NUR 590 Week 4 Assignment Evidence-Based Practice Proposal – Section D: Change Model
NUR 590 Week 4 Assignment Evidence-Based Practice Proposal – Section D: Change Model
Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
Patient care problems require practical and sustainable solutions. Such solutions are evidence-based, and their implementation should be supported by leaders, staff, and the target patient groups. Models of change provide change proponents with a systematic approach to change implementation. Most recommend a stepwise approach to change implementation involving problem identification, searching for solutions, and implementing the findings (Duff et al., 2020). They ensure that nurses and other change leaders work towards tangible results. The purpose of this assignment is to describe the selected model for change and its application in the proposed project.
The use of nursing theories is critical to patient care because of the different purposes that they serve. Nursing theories assist in informing every interaction between nurses and patients. Through defining the features of the nurse-patient interaction, these theories shape how nurses develop relationships with patients (Wei et al., 2019). The purpose of most nursing theories is to help nurses identify care needs among patients, articulate what they can do for patients and why they do it, and determine the kind of information to collect to develop care plans. Through theories, nurses can comprehend and evaluate health situations, explain and anticipate certain responses from patients and map out objectives and anticipated outcomes (Bahabadi et al., 2020). These theories also help nurses determine the interventions to deliver, best practices, and selection of productive areas for research. The implication is that nursing theories are fundamental to quality care provision as they help nurses to possess background propositions to offer the best care.
The Selected Model and Relevance
The Iowa model will guide the project implementation process. It promotes evidence-based practice (EBP) in health practice and ensures that organizational change addresses priority patient care concerns (Duff et al., 2020). Its central components include: improving patient outcomes based on scientific evidence, enhancing nursing practice, and helping to monitor healthcare costs. Hanrahan et al. (2019) asserted that utilizing the Iowa model improves nurses’ capacity to utilize EBP in healthcare delivery and work in teams to achieve better outcomes. The proposed project involves utilizing case management in chronic disease management for patients visiting the emergency department. The Iowa model is relevant to the project since it will ensure that the solutions are evidence-based and can achieve the targeted outcomes.
Stages of the Iowa Model
The Iowa Model for EBP integration into practice has eight steps. As Green (2020) explained, the first step involves identifying the trigger necessitating practice change. The second step is determining whether the problem is a priority based on its effects on patient care, health processes, practitioners’ health, and other elements. Next, the change leader identifies a team to help in evaluating and implementing the EBP change. Such a team allows interdisciplinary stakeholders to solve a problem together hence better results. The fourth step is gathering and analyzing appropriate research to guide practice change.
After gathering research (step 4), the next step is to critique and synthesize the research from the highest level of evidence possible. The primary purpose of this step is to evaluate whether the change is scientifically possible (Cullen et al., 2022). The sixth step involved deciding whether there is adequate research to implement a practice change. Next, a pilot program is conducted (step 7), and the results are evaluated (step 8). The changes are then introduced into practice based on the evaluation results. The revised model advises change proponents to disseminate results (Cullen et al., 2022). Dissemination helps health professionals to adopt similar interventions in other settings to improve patient care.
Applying Each Stage of the Iowa Model
Applying the Iowa model in the proposed implementation would first involve identifying the trigger. Currently, a problem-focused trigger has been identified- chronic illnesses for patients visiting the emergency department. The second step would involve determining its priority level. It is a priority requiring immediate intervention since chronic diseases increase the spending of hospital resources by increasing unplanned admissions and emergency department visits (Chiaranai et al., 2018). The interprofessional team for developing, evaluating, and implementing the change would involve the management, departmental leaders, the change proponent, and nurses. Evidence should be sourced from current and scholarly literature supporting the application of case management in chronic diseases management. The research would be further critiqued and synthesized to determine whether there is adequate research to implement case management. A pilot program would then follow to evaluate the effectiveness of case management before full adoption. The concept map (Appendix A) illustrates the application of the Iowa model in the project.
