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NUR 590 Models and Frameworks that can Facilitate Change

NUR 590 Models and Frameworks that can Facilitate Change

NUR 590 Models and Frameworks that can Facilitate Change

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Examine the many models and frameworks for facilitating transformation. Compare the two and explain why one is better for your evidence-based practice idea. Explain your reasoning.
The Star Model describes how specific types of knowledge, such as systematic reviews and clinical practice guidelines, can help move research into practice. It is a model for understanding the knowledge cycles, nature, and qualities that are used in various stages of EBP in translating evidence into clinical decision making. The clinical scholar model was created and implemented to foster an inquiry-driven culture, educate direct care providers, and oversee a mentorship program for EBP and research at the point of care. It started out as an interactive, outcome-oriented instructional program for nurses, but it has since expanded into an interdisciplinary educational program for direct care providers (Melnyk, 2019). The Star Model would be most useful in my evidence-based practice concept. This paradigm examines current practice and employs knowledge to effect change. There is a lot of information for my proposal on both patient and nurse unhappiness with the present mourning procedure when a patient has a miscarriage in the ED. There hasn’t been a lot of research done on the application of best practices and protocols. As a result, the Star Model will enable me to use my understanding of the subject and create a change.

My experience with my leadership so far has been mostly positive. There was one instance that I will never forget when this executive leader, who is supposed to hold one of the highest positions in the hospital, came to visit our unit during our morning huddles. We discussed the new staffing method the hospital is about to implement, known as the NHPPD (Nursing actual Hours Per Patient Day) method. Of course, questions about patient acuities came up. Our unit is known for caring for acute medical psyche geriatric patients and is the designated acute medical-surgical- COVID unit. Our concern, of course, is patient acuities. The presenter did not answer many of our questions directly or clearly. Finally, the executive leader said, “If you are not happy with the staffing method, the door is open for you.” For us staff, it simply means shut up and suck it up, or you may be free to resign. I understand that being a leader is stressful, and you may not be able to please everybody, but still, you are being looked up to, and your knowledge, decisions, and attitude as a leader your subordinates are following as an inspiration. Patience is a virtue. A leader should be a force to calm down and bring balance. People look up to you for answers and solutions if there is an issue. Clearly, that leader did not show patience or compassion to her staff.

Resource:
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.
Change facilitation requires forethought and intentional planning and execution if a well-supported, sustainable change is going to be made on a larger scale – especially in healthcare. Evidence-base practice models may include theoretical models grouped into evidence-based practice/research utilization and knowledge transformation processes, strategic organizational change theory or knowledge exchange and synthesis for application and inquiry (Melnyk & Fineout-Overholt, 2019). However, it is becoming more widely acknowledged that a formalized approach must be considered to successfully implement these evidence-based models.

Also Read: NUR 590 Comparison of Organizational Readiness Tools

https://nursingassignmentgurus.com/nur-590-models-and-frameworks-that-can-facilitate-change/

Eight different models have been identified as key drivers for evidence-based integration and change management. These include: 1. The Stetler Model of Evidence-Based Practice, 2. The Iowa Model of Evidence-Based Practice, 3. The Model for Evidence-Based Practice Change, 4. The Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP, 6. The Clinical Scholar Model, 7. The Johns Hopkins Nursing Evidence-Based Practice Model, and 8. The Stevens Star Model of Knowledge Transformation (Melnyk & Fineout-Overholt, 2019).

