NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay
In the implementation of new initiatives in healthcare settings, change models are critical. The models reveal the strategies to be used in change implementation. They also include information about the outcome data that will be used for evaluation. As a result, this section of the project looks into the change model that will be used to implement the change.
The trans-theoretical model of behavioral change will be used in this project. After researching how smokers quit smoking and the factors that influenced the process, DiClemente and Prochaska developed the trans-theoretical model in the 1970s. The model looks into people’s decisions to embrace change as well as the behaviors needed to influence the process. According to the trans-theoretical model, behavioral change is a cyclical process. Individuals embrace change in a series of steps that determine the duration of the change. The trans-theoretical model is applicable to the proposed project because it provides insights into the determinants of change. It also allows for the determination of the success of the strategies implemented at each stage of the project (Cavaiola & Smith, 2020). Finally, it outlines a step-by-step process for implementing and assessing the level of change adoption in an organization.
The trans-theoretical model is developed in stages. Among the steps are precontemplation, contemplation, preparation, action, maintenance, and termination. Each step of the trans-theoretical model applies to the proposed change initiative. The trans-theoretical model begins with pre-contemplation. When people have no plans to take action to improve their situation, they are in pre-contemplation. Because they are unaware of the negative consequences of their actions, determining the need for change in their daily routines is difficult. This stage is concerned with the proposed initiative. Nurses are oblivious to the significance of implementing evidence-based strategies to reduce the prevalence of catheter-associated urinary tract infection (Gellman & Turner, 2019). As a result, they have no immediate plans to take action.
Contemplation is the second stage of the trans-theoretical model. This is the stage at which people become aware of the negative consequences of their current actions. As a result, they are eager to act in the near future. Adopters also consider the advantages and disadvantages of changing their behaviors. However, there is a lot of ambiguity among them. This step is relevant to the proposed initiative because it raises nurses’ awareness of 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 investigate the advantages of interventions such as meatus cleaning with 0.1% chlorhexedine over their standard practice of using normal saline. Nurses emphasize both the benefits and risks of behavior change.
The model’s third stage is preparation. This is the stage at which change adopters are ready and willing to take action related to the change in a short period of time. Small steps are taken by the adopters to contribute to the desired behavioral change. They believe that the change will benefit them and their daily activities (Gellman & Turner, 2019). In this step, nurses are ready to implement the proposed initiative. They begin implementing the initiative on a small scale to assess its impact on patient outcomes. Nurses believe that implementing the initiative will result in better care outcomes.
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Assessment Description
Applying a ensures that a process is in place to guide the efforts for . In 500-750 words, discuss the model or framework you will use to implement your evidence-based practice proposal project. You will use the model or framework you select in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.
Include the following:
- and discuss its relevance to your project.
- Discuss each of the stages in the .
- Describe how you would apply each stage of the model or theoretical framework in your proposed implementation.
- Create a concept map for the you selected to illustrate how it will be applied to your project. Attach this as an appendix at the end of your paper.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing
1.2 Apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level.
Resources
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Guidelines and Measures
Study “Guidelines and Measures,” located on the Agency for Healthcare Research and Quality website.
https://www.ahrq.gov/gam/index.html
Study Designs
Review “Study Designs,” located on the Centre for Evidence Based Medicine (CEBM) website.
https://www.cebm.ox.ac.uk/resources/ebm-tools/study-designs
Evidence Based Medicine: Levels of Evidence
Read “Evidence Based Medicine: Levels of Evidence,” by the University of Illinois/Chicago’s Library of the Health Sciences at Peo
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http://researchguides.uic.edu/content.php?pid=232200&sid=1921074
Nursing Best Practice Guidelines
Investigate the Nursing Best Practice Guidelines page of the Registered Nurses Association of Ontario (RNAO) website.
http://www.rnao.org/Page.asp?PageID=861&SiteNodeID=133
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.
NUR 590 Topic 3 DQ 2
Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.
The Star Model explains how specific forms of knowledge, such as the systematic review and the clinical practice guideline, are solutions for moving research into practice. It is a model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various phases of EBP in moving evidence into clinical decision making. The clinical scholar model was developed and implemented to promote the spirit of inquiry, educate direct care providers, and guide a mentorship program for EBP and the conduct of research at the point of care. It began as an interactive, outcomes-oriented educational program for nurses but has evolved into an interdisciplinary educational program for direct care providers (Melnyk, 2019). In my evidence-based practice proposal, the Star Model would be most beneficial. This model reviews current practice and applies knowledge for change. For my proposal, there is a lot of research on both patient and nurse dissatisfaction with the current bereavement process when a patient experiences a miscarriage in the ED. There is not a lot of research on implementation of better practice and protocols. Therefore, the Star Model will allow for me to take the knowledge of the subject and develop a change.
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.
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