Change models guide nurses in implementing EBP in health practice. They emphasize implementing evidence-based change to improve patient care and other critical health outcomes. The Iowa model is appropriate for the proposed project. It will ensure that an interdisciplinary team works together to implement the proposed change.
Chiaranai, C., Chularee, S., & Srithongluang, S. (2018). Older people living with chronic illness. Geriatric Nursing, 39(5), 513-520. https://doi.org/10.1016/j.gerinurse.2018.02.004
Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa Implementation for Sustainability Framework. Implementation Science, 17(1), 1-20. https://doi.org/10.1186/s13012-021-01157-5
Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: An interpretive description. Implementation Science Communications, 1(1), 1-9. https://doi.org/10.1186/s43058-020-00070-0
Green, C. (2020). Application of the Iowa Model, an evidence-based practice model, when initiating clinical project pilots to evaluate how self-care techniques affect simulated nursing performance. SAGE Publications Ltd. https://dx.doi.org/10.4135/9781529743616
Hanrahan, K., Fowler, C., & McCarthy, A. M. (2019). Iowa model revised: Research and evidence-based practice application. Journal of Pediatric Nursing, 48, 121-122. https://doi.org/10.1016/j.pedn.2019.04.023
In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:
Identify the selected model or theoretical framework and discuss its relevance to your project.
Discuss each of the stages in the change model/framework.
Describe how you would apply each stage in your proposed implementation.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Also Read: NUR 590 Week 3 Assignment Evidence-Based Practice Proposal – Section C: Solution Description
Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.
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.
Amit-Aharon, A., Melnikov, S., & Warshawski, S. (2020). The effect of evidence-based practice
perception, information literacy self-efficacy, and academic motivation on nursing students’ future implementation of evidence-based practice. Journal of professional nursing, 36(6), 497-502. DOI: 10.1016/j.profnurs.2020.04.001.
Cullen, L., Hanrahan, K., Farrington, M., Anderson, R., Dimmer, E., Miner, R., … & Rod, E.
(2020). Evidence-based practice change champion program improves quality care. JONA: The Journal of Nursing Administration, 50(3), 128-134.
DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:
Essential Knowledge for the Profession. Jones & Bartlett Learning.
Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based
practice environment: an interpretive description. Implementation science communications, 1(1), 1-9. DOI: https://doi.org/10.1186/s43058-020-00070-0
Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins.
The success of healthcare organizations is largely dependent on the manner in which evidence-based projects are implemented. It is evident that successful implementation of evidence-based projects in healthcare is largely influenced by active stakeholder involvement in the process. There is also the evidence that a change model should be utilized to ensure the success of the process. The model prepares the adopters for the change and ensures sustainability of the change. Therefore, this section of the research paper explores the change model that will be utilized to ensure the success of my evidence-based project.
The Selected Model and Its Relevance to My Project
The implementation of my evidence-based project will utilize transtheoretical model. Diclemente and Prochaska developed the transtheoretical model of change in the 1970 after observing the manner in which smokers quit their smoking habits. The model is suitable for the project because it provides a better understanding of the motives for individual change in behavior and factors that influence it. It also provides insights into the ways in which lifestyle and behavioral change can be promoted through the creation of awareness among the populations at risk. According to the model, behavioral change is not a sudden occurrence or process. It occurs in a series of steps and a cyclical process. As a result, it fits the proposed project, as it will guide sequential implementation of the change in my institution (Prochaska & Prochaska, 2016). Further, the cyclical nature of change implies that the implementers are able to apply different constructs and behavioral theories to ensure the success of the change, hence, its suitability for the project.
Stages of Change and their Applicability to the Project
According to the transtheoretical model of change, there exist six stages of change. They include precontemplation, contemplation, preparation, action, maintenance, and termination. Each of these stages is applicable to the evidence-practice project as discussed below.