Upon comparing the Stetler Model and Johns Hopkins Model, the Stetler Model has been regularly revised, and involves integrating evidence-base practice information into practical, sustainable day to day standards for patient care. With critical thinking and utilization of both internal and external evidence to support practice change, the Stetler Model hinges on five phases, and multiple steps to identify and support use of evidence, determined by critical thinking (Melnyk & Fineout-Overholt, 2019). A “toolkit” of sorts has been developed to implement consensus guidelines and evidence-base practice change. Upon comparison, the Johns Hopkins Model supports its use by bedside registered nurses with aim to implement research results in an evidence-based practice format. The key objective is to make it easy for direct caregivers to make change at a grass-roots level, while positively impacting patient outcomes in a meaningful way. A problem-solving approach to address clinical questions, the 18-step process allows for non-randomized control trial designed evaluations and quality improvement initiatives to take place(Melnyk & Fineout-Overholt, 2019).. With mindfulness that registered nurses encounter challenges that require a fix “tomorrow”, with potential use of nonresearch evidence by use of four pathways.

For my PICOT with aim to reduce occurrence of CLABSIs in patients with a central line, I believe either model could be used to implement meaningful change. However, the Stetler model is better suited for a randomized control trial approach, which is the method I believe to be best suited to gain the most sound, valid and reliable results. By way of using critical thinking and various types of evidence (internal AND external), the Stetler model allows for easy implementation of evidence gathered by way of a toolkit and use of consensus guidelines and policy change.

References

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539
The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp & Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017). Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research. The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.
It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).

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NUR 590 Models and Frameworks that can Facilitate Change
NUR 590 Models and Frameworks that can Facilitate Change

References:

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12223

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). p. 434-437. Wolters Kluwer Health.

Two models that facilitate change and are supported by evidence-based practice are Kotter’s Change Management Model and Kurt Lewin’s Change Model. Kotter’s Change Management Model is a standard theory used worldwide that consists of eight stages that focus on the employee’s responses when it comes to change (Kotter, 2019). These eight stages include increasing urgency, building the team, communicating, getting the vision correct, moving things, incorporating change, not giving up, and focusing on short-term goals. Using Kotter’s method allows an organization to achieve successful quantitative and qualitative results while focusing on cost-efficient approaches towards health opportunities, demand for change, and barriers. Kurt Lewin’s Change Model is a standard method that has proven effective management models for change. Lewin’s model has three phases: unfreezing, changing, and refreezing (Hussain et al., 2018). The model aids organizations in better comprehending organizational and structural change. The two different approaches provide valuable insights into how effective change management occurs. When used together, they tend to balance each other out when it comes to the weaknesses of each method one by one. In the evidence-based proposal, Kotter’s model is a better method when focusing on organizational detail.
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 & Knowledge, 3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002
Kotter, J. (2019). John Kotter’s Eight Step Change Model. https://portal.ct.gov/-/media/SDE/Turnaround/School-Improvement-Resources/Kotters_model.pdf
The two models that I reviewed are the Iowa Model of Evidence-Based Practice and the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP).
The Iowa Model was developed by nurses in the 1990’s and then revised in 2015 due to dramatic changes in healthcare (Buckwalter et al., 2017). The revision included translation research and patient engagement (Buckwalter et al., 2017). This model is application oriented and provides a step-by-step guide to the EBP (Evidence Based Practice) process (Buckwalter et al., 2017). This model outlines a multiphase change process with feedback loops. It is widely recognized for its applicability and ease of use by interprofessional teams. It can be used by novice to expert users and can be used in a variety of settings (Buckwalter et al., 2017). Since 2001 there have been over 3900 requests to use the Iowa Model from all 50 states and 130 countries (Buckwalter et al., 2017). It is focused on triggers both problem and knowledge focused. It consists of 11 categories/steps.
These categories/steps include: (Melnyk & Fineout-Overholt, 2019).
1. Identify triggering issues/opportunities: Encourages clinicians to identify questions. Triggers may have data that highlights an area for improvement. Question current practice.
2. Clinical applications: Nurses identify clinically relevant practice questions.
3. State the question or purpose: Includes a clearly stated purpose. Using PPPICO (problem(patient), population, pilot area, intervention, comparison, and desired outcome)
4. Topic Priority: Establish whether it aligns with organizational priorities.
5. Form a team.
6. Assemble and appraise evidence.
7. Sufficient evidence.
8. Design and pilot the practice change.
9. Decide if the change is appropriate for practice.
10. Integrate and sustain practice.
11. Disseminate results

