (Linsely et al.,2019). It is important to note that in some cases, positive outcomes may not be the results observed. Hence the project team should always put measures in place that can be used as part of the mitigation process in the event that the results obtained are not positive. As part of the plan, among the strategies to be used in the event that the results are not positive is the do a reexamination of the implemented intervention. Reexamination can be vital in offering insights into particular or specific areas which might have led to the observed failure. Another expected strategy is the extension of the project timeline. Extending the project timeline can be necessary to help the project team identify areas of weakness, revise vital parts of the project and implement corrective measures to help in improving the chances of the project succeeding.

The Plans to Maintain, Extend, Revise, and Discontinue the Proposed Solution

An implemented evidence-based practice project can lead to various outcomes; in some cases, the outcomes can be desirable, while in other cases, the outcomes may not be desirable. Therefore, it is important to put in place an appropriate plan to maintain, extend, revise, or discontinue the implemented solution or initiative as part of the overall plan; the project will be maintained if the outcomes turn out to be as expected. In other words, the project will be maintained if the outcomes are positive and the implemented solution is positively affecting or impacting the patients.

As part of the plan, the project will also be maintained if it is cost-effective. Healthcare cost has recently become an important point in the healthcare environment as the costs have been going up. As such, any quality improvement projects or evidence-based practice projects should be cost-effective. Therefore, this project will not be different and will, therefore, be maintained if it is cost-effective. In some cases, the evaluation phase may produce or give results that are not conclusive. In such cases, there may be a need to get appropriate results that can be used in evaluating the project outcomes. Such cases require that the project be extended. Therefore, the project will be extended if the outcomes and inconclusive (Melnyk & Fine-Overholt, 2022). The major purpose of extending the project is to obtain appropriate additional data that can then be applied to determine the effectiveness of the project.

Under certain conditions, the project may need to be revised. A revision will be pursued if the strategies do not align with the project outcomes. The revision will be undertaken to get more time which can be used in adopting improvement interventions. Such improvement interventions will increase the chances of the project succeeding. As part of the plan, the project may also be discontinued under particular instances or circumstances. For example, discontinuation will occur in the case that the project causes harm to the patients and the staff. The solution will also be discontinued if it pauses a risk to the lives of the staff and the patients.

Conclusion

The adverse impacts of CAUTI have led to research efforts over the years to help control and prevent these infections. Therefore, various evidence-based interventions exist. However, it is worth noting that these evidence-based interventions have shown varied efficacy; in addition, the problem still persists in the patient care setting. As such, the proposed evidence-based approach or intervention is the use of a CAUTI bundle. As opposed to single interventions which can be applied to prevent and reduce the rates of CAUTI, a bundle-based care approach entails combining or integrating various interventions for better outcomes. Therefore, the bundle care approach chosen entails various activities that can have a synergistic effect of reducing CAUTI rates or preventing them. It is expected that the proposed evidence-based practice solution of using a CAUTI bundle will lead to a significant reduction in the number of patients acquiring CAUTI in hospital settings. The literature review performed showed that the use of CAUTI bundles in controlling the rates of CAUTI could largely be effective when appropriately applied. This write-up has also explored various aspects of the project, such as literature review, organizational culture and readiness for change, the change framework, project implementation, and project evaluation.

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Throughout this course I have gained a much deeper understanding of the process of implementing and integrating evidence-based research into clinical practice and the role of the advanced practice registered nurse in facilitating that process. A large part of being able to advocate for change in our organizations is creating an organizational culture receptive to change. I can work as both a nursing leader on my unit and an eventual nursing educator to teach other nurses about the importance of evidence-based practice (EBP) and why it is important to challenge the norm instead of simply accepting things as they have always been done. I was surprised to learn that a large part of the delay in taking evidence from research and applying it to practice stems from an ineffective implementation plan; poorly constructed implementation plans or change mobilized without a plan at all can cause delays in research integration of up to twenty years (Campione et al., 2021). Though I am still somewhat uncertain in my ability to truly strategize an implementation plan for EBP at this point, I feel as though I could contribute helpful discussion to a change team looking to mobilize EBP at my facility if the opportunity arose thanks to the knowledge I have gained in this course. Lastly, I would like to get more involved in the research and integration of telehealth technologies into acute care and outpatient monitoring, as I can see so much potential and room for improvement in the existing technologies we have, with only more flexibility for use as technology continues to advance. Getting more nurses educated in the use of telehealth technologies will allow for the dissemination of their use across more spectrums of care, and I hope to find ways to better utilize these technologies to address health disparities such as poor transportation to health clinics preventing compliance with routine checkups.