NUR 590 Models and Frameworks that can Facilitate Change
NUR 590 Models and Frameworks that can Facilitate Change
NUR 590 Models and Frameworks that can Facilitate Change
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Examine the many models and frameworks for facilitating transformation. Compare the two and explain why one is better for your evidence-based practice idea. Explain your reasoning.
The Star Model describes how specific types of knowledge, such as systematic reviews and clinical practice guidelines, can help move research into practice. It is a model for understanding the knowledge cycles, nature, and qualities that are used in various stages of EBP in translating evidence into clinical decision making. The clinical scholar model was created and implemented to foster an inquiry-driven culture, educate direct care providers, and oversee a mentorship program for EBP and research at the point of care. It started out as an interactive, outcome-oriented instructional program for nurses, but it has since expanded into an interdisciplinary educational program for direct care providers (Melnyk, 2019). The Star Model would be most useful in my evidence-based practice concept. This paradigm examines current practice and employs knowledge to effect change. There is a lot of information for my proposal on both patient and nurse unhappiness with the present mourning procedure when a patient has a miscarriage in the ED. There hasn’t been a lot of research done on the application of best practices and protocols. As a result, the Star Model will enable me to use my understanding of the subject and create a change.
NUR 590 Models and Frameworks that can Facilitate 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.
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Also Read: NUR 590 Comparison of Organizational Readiness Tools
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.
NUR 590 Models and Frameworks that can Facilitate 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
The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp & Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017). Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research. The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.
It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).
NUR 590 Models and Frameworks that can Facilitate Change References:
Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12223
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). p. 434-437. Wolters Kluwer Health.
Two models that facilitate change and are supported by evidence-based practice are Kotter’s Change Management Model and Kurt Lewin’s Change Model. Kotter’s Change Management Model is a standard theory used worldwide that consists of eight stages that focus on the employee’s responses when it comes to change (Kotter, 2019). These eight stages include increasing urgency, building the team, communicating, getting the vision correct, moving things, incorporating change, not giving up, and focusing on short-term goals. Using Kotter’s method allows an organization to achieve successful quantitative and qualitative results while focusing on cost-efficient approaches towards health opportunities, demand for change, and barriers. Kurt Lewin’s Change Model is a standard method that has proven effective management models for change. Lewin’s model has three phases: unfreezing, changing, and refreezing (Hussain et al., 2018). The model aids organizations in better comprehending organizational and structural change. The two different approaches provide valuable insights into how effective change management occurs. When used together, they tend to balance each other out when it comes to the weaknesses of each method one by one. In the evidence-based proposal, Kotter’s model is a better method when focusing on organizational detail.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s Change model: a Critical Review of the Role of Leadership and Employee Involvement in Organizational Change. Journal of Innovation & Knowledge, 3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002
Kotter, J. (2019). John Kotter’s Eight Step Change Model. https://portal.ct.gov/-/media/SDE/Turnaround/School-Improvement-Resources/Kotters_model.pdf
The two models that I reviewed are the Iowa Model of Evidence-Based Practice and the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP).
The Iowa Model was developed by nurses in the 1990’s and then revised in 2015 due to dramatic changes in healthcare (Buckwalter et al., 2017). The revision included translation research and patient engagement (Buckwalter et al., 2017). This model is application oriented and provides a step-by-step guide to the EBP (Evidence Based Practice) process (Buckwalter et al., 2017). This model outlines a multiphase change process with feedback loops. It is widely recognized for its applicability and ease of use by interprofessional teams. It can be used by novice to expert users and can be used in a variety of settings (Buckwalter et al., 2017). Since 2001 there have been over 3900 requests to use the Iowa Model from all 50 states and 130 countries (Buckwalter et al., 2017). It is focused on triggers both problem and knowledge focused. It consists of 11 categories/steps.
These categories/steps include: (Melnyk & Fineout-Overholt, 2019).
1. Identify triggering issues/opportunities: Encourages clinicians to identify questions. Triggers may have data that highlights an area for improvement. Question current practice.
2. Clinical applications: Nurses identify clinically relevant practice questions.
3. State the question or purpose: Includes a clearly stated purpose. Using PPPICO (problem(patient), population, pilot area, intervention, comparison, and desired outcome)
4. Topic Priority: Establish whether it aligns with organizational priorities.
5. Form a team.
6. Assemble and appraise evidence.
7. Sufficient evidence.
8. Design and pilot the practice change.
9. Decide if the change is appropriate for practice.
10. Integrate and sustain practice.
11. Disseminate results
The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is also a model that guides bedside nurses in translating evidence into practice. It was developed by Hospital leadership to accelerate the transfer of new knowledge into practice (Melnyk & Fineout-Overholt, 2019). Bedside nurses evaluated and piloted the model. This model is an open system which can be influenced by both internal and external factors (Melnyk & Fineout-Overholt, 2019) The model starts with an inquiry (question) which leads to a PET (Practice, Question, Evidence and Translation) process (Melnyk & Fineout-Overholt, 2019). Within each phase there are 19 prescriptive steps (Melnyk & Fineout-Overholt, 2019). The process is linear and may be interactive as the process evolves (Melnyk & Fineout-Overholt, 2019) There are ten tools to support the critical steps and online learning modules. The tools were developed by bedside nurses and contain check box formats, definition, and guidelines for use (Melnyk & Fineout-Overholt, 2019). It is simplified and easy to understand. This model may appeal to Nurse Educators as it has been applied in academic settings. The JHNEBP Model provides a structure for EBP education with mentoring, program planning, execution, and outcomes data collection (Friesen et al., 2017).
