Reply: 

In order to implement an evidenced based project the nurse must understand the health care system at the local level. The nurse must have an idea of the resources that are available, the demographics and patient population that are affected and the make up of the leadership team at the health care system. According to my preceptor, having the support of leadership is imperative in trying to implement any changes to the organization. The nurse must also understand the leadership style of those in charge of the organization. Transformational leaders inspire both patients and other health providers to achieve common goals that lead to better health outcomes and realization of program goals and objectives (Sfantou et al, 2017). There are various leadership styles, and having a clear understanding of the leadership style of the leaders of the organization, will guide the nurse in presenting and evidenced based proposal that they will be receptive to.

The key to transformational change or any change is to have leadership that is able to understand it, support it, explain it, and move the organization to commit to it (Cowell et al, 2018). I will take into consideration what my preceptor has advised when conducting this project. I will get an understanding of what the nurses are reporting that is leading to turnover, create and evidenced based solution and then present the idea to the leaders of the organization regarding how best to solve the issue. Observing or inquiring about the leadership style of the leaders of the organization will be helpful in creating a proposal that will be positively received. (Nicole)

Understanding the healthcare system at the local level when planning an EBP project is necessary, especially when planning for effective implementation. It facilitates an essential understanding of the available resources for the implementation of the process, and the readiness of the care providers for the implementation of the project is essential in improvising the project’s success (Theobald et al., 2018). Conducting research at the local level facilitates how the implemented EBP would improve the patient care process. It elaborates on the availability or the inadequacy of the necessary resources for facilitating the EPB and ensures that the healthcare facility can effectively facilitate the implementation process.

An effective research process further focuses on understanding the patients’ values and the readiness of the nurses and other care providers to implement the Evidence practice (Sutton et al., 2020). It facilitates effective education for the nurses and the patients in the implementation process to ensure that the nurses and the patients receive the necessary information relating to the implementation of the EBP. While focusing on introducing the PPE in the health system, it is necessary to conduct research at the local level to determine if there are enough resources to facilitate the introduction of the PPE in the care process. It is further necessary to conduct efficient education to sensitize the nurses and the patient on the importance of introducing the PPE in the care practice.

The considerations that I would make in the change project include the involvement of the nursing practitioners, the patients, and the health agencies in implementing the project. The involvement of the various stakeholders in implementing the EBP is essential in facilitating the success of the EBP (Sutton et al., 2020). It ensures that the necessary in the implementation process as it facilitates the success of the project at various levels. The involvement of the health agencies would be essential in ensuring that the best standards and processes are adhered to in the implementation process. The involvement of the patients and nurse, especially through the education process, facilitates the ability of the healthcare practitioners to engage the necessary education to the implementation teams, consequently resulting in more acceptability of the projects.(Margaret)

There are a number of reasons that make having an understanding of the healthcare system important when looking at implementing evidence-based practice (EBP) at the local level. EBP is a problem solving approach that compiles and uses the best available evidence and expertise, that leads to safe patient care and outcomes (Yoo et al, 2019). Knowing the basis of EBP practice it is essential to understand your local healthcare system to be able to fully implement and carry out these practices. What may work for one community may not work for another. A key player in determining the basis of a community is by evaluating local social determinants of health (SDH). These determinants can be described as non-medical factors that influence health outcomes (World Health Organization (WHO), 2022). These conditions are shown in the places where people are born, grow, work, live, and age (WHO, 2022). Nurses and healthcare personnel should take into consideration what factors influence each of these conditions and implement EBP off these findings. This will help guide the direction of implementation and help to ensure the practices implemented will work within the community.

When reflecting on my local community and capstone project there are various factors I can take into consideration. I need to look at the population I will be serving, the type of work they do, and be culturally aware. Many people in my community work in the Trona mines and oil fields surrounding the town. This work includes manual labor and many long days working and using your hands. Many individuals do not want to be out of work for a long length of time, making it easier and more convenient for them to come to their local clinic and have carpal tunnel surgeries performed. An influx of WALANT procedures has been seen due to this. My preceptor made it a point for me to take into consideration that this population of people often “tough things out” and may not show or state that they are in pain. I will have to pay close attention to this and fully evaluate each individual to ensure their pain is adequately controlled during surgeries. (katherine)

Topic DQ2…………………………………………………………………

Udod & Wagner explain that “Kurt Lewin (1951) is known as a pioneer in the study of group dynamics and organizational development. He theorized a three-stage model of change (unfreezing-change-refreezing model) in order to identify and examine the factors and forces that influence a situation” (Force Field Model and The Unfreezing-Change-Refreezing Model, para.1). Lewis is known to have theorized the basics of the change theory and others like Lippitt, Watson, and Westley (1958) modified the theory with additional steps and processes (Udod&Wagner, n.d.).

