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Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

NUR-590 Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Evidence-based practice projects are based on the spirit of inquiry of practitioners (nurses or physicians) and existing research from other practitioners. When planning research projects, it is imperative to use a framework that can provide a map of the elements and questions that will require attention and to be addressed to ensure the success of the project (Christenbery et al., 2019). This manuscript will describe the Stetler Model and how it will be used to develop and implement this evidence-based project.

Selected Model or Framework for Change & Benefits

As stated earlier, the selected model is the Stetler Model. This model was chosen because of its simplicity, critical thinking focus, and how similar it is to the nursing process. This model was first published in 1976, with two later revisions in 2001 and 2010 (Melnik & Fineout-Overholt, 2018). The Stetler Model contains five phases, each phase contains questions and critical thinking tips designed to facilitate safe and effective use of research findings (Stetler, 2001). This model is also practitioner-oriented because focuses on the use of findings by the individual practitioner/group of practitioners and it uses internal and external evidence. Another benefit of using this model is that validates patients’ preferences and wishes and counts it as interval evidence that can be used to evaluate outcomes and achieve best practice. Again, the model focuses on enhancing the interaction between patients and providers based on its attributes as patient-centered and provider-driven.

Stages of the Change Model: Stetler Model

The Stetler model allows nurse practitioners to evaluate how to implement research evidence in clinical practice in creating change that focuses on and promotes patient-centric care. The model entails five steps or phases. These include preparation, validation, comparative evaluation and decision-making, translation or application, and evaluation. The preparation phase entails identifying the priority needs and purpose of the project (Karl & Mion, 2020). These include the context or setting and relevant sources of evidence.

The validation stage assesses the sources of evidence to attain their level and overall quality (Stetler, 2001). This includes determining if they have merit and whether they should be accepted based on the purpose of the project. The stage assists in reducing errors in making critical decisions and categorization of evidence. The third stage requires a comparative analysis or evaluation and decision-making on the evidence findings where the practitioner or organization logically summarizes the outcomes of the research search. The stage entails highlighting the similarities and differences in the evaluated sources of evidence (Christenbery, 2019). During this stage, the organization determines if it is acceptable and feasible to implement the findings in clinical practice to improve patient care and processes.

The fourth stage is the translation or application where the provider or organization develops strategies for the implementation of the summarized results and evidence from existing literature. The stage implores the provider and organization to identify core implications that justify the use of these findings to create change in care practice (Melnik et al., 2018). The fifth stage is about evaluating the expected outcomes of the project and determining if it has attained the set goals. The implication is that the evaluation should ascertain if the project was successfully implemented to attain its goals and aspirations for change in the organization. Each phase of the model is designed to facilitate critical thinking on the practical use of the research findings, lead to the use of evidence in the context of daily clinical practice and reduce or prevent any human errors arising from decision-making.

Application of the Model in Proposed Implementation

 The model is critical to the implementation of the proposed EBP project in the practice setting to create meaningful changes in processes and patient outcomes through improved efficiencies and workflow while integrating patient-centered needs and addressing their core concerns. The application of the model will entail identifying the EBP change project’s purpose. In this case, it entails improving processes and patient outcomes through efficiency and workflow practices. Further, at this stage, searching for relevant sources of evidence would also occur through the evaluation of existing literature on past studies. A core aspect at this stage would be the development of a PICOT question framework to guide the EBP project proposal (Karl et al., 2020). The PICOT framework identifies the population or problem, the intervention, the comparison with another aspect, outcomes from the project, and the duration or time of the implementation to create change.

The validation would occur by ensuring that the level of evidence and quality is high. For instance, the project will use level I, II, and II articles like systematic reviews, meta-analyses, and randomized control trials. The comparative evaluation will entail providing a summary of the themes from the studies, especially categorizing the similarities and differences emanating from the evaluated sources. In the translation or application phase, the project will develop effective strategies like nursing sessions, improving health information technologies, stakeholder engagement, and forming teams as well as change champions in different departments to implement these changes (Christenbery, 2019). Effective communication will also be a core aspect of the application phase. The evaluation will measure the overall project outcomes and ascertain if it attained its goals. The evaluation will occur simultaneously to ensure that any errors are identified and rectified.

Conclusion

Evidence-based practice (EBP) change implementation frameworks are critical to executing proposed EBP projects in healthcare settings. These models offer guidelines and allow practitioners and organizations to carry out changes in an effective manner to enhance quality care. EBP change processes are patient-centered and leverage practitioners’ knowledge and expertise to improve overall care delivery.

