NUR-590 Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change
Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change
Models of change are important in the implementation of new initiatives in healthcare settings. The models provide insights into the strategies that should be utilized in the implementation of change. They also provide information about the outcome data that will be used for evaluation purposes. Therefore, this section of the project examines the model of change that will be utilized in the implementation of the change.
Selected Model and Relevance
The trans-theoretical model of behavioral change will be utilized in the project. DiClemente and Prochaska developed the trans-theoretical model in the 1970s following their examination of the ways in which smokers quit smoking and the factors that influenced the process. The model examines the decision-making by individuals to embrace change and behaviors that are needed to influence the process. The trans-theoretical model recognizes the fact that behavioral change is a cyclical process. Individuals embrace change through a series of steps that will determine the sustainability of change. The trans-theoretical model is applicable to the proposed project because it provides insights into the determinants of change. It also enables the determination of success of the strategies implemented at each stage of the project (Cavaiola & Smith, 2020). Lastly, it provides step-wise approach to implementing and determining the level of adoption of change in an organization.
Stages of the Model and Application to the Proposed Implementation
Change in the trans-theoretical model occurs in steps. The steps include precontemplation, contemplation, preparation, action, maintenance, and termination. Each of the steps of the trans-theoretical model is applicable to the proposed change initiative. The first step in the trans-theoretical model is pre-contemplation. Pre-contemplation is the phase where the people have no plans of taking action to improve their situation. Their lack of awareness about the negative effect of their behaviors makes it hard for them to determine a need for change in their daily routines. This stage is applicable to the proposed initiative. Nurses are not aware of the need for the adoption of evidence-based strategies to reduce the rate of catheter-associated urinary tract infection (Gellman & Turner, 2019). As a result, the do not have any intentions to take action in any near future.
The second stage in the trans-theoretical model is contemplation. This is the phase where people become aware of the negative effect of their current behaviors. As a result, they are willing to take action in the near future. The adopters also explore the benefits as well as risks of changing their behaviors. There is however a high degree of ambivalence among them. The applicability of this step to the proposed initiative is that nurses will be aware about the need for evidence-based interventions to prevent and reduce the rate of catheter-associated urinary tract infections (Hagger et al., 2020). Nurses begin to explore the benefits of interventions such as meatus cleaning with 0.1% Chlorhexedine when compared to their usual practice of using normal saline. Nurses place emphasis on both the benefits as well as risks of behavior change.
The third stage of the model is preparation. This is the phase where the adopters of change are ready and willing to take actions
related to the change within a short period. The adopters implement small steps that would contribute to the desired behavioral change. They believe that the change will have benefits to them and their daily routines (Gellman & Turner, 2019). Nurses are ready to adopt the proposed initiative in this step. They start implementing the initiative in small scale to determine its effect on patient outcomes. Nurses believe that the implementation of the initiative would result in positive outcomes in care.
The fourth step in the model is action. This step is characterized by the recent change in behavior of the adopters. The adopters intend to continue implementing the change initiative. They modify their practices and behaviors to support the change. Nurses in this stage have considered the use of the initiative in their daily routines. They have realized the benefits of the intervention in reducing the risk and rate of catheter-associated urinary tract infections (Anisman, 2021). As a result, they are willing to explore additional ways in which the success of the change initiative can be achieved.
Maintenance is the fifth stage in the trans-theoretical model. The adopters of the change have sustained their behaviors that support the change. They work towards adopting behaviors that will prevent relapse. The nurses in this step have sustained the use of the initiative in patient care. They explore ways in which they can prevent the use of normal saline prior to insertion of urinary catheter. Termination is the last phase where the adopters do not have any intention to relapse to their traditional behaviors. The change has been incorporated into the organizational culture (Cavaiola & Smith, 2020). In this case, the use of the proposed initiative has been incorporated into the organizational culture, hence, the strengthening of excellence in patient care.
In summary, the trans-theoretical model will be used in the implementation of the project. The model is appropriate because it will facilitate sustainable change in the organization. The trans-theoretical model has steps that will guide the implementation process. Therefore, a focus will be placed on ensuring that the needs of the stakeholders are met at each stage for the successful implementation of the project.