Precontemplation is the first stage of change in the transtheoretical model. The stage is characterized by the adopters not willing to take any action to change their situation. Their lack of willingness is attributed to their low level of awareness associated with their behaviors that are producing negative outcomes to their lives. As a result, they often underestimate the benefits of changing their behaviors and focus more on the disadvantages of changing their behaviors or lifestyles. This stage applies to the proposed change initiative. The African American patients with diabetes type 2 are not aware of the importance of adhering to their prescribed treatment. They do not understand that their lack or low adherence to treatment has adverse outcome on their health (De Chesnay & Anderson, 2019). Consequently, the hold strongly to misinformed information related to effective management of the disease.
This is the second stage in the transtheoretical model. The adopters of the change in this stage are willing to adopt the desired lifestyle and behavioral change. They are also aware about the negative consequences of their behaviors on their health. As a result, they begin exploring the practical solutions that can be adopted to change their circumstances. They also consider the benefits as well as risks of the need for behavioral change. Despite this awareness, they might be reluctant to embrace the desired changes for healthier lives (Hayden, 2017). This stage applies to the proposed intervention. The African American patients become aware of the negative consequences of poor adherence to recommended treatment. They begin to explore the available interventions that can be adopted to improve their adherence. However, ambivalence among them might still hinder the adoption of the desired lifestyle and behavioral modifications to increase their level of adherence to treatment.
The adopters in this stage are willing to take action for their health problem within a shorter period (usually 30 days). They begin exploring small steps that will ensure that they successfully embrace the needed change. The steps help them in guiding the adoption of new healthy behaviors or lifestyles that will promote their health and wellbeing (Potter et al., 2016). This stage is also applicable to the proposed change. The adopters of the change are aware of the negative consequences of lack of or poor adherence to treatment. As a result, they take small steps that will promote their adherence in the end. The proposed intervention will be embraced by a majority of the population to achieve their desired health goals.
The adopters in this stage have experienced a recent change in their behavior. They are willing to progress with the adoption of the recommended interventions to promote further behavioral change. As a result, they modify their problematic behaviors by acquiring new healthy behaviors that will promote their health (Hayden, 2017). The African American patients with diabetes type 2 will have sustained their behavioral change for a substantial period (six months) at this stage. As a result, they constantly seek new behaviors that will increase their adherence. They put the recommendations from the health information technologies into their daily routines.
The adopters in this stage have had more than six months of continuous behavioral and lifestyle change. As a result, the focus of the adoption of change is prevention of relapse to earlier behaviors. Motivators need to be provided to ensure sustainability in the change process (Potter et al., 2016). The African Americans with diabetes type 2 have shown significant dedication to behavioral and lifestyle changes in this stage. Therefore, they need to be motivated to focus more on their success in order to prevent relapse to their earlier behaviors.
This is the last stage in the model where the adopters are no longer willing to relapse to their earlier behaviors. Sustainability in the change process has been achieved (Little, Sillence & Joinson, 2016). The African American patients will have successfully embraced the change in this stage. They are not willing to relapse to unhealthy behaviors that contributed to poor or lack of adherence to treatment among them. Consequently, health promotion is achieved in this phase.
The transtheoretical model is the most appropriate for the proposed change. It will provide a stepwise approach towards the implementation of change. Its successful use will minimize the risk of resistance from the adopters. It will also ensure sustainability of the desired interventions to promote lifestyle and behavioral change among the adopters. Therefore, it proves effective for the proposed change in this project.
De Chesnay, M., & Anderson, B. (2019). Caring for the Vulnerable. Jones & Bartlett Learning.
Hayden, J. (2017). Introduction to health behavior theory. Jones & Bartlett Learning.
Little, L., Sillence, E., & Joinson, A. (Eds.). (2016). Behavior change research and theory: psychological and technological perspectives. Academic Press.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book. Elsevier health sciences.
Prochaska, J. O., & Prochaska, J. M. (2016). Changing to thrive: using the stages of change to overcome the top threats to your health and happiness. Simon and Schuster.