Section A: Organizational Culture and Readiness Assessment
Evidence-based practice (EBP) is an essential component in a care facility that aims to improve quality outcomes to patients. Essentially, the EBP protocols aim to integrate clinical expertise with needs, interests and cultural values of patients in a given healthcare organization (Melnyk, 2016). However, before implementing the EBP, one needs to conduct an Organizational Culture and Readiness Assessment to determine the workability of the proposed framework in the selected health institution.
I, therefore, conducted the assessment in the organization I currently work in to identify the relevance of the proposed EBP. Results from the Organizational Culture and Readiness Assessment using a questionnaire indicated that the care facility is ready to implement the evidence-based practice. This is based on the premise that the stakeholders of the hospital are willing to put into action the EBP protocols to optimize patient care and build the reputation of the facility in the region. The facility I deliver my service in is small, has very limited resources and is not readily accessible to the residents of Englewood in California. However, members of the staff have a conviction that the proposed EBP will improve quality to the facility and enhance its reliability to patients.
In the assessment, out of the twelve responded I interviewed, nine supported the proposed EBP. The participants who vouched for the change suggested that the facility has trailed in quality provision and that time was handy for them to provide services that meet the expectations of clients (Melnyk, 2016). On the other hand, participants against the implementation cited inadequate resources, time wasting to provide educational strategies for the EBP and lack of managerial commitment to comprehend the components of the proposed program.
Section B: Proposal/Problem Statement and Literature Review
PICOT Question: In African American adult diabetic patients, how does cultural competence compared to the current educational approaches influence glycemic control within six months of disease management?
The Project Purpose and Problem Statement
The main purpose of the EBP is to improve health education by providing information on self-care for African American adults diagnosed with diabetes seeking care at our facilities. Concerns have been raised about poor glycemic control for the population especially those on medical reviews (Melnyk, 2016). It has been established that the population relies on traditional and spiritual approaches to combat the condition but this has not garnered evidence of improved care.
Supportive Rationale
African Americans are one of the racial groups in the United States of America disproportionately affected by diabetes due to a higher prevalence rate of the condition among the population compared to non-Hispanic whites. Concerns continue to rise with regard to health education on self-care for the black-Americans since a majority practice lifestyle habits that predispose them to risk of developing diabetes. The high rates of diabetes among the population is attributed to overreliance on traditional diabetes management practices since a majority reside in poor resource setting with limited access to quality healthcare. Besides, most African Americans have low incomes and may seek health services when their diabetic condition is in advanced stages. However, aspects of self-care such as adherence to diabetes medication, dietary choices, and physical exercise are on top of the list as major challenges affecting African Americans with diabetes.
Summary of the Research Conducted
In order to derive the effectiveness of the proposed EBP protocol, literature review search was conducted to find systematic reviews relevant to the PICOT clinical question. The CINAHL medical database was used to search for three keywords of diabetes, African Americans and Self-care [diabet AND (African American OR Black) AND Self-care (Cultural Knowledge OR Health Education). Four study articles were identified and their findings summarized.
The research found is consistent with the clinical question to develop a protocol for self-care education for African American adults with diabetes seeking care at our facility. Studies by Murrock, Taylor, and Marino (2013) indicate that self-management education approaches resulted in significant improvement of glycemic control for black-Americans seeking care at a health facility. The study further recommends the adoption of this EBP in the primary care setting to improve health outcomes to clients seeking care. This study strongly provides information that supports the PICOT clinical question but the outcomes were found to have high attrition rates.
Findings by Bhattacharya (2013) on spirituality indicate that culturally competent interventions with regard to patient education improved quality outcomes as evidenced by improved HbA1c measures among the African Americans adults with diabetes. Besides, the study further illustrates that culturally competent strategies incorporated community health workers into the aspect of care which led to improved glycemic control. Even though the review addressed the PICOT question, it required bilingual professionals to translate evidence into practice and this took a lot of time.
The two studies by Williams et al. (2014) and Byers et al. (2016) supported the use of Diabetes Self-Management Education (DSME) as an aspect of self-care in diabetes management. The first review emphasized on the use of educational materials to illustrate the self-care approaches and describe the patterns of care to encourage positive changes to lifestyle habits especially on dietary choices among black-Americans in rural setting. On the other hand, Byers et al. (2016) recommend the use of guidelines established by the American Association of Diabetes Educators (AADE) to provide educational approaches that are tailored towards the culture and health beliefs of patients. In other words, self-care education should respond to the cultural background of African Americans. While these systematic reviews address the major components of the PICOT clinical question, they were categorized as weak evidence due to a lack of randomized control trials. The second study used a small sample size which compromised the accuracy of the findings as they were based on generalization.
References
Bhattacharya, G. (2013). Spirituality and type 2 diabetes self-management among African Americans in the Arkansas Delta. Journal of Social Service Research, 39(4), 469-482.