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The evidence-based practice (EBP) process results from integration of existing research, clinical expertise, and patient preferences aimed at customizing care and promoting effective care decision-making (Cullen et al., 2020). As such, the use of effective frameworks or models for change in the EBP allows change implementers to use appropriate models to guide the process to attain the expected outcomes. These models are critical in ensuring that all stakeholders accept changes so that there is minimal or no resistance (Amit-Aharon et al., 2020). Nurses as the core implementers of change require enough knowledge and participation to comprehend different components of the proposed change aimed at reducing falls among adult-hospitalized patients in medical-surgical unit through the use of TIPS toolkit as a bundled care approach. The purpose of this paper is to select and describe an evidence-based practice framework or model for change in implementing the mentioned intervention in clinical settings to reduce falls and their adverse effects.
Selected Model or Framework for Change
Organizations implementing EBP change interventions should adopt models that best fit their situations, align with the quality improvement goals and address priority clinical issues as well as guide a systematic and evaluative approach to enhancing collaboration in practice change (Melnyk et al., 2022). The selected model for this change process is the Iowa evidence-based practice to promote quality care (IEBPPQC). The Iowa model is appropriate for this project because it continues to be reviewed to better address sustainability of the EBP, enhance inter-professional change implementation and patient-centered care for clinicians and advanced practice registered nurses (APRNs), guiding them through a team-based and multiple process.
Stages of the Iowa EBP Model
The Iowa model is one of the most popular approaches in addressing and implementing changes to improve quality and patient outcomes. The model has seven essential stages or steps. These include identification of a problem-based trigger or knowledge-focused issue that generate the need for change in practice, determining if the issue is a priority for the healthcare organization, and analyzing the interest of the organizational team and stakeholders which entails searching for, appraising, and synthesizing literature associated with the issue (DeNisco, 2019). The fourth stage is to evaluate the availability and merit of evidence which implies understanding the level of evidence and its quality. The fifth step in the Iowa model is to pilot practice change based on the credibility and reliability of the available evidence. The pilot change intervention aims at assessing the level of impact that such practice will have on the organization, patients, and other stakeholders.
The sixth step is to evaluate the results of the pilot practice intervention to ascertain if the organization should or should not implement the practice change. The seventh step is to disseminate the change across the department if it is feasible and can result in significant benefits to the different stakeholders. After introducing the change, it is essential for stakeholders to continue monitoring, evaluating and analyzing the results while making necessary alterations to attain the expected outcomes.
Application of Each Stage of the Iowa Model
The Iowa EBP model is easy to use for the current issue of preventing and reducing falls among hospitalized adults in medical-surgical unit. The initial step in this case is to identify the need for change. The use of TIPS toolkit means that the stakeholders, especially nurses have identified falls as a trigger problem that reduces the quality of care because of its adverse effects on patients. Secondly, reducing and prevention of falls is a healthcare organization priority. The Centers for Medicare and Medicaid Services (CMS) considers patient falls as never events and does not compensate organizations for expenses and costs associated with the issue (DeNisco, 2019). As such, reducing and preventing falls is a priority for the organization to improve the quality of care it offers to patients and enhancing their overall safety.
The change team’s topic of interest on falls’ prevention through the TIPS toolkit is essential for the organization. In this case, team comprises of different stakeholders interested in developing, evaluating and implementing changes to improve patient safety because of their increased susceptibility to falls due to their condition. The EBP team in this case, comprises of different players, from physicians to nurses and physiotherapists as well as quality assurance experts to ensure that the proposed EBP intervention attains its set goals based on the PICOT framework. The next step for the team is to gather and analyze research associated to the desired practice change (Melnyk et al., 2022). As demonstrated through literature review and synthesis, sufficient evidence exists to support the use of fall TIPS toolkit to reduce and prevent falls in medical-surgical units among adult patients. The research illustrates that different facilities use the TIPS toolkit in their efforts to prevent and reduce falls.
The next aspect of the project will be to implement a pilot change practice based on the availability of not just reliable but also credible evidence (Duff et al., 2020). Based on the results from the pilot intervention, the team will appraise the outcomes before rolling out the entire change practice initiative to reduce falls and disseminate the process to nurses in the unit. As such, the intervention would become part of the routine process and culture in its quality improvement initiatives to attain better patient outcomes.
The use of an appropriate EBP model is essential for change implementation teams to achieve the desired changes in quality care improvement. The Iowa change model remains one of the most popular and easy to use frameworks to implement EBP interventions in healthcare organizations. As illustrated, this model is appropriate for the identified health issue of patient falls among adult patients in medical-surgical units as it will help the change team achieve desired outcomes.
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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.
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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