Feb 23, 2024 NUR 590 Evidence Based Practice Project Week 4 Assignment
NUR 590 Evidence Based Practice Project Week 4 Assignment
NUR 590 Evidence Based Practice Project Week 4 Assignment
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 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.
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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.
Conclusion
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.
NUR 590 Evidence Based Practice Project Week 4 Assignment References
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
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.
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.
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.
Section D: Change Model
The successful implementation of the proposed evidence-based project will depend on largely on the adopted model of change. Models of change provide frameworks that guide the interventions that are used to introduce the initiative in the clinical settings. Models also provide information about the different ways in which the implementation process of the change can be evaluated. Therefore, this section of the project explores the theory of change that will be adopted in the implementation of the evidence-based practice project.
Selected Model and Relevance to the Project
The selected model for use in the implementation of the project is the transtheoretical model of change. The transtheoretical model of change is also referred as the stages of change model. DiClemente and Prochaska developed it in the 1970s following their study on the experiences of smokers as they quit their smoking behaviors. The transtheoretical model focuses on the steps that individuals take in chancing their behaviors. The model also provides insights into the interventions that implementers of change need to embrace to initiate intentional change. The model is applicable to the project because it provides information on the ways in which gradual adoption of the change initiative can be achieved (Gellman & Turner, 2019). Transtheoretical model proposes that change occurs in steps that include pre-contemplation, contemplation, preparation, action, maintenance, and termination.
Stages and their Application
The first step in the transtheoretical model is pre-contemplation. Pre-contemplation is characterized by the adopters of change not willing to take any action that supports the change in the near future. The adopters are not willing to embrace the change due to their low level of awareness or lack of access to the support that they need to embrace the change. The adopters also have low level of awareness about the negative effect that their existing behaviors have on their health. As a result, they tend to underestimate the benefit of embracing interventions that will contribute positively to their behavior, health and wellbeing (Quartuch et al., 2021). African American women with osteoporosis are not aware of the importance of dietary supplementation of calcium and vitamin D to prevent fractures in this stage. Their low level of awareness affects their participation in healthy behaviors and lifestyle that minimize the risk of fractures. Therefore, they do not show any intentions of embracing dietary supplementation for calcium and vitamin D.
The second step in the transtheoretical model is contemplation. Contemplation is the stage where the adopters of the change begin to engage in healthy behaviors in the near future. The adopters of the change have become aware about the negative consequences of their behaviors. As a result, they explore the benefits as well as risks of adopting healthy behaviors and lifestyles that promote their health. Despite being informed about the benefits of change in their behaviors, the adopters are still ambivalent towards embracing change in this stage (Hagger et al., 2020). African American women will demonstrate the intention to embrace dietary supplementation of calcium and vitamin D in the contemplation stage. They also begin embracing dietary supplementation of calcium and vitamin D in their routines. However, they are unsure of the absolute use of the interventions as a way of minimizing and preventing the risk of fractures among them.
The third step in the model is preparation. Preparation is the stage where the adopters are willing to implement the change within a short period, usually 30 days. The adopters have made the decision to implement the change and use its interventions to promote their desired change in behavior. The adopters believe that changing their behaviors will contribute to their health and wellbeing (Boff et al., 2020). African American women with osteoporosis will have made a decision to implement dietary supplementation of calcium and vitamin D as part of their healthy lifestyle and behavior. They do so with a belief that the use of dietary supplements will improve their health by minimizing their risk of adverse events such as fractures and unnecessary hospitalizations.
The fourth step in the transtheoretical model is action. Action entails the adopters having changed their behaviors and willing to keep implementing additional interventions that will contribute to their positive change in behavior. The adopters modify their lifestyles and behaviors to accommodate the new interventions that contribute their health (Friman et al., 2017). The African American women with osteoporosis will have transformed their lifestyle and behaviors in this stage. They intend to maintain the use of dietary supplementation of calcium and vitamin D to prevent fractures. They also demonstrate willingness to learn about additional interventions that they need to promote their health.
The fifth and sixth stages in the transtheoretical model are maintenance and termination. The adopters of change having sustained their behavioral change characterize maintenance stage. The adopters explore interventions that they need to embrace to prevent relapse to their traditional behaviors and lifestyles. African American women with osteoporosis will have stabilized in the adoption of dietary supplementation of calcium and vitamin D at this step. They therefore explore interventions that they need to prevent relapse to their earlier behaviors that predisposed them to fractures and poor health outcomes due to osteoporosis. The termination stage is the last stage where the adopters do not have the desire to relapse to their unhealthy behaviors (Hagger et al., 2020). The African American women with osteoporosis have incorporated dietary supplementation of calcium and vitamin D into their routines.
Conclusion
Overall, transtheoretical model will be adopted in the implementation of the proposed change. The model will guide the development of the interventions that are needed for the success of the project as well as its evaluation. Transtheoretical model will also provide insights into the interventions that are needed to ensure project sustainability. Therefore, it is anticipated that effective use of the model will contribute to the success of the project.
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