Lippitt, Watson, and Westley’s theory called the planned change model uses a seven-step process instead of three; “(1) diagnosing the problem; (2) assessing the motivation and capacity for change in the system; (3) assessing the resources and motivation of the change agent; (4) establishing change objectives and strategies; (5) determining the role of the change agent; (6) maintaining the change; and (7) gradually terminating the helping relationship as the change becomes part of the organizational culture” (Udod & Wagner, n.d. Planned Change, para.1).

The planned change model is suited to my change project because the steps in this model focus on the population that is affected by the change placing emphasis on communication skills, establishing rapport, and strategizing problem-solving skills (Udod & Wagner, n.d.). (Rie)

Imogene King’s Theory of Goal Attainment focus on attainment of certain life goals. According to King, the patient is a social being who has three fundamental needs: the need for health information, the need for care that seeks to prevent illness, and the need for care when the patient is unable to help him or herself. Furthermore, it explains the importance of the nurse-patient relationship, working together to set and achieve goals. King’s theory is not far from patient center care. By involving the patient in their care makes them responsible for their care.

Kurt Lewin’s Theory identifies three concepts which are driving forces, restraining forces, and equilibrium. The focus is of change entails creating the perception that a change is needed, then moving toward the new, desired level of behavior and finally solidifying that new behavior as the norm. Driving forces are forces that push in a direction that causes change to occur. Therefore, facilitating change push in the desired direction, being positive. Now, restraining forces are those forces that counter driving forces which can hinder change because they push the person in the opposite direction. This causes a shift in the equilibrium which also opposes change. Equilibrium is a state of being when the driving forces and restraining forces are equal.

The Lewin theory driving force make the most sense for implementing evidence base practice intervention for my change project. Developing change of a new process in can bring about change that will have positive patient outcome. I hope to bring about changed to help decrease mediation errors as well as bringing awareness and education. My preceptor uses this same approach which resulted in changed process within the organization she works. (Nicole)

Roger’s Five-Stage Change Theory involves awareness, interest, evaluation, implementation, and adoption (Nursingworld, 2021). Stage 1 involves imparting knowledge in terms of the reason for change, how it will occur, and who will be involved (Nursingworld, 2021). Stage 2 involves persuading the employees to accept change by relaying essential information and note that attitudes, both favorable, and unfavorable, are formed (Nursingworld, 2021). Stage 3 is deciding whether to ultimately adopt the change by analyzing data and implementing a pilot study or trial of the new processes triggered by the change (Nursingworld, 2021). Stage 4 is actually implementing the change on a more permanent or established basis as the organization evolves to accommodate the change, and stage 5 includes confirming the adoption of the change by the employees responsible for and affected by the change (Nursingworld, 2021).

Lewin’s Change Theory is a three-step model based on the premise that behavior is a dynamic balance of forces working in opposition (Nursingworld, 2021). This theory includes three main steps, which are known as the unfreeze, change, and refreezing stages. The unfreezing stage involves altering behavior to unfreeze or agitate the equilibrium state (Nursingworld, 2021). This stage is necessary especially if there is resistance to change because it helps to overcome adversity and achieve conformity. The second step is to change, which involves the movement of the employees to a new level of equilibrium. This stage helps employees view change from a new perspective, to work together to achieve desired outcomes of change, and to facilitate consistency among management and employees (Nursingworld, 2021). The last stage is the freezing stage, which is known for attaining equilibrium with the newly desired behaviors. Stage 3 occurs after change is implemented so that new behaviors and desired outcomes can be integrated into the organization (Nursingworld, 2021).

For my own topic and subsequent implementation of EBP, I believe Roger’s Five-Stage Change Theory would work best. This is because I would first need to educate the appropriate people on what lateral violence is and why there is such a reason for change. In addition, I will have to state how I believe the change will occur and who will be involved with the process. Second, I would need to show the statistics to nurses and nurse managers and directors to shift their attitudes to see why this change is essential and give them a greater understanding of how the prevalence of lateral violence affects the nursing profession profoundly. Third, those in charge of implementing EBP will determine if this is something they would be willing to adopt into their facility based on the information I am presenting them. The last two steps include the actual implementation and adoption of the EBP if they choose that is a need for their hospital.(Ashley)