The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is also a model that guides bedside nurses in translating evidence into practice. It was developed by Hospital leadership to accelerate the transfer of new knowledge into practice (Melnyk & Fineout-Overholt, 2019). Bedside nurses evaluated and piloted the model. This model is an open system which can be influenced by both internal and external factors (Melnyk & Fineout-Overholt, 2019) The model starts with an inquiry (question) which leads to a PET (Practice, Question, Evidence and Translation) process (Melnyk & Fineout-Overholt, 2019). Within each phase there are 19 prescriptive steps (Melnyk & Fineout-Overholt, 2019). The process is linear and may be interactive as the process evolves (Melnyk & Fineout-Overholt, 2019) There are ten tools to support the critical steps and online learning modules. The tools were developed by bedside nurses and contain check box formats, definition, and guidelines for use (Melnyk & Fineout-Overholt, 2019). It is simplified and easy to understand. This model may appeal to Nurse Educators as it has been applied in academic settings. The JHNEBP Model provides a structure for EBP education with mentoring, program planning, execution, and outcomes data collection (Friesen et al., 2017).
In comparing the two models both seem similar in many ways. Both seem widely used and easy to use. The one that I would choose for my EBP project would be the Iowa Model of Evidence- Based Practice because it talks more about using a pilot unit. For my project I would like to pilot two units to evaluate and then disseminate to the rest of the organization. A number of clinically important topics have been addressed using the Iowa Model, for example prevention of catheter associated urinary tract infections. This was appealing to me since my project goal is to reduce CAUTI (Catheter Associated Urinary Tract Infection) rates and use through patient/family education and empowerment. This model also talks about patient engagement which applies to my project as well (Melnyk & Fineout-Overholt, 2019).
References:
Buckwalter, K.C., Cullen, L., Hanraham, K., Kleiber, C., McCarthy, A.M., Rakel, B., Steelman, V., & Tripp, R.T. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldview on Evidence-Based Nursing, 14 (3), 175-182. https://doi-org.lopes.idm.oclc.org/10.111/wvn.12223.
Friesen, M.A., Brady, J.M., Milligan, R., & Christensen, P.(2017). Findings from a piot study bringing evidence-based practice to the bedside. Worldview on Evidence-Based Nursing, 14 (1), 22-34. https://doi-org.idm.oclc.org/10.111/wvn.12195.
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539 

The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp & Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017). Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research. The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.

It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).

References:

 

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing14(3), 175–182. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12223

 

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). p. 434-437. Wolters Kluwer Health.

 

Two models that facilitate change and are supported by evidence-based practice are Kotter’s Change Management Model and Kurt Lewin’s Change Model. Kotter’s Change Management Model is a standard theory used worldwide that consists of eight stages that focus on the employee’s responses when it comes to change (Kotter, 2019). These eight stages include increasing urgency, building the team, communicating, getting the vision correct, moving things, incorporating change, not giving up, and focusing on short-term goals. Using Kotter’s method allows an organization to achieve successful quantitative and qualitative results while focusing on cost-efficient approaches towards health opportunities, demand for change, and barriers. Kurt Lewin’s Change Model is a standard method that has proven effective management models for change. Lewin’s model has three phases: unfreezing, changing, and refreezing (Hussain et al., 2018). The model aids organizations in better comprehending organizational and structural change. The two different approaches provide valuable insights into how effective change management occurs. When used together, they tend to balance each other out when it comes to the weaknesses of each method one by one. In the evidence-based proposal, Kotter’s model is a better method when focusing on organizational detail. 

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

Kotter, J. (2019). John Kotter’s Eight Step Change Model. https://portal.ct.gov/-/media/SDE/Turnaround/School-Improvement-Resources/Kotters_model.pdf