In comparing the two models both seem similar in many ways. Both seem widely used and easy to use. The one that I would choose for my EBP project would be the Iowa Model of Evidence- Based Practice because it talks more about using a pilot unit. For my project I would like to pilot two units to evaluate and then disseminate to the rest of the organization. A number of clinically important topics have been addressed using the Iowa Model, for example prevention of catheter associated urinary tract infections. This was appealing to me since my project goal is to reduce CAUTI (Catheter Associated Urinary Tract Infection) rates and use through patient/family education and empowerment. This model also talks about patient engagement which applies to my project as well (Melnyk & Fineout-Overholt, 2019).
NUR 590 Models and Frameworks that can Facilitate Change References:
Buckwalter, K.C., Cullen, L., Hanraham, K., Kleiber, C., McCarthy, A.M., Rakel, B., Steelman, V., & Tripp, R.T. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldview on Evidence-Based Nursing, 14 (3), 175-182. https://doi-org.lopes.idm.oclc.org/10.111/wvn.12223.
Friesen, M.A., Brady, J.M., Milligan, R., & Christensen, P.(2017). Findings from a piot study bringing evidence-based practice to the bedside. Worldview on Evidence-Based Nursing, 14 (1), 22-34. https://doi-org.idm.oclc.org/10.111/wvn.12195.
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
Implementation of an evidence-based practice project is usually not a straightforward process hence a need to have an appropriate plan for each phase. Implementation can be supported by using various proven strategies, such as following established models or frameworks for change. Such frameworks or models offer foundations upon which the project can be implemented (Jayatilleke, S., & Lai, 2018). Fortunately, several change models or frameworks exist that can be used to aid the implementation of EBP projects. The implication is that project implementers should choose the most appropriate model, which will not lead to any bias and failures in implementation. Therefore, the purpose of this assignment is to explore the change model or framework which will be used in guiding the implementation of the proposed EBP project and explain how the stages of the change will be used in implementing the project.
The Selected Model For Change
The selected model for change to guide the implementation of this project is Kurt Lewin’s change model. According to this model, change takes place in three different phases. In addition, the process of change is usually associated with two different types of forces, which are the restraining forces and the driving forces (Hussain et al.,2018). While the driving forces enhance the change process, the restraining forces prevent change from occurring. The implication is that for a change process to be successful, the driving forces must be greater than the restraining forces.
The Stages in The Change Model
Kurt Lewin’s change model states that change takes place in three phases. The phases include unfreezing, change, and refreezing. The unfreezing phase is the first phase, where the change implementers create an urgent need for change. Such a step is supported by various statistics that may warrant a need for change. As such, the phase prepares the affected stakeholders for the impending change (Hussain et al.,2018). Effective communication is important in this phase. The next phase is the change phase, where the implementation of the proposed change takes place. In most cases, the proposed change is implemented, and its viability is explored. The last stage is the refreezing stage. This last phase involves supporting the individuals to accept the implemented change and stabilize. In addition, the implemented intervention is embraced as part of the organizational culture and as a new strategy for doing things in the organization.
The Application of The Model in The Proposed Implementation
The project focuses on the application of a CAUTI bundle to help in lowering the rates of CAUTI in the organization. Lewin’s model will be used to manage the change as appropriate. The first phase, which involves unfreezing, will entail informing the organization’s stakeholders of the urgent need to bring down the rates of CAUTI in the facility. In the implementation phase, the staff will be educated on the CAUTI bundle before implementation of the same is undertaken. The final phase will involve refreezing (Muldoon, 2020). At this phase, it is expected that the organization will adopt CAUTI bundles as the standard care for patients to prevent CAUTI.
Conclusion
Evidence-based practice projects are key to improving patient care outcomes in care settings. As such, appropriate strategies should be used to ensure that their implementation is a success. Therefore, this write-up has explored the use of Lewin’s model as a model to help manage the change process. The stages of the change have been described, and how the phases or stages will be used in implementing the proposed change of CAUTI bundle care.
NUR 590 Models and Frameworks that can Facilitate Change References
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002
Jayatilleke, S., & Lai, R. (2018). A systematic review of requirements change management. Information and Software Technology, 93, 163-185. https://doi.org/10.1016/j.infsof.2017.09.004
Muldoon, J. (2020). Kurt Lewin: Organizational Change. The Palgrave Handbook of Management History, 615–632.