 

References

Christenbery, T. L. (2019). Evidence-based practice in nursing: Foundations, skills, and roles.

Springer Publishing Company.

Karl, J., & Mion, L. (2020). Research data in hospitals and health systems. In Data for Nurses

(pp. 31-46). Academic Press.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based Practice in nursing &

            healthcare (4th ed.). Wolters Kluwer Health.

Stetler, C.B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-

based practice. Nursing Outlook, 49 (6) P. 272-279. https://doi.org/10.1067/mno.2001.120517.

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. Therefore, the purpose of this paper is to explore the change model that will be used to guide the implementation of the proposed project.

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 (Cavaiola & Smith, 2020). 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 (Gellman & Turner, 2019). 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 (Anisman, 2021). 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 (Miller, 2020). They implement the initiatives that are needed to ensure the desired change in treatment outcomes among patients with substance use disorder.

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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 (Hagger et al., 2020). 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 (Miller, 2020). 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.

Concept Map

 

Conclusion

In conclusion, the trans-theoretical model will guide the implementation of the proposed change initiative. The model is applicable, as it provides comprehensive guidance on the ways in which the desired change can be achieved in patient care. The model will also provide insights into the ways in which sustained change can be achieved in healthcare. Therefore, its effective use is anticipated to result in enhanced organizational benefits.

 

References

Anisman, H. (2021). Health Psychology: A Biopsychosocial Approach. SAGE.

Cavaiola, A. A., & Smith, M. (2020). A Comprehensive Guide to Addiction Theory and Counseling Techniques. Taylor & Francis Group.

Gellman, M. D., & Turner, J. R. (2019). Encyclopedia of Behavioral Medicine. Springer New York.

Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N., & Lintunen, T. (2020). The Handbook of Behavior Change. Cambridge University Press.

Miller, G. (2020). Learning the Language of Addiction Counseling. John Wiley & Sons.

 

The success of health organizations in the modern world relies largely on the implementation of transformative initiatives. Depending on the nature of an identified clinical problem or issue, particular interventions can be used to help solve the problems or reduce their occurrence rates. In most cases, the initiatives are implemented in the form of change initiatives (Nilsen et al.,2020). The changes aim at streamlining the existing systems and processes in an organization. Such initiatives can be driven by frameworks that offer a ground for implementation. Change models guide the strategies adopted in the change process. Therefore, the purpose of this paper is to explore a change that will be utilized in the project, its steps, and how they will be applied.

The Selected Model

The selected model that will guide the implementation of the evidence-based practice project is Kurt Lewin’s model of change. Lewin’s model is a psychological theory that organizations utilize to guide the change process. Lewin developed the model in the 1950s for use by leaders and managers to understand the process of change in the organization and influencing factors. According to him, management and leadership should engage in a range of activities for the change process to be successful. They include activity and commitment planning and the transformation of the existing organization’s structures (Wilson, 2019).

Lewin’s theory of change is applicable to my project because it entails behavioral change. The adopters of the proposed change should embrace behaviors that align with the change for its success. The model supports the implementation of change based on best practices. The focus on creating an enabling environment and preparing the adopters minimizes the potential of change failure, hence, the use of best practices in the process (Hidayat et al., 2020; Wilson, 2019). Therefore, its application to the proposed evidence-based practice is anticipated to yield sustainable outcomes.

Stages of the Model and their Application

Kurt Lewin proposed that change occurs in three steps. They include unfreezing, change, and refreezing. The change process must occur in these steps for it to be a success in an organization. Unfreezing is the first step of the change process in the model. It is characterized by preparing the adopters for the change process (Hussain et al.,2018). The change management team makes stakeholders understand the need for change by referring to the statistics of an increased rate of patient falls among hospitalized patients, which have been high. Such a step will be key in preparing every stakeholder for an impending change to help address the increased rates of patient falls. Effective communication is crucial in this stage to motivate the adopters to begin thinking and acting in ways that support the change (Harrison et al., 2021). Open communication will be encouraged to enable them to express their views and concerns about the change.

Change or transition is the second step in Lewin’s model of change. The targets of change have accepted the change in this phase and start embracing new ways of doing things. It is characterized by the implementation of change for the achievement of the set outcomes. Change management teams employ strategies such as open communication, teamwork, active involvement, coaching, mentorship, and providing feedback in this stage to ensure successful change implementation. Training is also offered to ensure the implementers have the desired competencies to support the change (Campbell et al., 2020; Wilson, 2019). This step of change is applicable to the proposed evidence-based practice project. At this point, the proposed intervention of automated fall detectors is implemented to help address the fall problem. The stakeholders are actively involved in the change process to promote their empowerment and project ownership. Feedback will be provided to ensure the elimination of potential threats to the change process.