Byers, D., Garth, K., Manley, D., & Chlebowy, D. (2016). Facilitators and barriers to Type 2 diabetes self-management among rural African American adults. Journal of Health Disparities Research and Practice, 9(1), 9.
Melnyk, B. M. (2016). Level of Evidence Plus Critical Appraisal of Its Quality Yields Confidence to Implement Evidence‐Based Practice Changes. Worldviews on Evidence‐Based Nursing, 13(5), 337-339.
Murrock, C. J., Taylor, E., & Marino, D. (2013). Dietary challenges of managing type 2 diabetes in African-American women. Women & health, 53(2), 173-184.
Williams, I. C., Utz, S. W., Hinton, I., Yan, G., Jones, R., & Reid, K. (2014). Enhancing diabetes self-care among rural African Americans with diabetes: results of a two-year culturally tailored intervention. The Diabetes Educator, 40(2), 231-239.
In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.
Section A: Organizational Culture and Readiness Assessment
It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness.
an analysis of 250 words from the results of the survey, addressing your organization’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization’s weaker areas.
sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
a summary of your results. The actual survey results do not need to be included.
Section B: Proposal/Problem Statement and Literature Review
In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:
your PICOT into a proposal or problem statement.
a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.
General Guidelines: Section A: Organizational Culture and Readiness Assessment
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.
Re: Topic 2 DQ 2
Population health is determined by ecological, global, and social determinants and factors such as nutrition, genetics, lifestyle, environment, and socioeconomic factors. However, the two key determinants of population health are nutrition and lifestyle (Olshansky, 2017). As a crucial determinant of health, nutrition is perceived in three dimensions: person, family, and community. In rural settings, nutrition is a significant challenge that affects population health as people have limited access to healthy foods. As a result, they are likely to experience calorie deficiency, protein malnutrition, premature deaths, low birth weights, and other issues. Although people have access to healthy foods in the urban regions, they face lifestyle challenges such as less physical activity and obesity due to junk foods (Olshansky, 2017). Environmental pollution influences population health, although the impact is more intensified in rural communities. People in rural regions are more exposed to hygiene, agrochemicals, and insecticides, while those in urban areas are more vulnerable to air and water pollution but are less affected. Health disparity resulting from inequality in household income, gender, and education is another socioeconomic determinant that affects population health (Olshansky, 2017).
The principle of genetics and genomics has also affected population health. For instance, genetic risks can influence the rate of morbidity of a particular disease, such as cancer. Available literature shows that diseases like cancer, Alzheimer’s disease, leukemia, and many others have been associated with genetic risks (Baird, 2017). To properly understand how ecological and global issues, social determinants of health, principles of genetics, and genomes affect population health, the application of translational research is necessary. The reason is that translational research involves four steps in which an issue can be researched, possible interventions examined, and the impact of these recommendations on population health assessed.
References
Baird, P. A. (2017). The role of genetics in population health. In R. G. Evans, M. L. Barer, & T. R. Marmor (Eds.), Why are some people healthy and others not? (pp. 133-160). Routledge.
Olshansky, E. F. (2017). Social determinants of health: The role of nursing. AJN The American Journal of Nursing, 117(12), 11.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
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.
Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, if it may be too costly, or if there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your problem statement before continuing.
Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the problem statement. Section A: Organizational Culture and Readiness Assessment
to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations that may need to be addressed.
Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, or professional expertise.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. Section A: Organizational Culture and Readiness Assessment
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.
Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, if it may be too costly, or if there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your problem statement before continuing.
Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the problem statement.
to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations that may need to be addressed.
Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, or professional expertise.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.
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.
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.
In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:
the selected model or theoretical framework and discuss its relevance to your project.
each of the stages in the change model/framework.
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.
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 setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
the process for delivering the (intervention) solution and indicate if any training will be needed.
an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
the strategies to deal with the management of any barriers, facilitators, and challenges.
the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.You are required to cite five to 10 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.
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 rationale for the methods used in collecting the outcome data.
the ways in which the outcome measures evaluate the extent to which the project objectives are achieved.
how the outcomes will be measured and evaluated based on the evidence. Address validity, reliability, and applicability.
strategies to take if outcomes do not provide positive results.
implications for practice and future research.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.
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.
Throughout this course, you have developed a formal, evidence-based practice proposal.
The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals must be submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed (3,500 and 5,000 words). The cover sheet, abstract, references pages, and appendices are not included in the word count.
Section headings for each section component are required. Evaluation of the proposal in all sections will be based upon the extent to which the depth of content reflects graduate-level critical thinking skills.
Each section (A-F) will be submitted as a separate assignment in Topics 1-6 so your instructor can provide feedback (refer to applicable topics for complete descriptions of each section).
The final paper submission in Topic 7 will consist of the completed project (with revisions to all sections), title page, abstract, compiled references list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms, as previously assigned in individual section assignments.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is 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.