The third step in the change model is refreezing. Stabilization of the desired change behaviors occurs in this step. The new intervention is accepted in the organization as part of the routine and the organization’s culture. The stakeholders become actively involved in identifying best practices that can sustain improved performance in the organization. Strategies such as rewarding performance, regular reviews and giving feedback, and establishing supportive policies and structures are crucial in this step (Hidayat et al., 2020; Teguh et al., 2019). The refreezing step is applicable to the proposed change. The adopters of change will have incorporated the desired behaviors into their routines. The use of automated fall detectors is accepted in the organization as part of the routine and the organization’s culture. As a result, rewards, positive reinforcements, and aligning the change with their daily routines will be encouraged for sustained change.

Conclusion

Change frameworks or models are important in implementing proposed change in the healthcare environment. Such models provide frameworks upon which the stages of proposed change can be implemented. The proposed change model for the project is Lewin’s model of change. The model will facilitate sustained change in the organization. The theory proposed change to occur in steps that include unfreezing, change, and refreezing. These steps are applicable to the proposed evidence-based practice project. Strategies to sustain positive outcomes with the change will be explored.

 

 

References

Campbell, A. R., Layne, D., Scott, E., & Wei, H. (2020). Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review. Journal of Nursing Management, 28(7), 1465–1472. https://doi.org/10.1111/jonm.13083

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of Healthcare Leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176

Hidayat, A. T., Hariyati, R. T. S. H. S., & Muhaeriwati, T. M. (2020). Applicability of Lewin’s Change Management Model for Optimization Management Function in Nursing Delegation between Head Nurse and Team Leader: A Mini Project in Jakarta Military Hospital. International Journal of Nursing and Health Services (IJNHS)3(4), 471-478.https://doi.org/10.35654/ijnhs.v2i2.136

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses, and assistant nurses. BMC Health Services Research20, 1-8. https://doi.org/10.1186/s12913-020-4999-8

Wilson, F. (2019). Impact of a Change in the Assistant Nurse Manager Model on Satisfaction and Work Engagement. DNP Projects. https://uknowledge.uky.edu/dnp_etds/279

Organizational readiness is the partnership and synchronization between people, workers, controlling systems, and management systems in an organization. Tools used to assess an organization’s readiness and its dependent factors are known as readiness assessment tools. The readiness of a hospital depends on the coordination of nurses, patients, medical personnel, doctors, and other personnel (Dearing, 2020). There are different tools to analyze the readiness of a healthcare system. For example, the Organizational Readiness to Change Assessment (ORCA) identifies and monitors organizational strengths and weaknesses to support the implementation of evidence-based practices. It consists of three significant scales that measure the strength of the evidence for the proposed change/innovation, the quality of the organizational context to support the practice change, and the organizational capacity to facilitate the transition (Helfrich et al., 2021). Another example is the Organization Capacity Assessment Tools (OCAT) which Marguerite Casey Foundation developed. It can access the overall framework of an organization. The analysis is through auditing, inspections, and observations; it deals with organizational management, program management, human resources management, and financial management. It will critically analyze the facilities available in an organization, specifically the instrumentation and other services. The assessment outcomes can be used for ranking the organizations (Daniels, 2020). Organizational Readiness to Change Assessment (ORCA) can be the most appropriate for assessing the organization in this study. For example, ORCA measures the strength of the evidence for the proposed change/innovation, which can be applied in geriatrics when there is a proposed change, program, or evidence-based practice that can help reduce the rate of falls among geriatric patients. With the use of ORCA, the strengths and weaknesses of the organization can be monitored and help implement changes and innovation inside the organization, especially in the geriatric unit. 

References 

Daniels, C.M. (2020). Organizational Capacity Assessment Tool (OCAT) User Guide.https://www.alnap.org/system/files/content/resource/files/main/calp-ocat-user-guide-2-0.pdf 

Dearing J. W. (2020). Organizational Readiness Tools for Global Health Intervention: A Review. Frontiers in public health, 6, 56.https://doi.org/10.3389/fpubh.2018.00056 

Helfrich, C.D., Li, Y.F., Sharp, N.D., & Sales, A.E. (2021). Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework. Implementation Science 4, 38.https://doi.org/10.1186/1748-5908-4-38