NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence
I anticipate issues with my project’s proposed implementation, including financial difficulties. My study is centered on the significance of continuous CPR during defibrillation. CPR has long been focused on the airway, breathing, and circulation. Recently, the American Heart Association announced that circulation would take precedence over cardiopulmonary resuscitation (American Heart Association., n.d.). This means that it has been demonstrated that early and continuous high-quality compressions improve circulation and perfusion during CPR, thereby improving patient outcomes. According to Clark et al., 2019, interruptions in chest compressions lasting more than 10 seconds are associated with poor outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting physicians and nurses to accept the new evidence-based practice is a significant barrier to implementation.
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People’s habits are extremely difficult to change, especially if they have been doing so for a long time. To encourage staff buy-in to this new practice, a significant amount of education and support from leadership, as well as clinical education, will be required. In addition, simulation studies revealed that ECG devices and the LUCUS device were the most effective for performing continuous compressions during defibrillation. These devices are very expensive and may be out of reach for small rural community hospitals. Small community hospitals will be unable to provide patients with the most up-to-date evidence-based practice care due to a lack of funding. This is not only a barrier to implementation, but also to providing the best possible care to the patient.
To assess the organization’s readiness, capacity, and strength to change and implement this project, I would use The Organizational Readiness to Change Assessment (ORCA) tool. For a project of this size, I believe this tool would be capable of assessing all areas of change in order to determine whether the organization is a good fit for the project and vice versa.
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When implementing a project, it is always crucial to foresee any potential problems before they materialize. As a result, I anticipate a few issues with the proposed implementation of my project. Financial concerns were the first identified barrier for the intended execution of my evidence-based project, and they remain so. I was able to identify a few financial management approaches, including the participation of senior management. Gaining the senior leadership team’s support will be easier if you are entirely transparent and honest with them about the implementation approach, including costs and cost-cutting measures. Another cost-cutting measure would be to form a team of subject matter experts and educators for the Physician Orders for Life-Sustaining Treatment (POLST) program using the system’s Respecting Choices Model. As the program is created within the system, the cost of accessing outside resources will reduce.
Lack of clinician support for the program and change management is the second anticipated problem.
Education, engagement, and communication are key tactics to address this issue.
Modern best practices, refresher training, audits, and reviews are all part of the education.
The engagement tactics include assuring stakeholder involvement, uniform workflow, teamwork, and trust in their job. Current POLST literature, events, regular updates on educational and participation opportunities, and newsletter development are just a few of the communication techniques.
NUR 590 Topic 2 DQ 2
Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.
It is best to anticipate any potential issues ahead of time, as with any project implementation. As a result, I anticipate a few potential issues with the proposed implementation of my project. Financial concerns have been identified as the first anticipated issue for the proposed implementation of my evidence-based project and will continue to be so. I was able to identify a few strategies to help with the financial issues, including involving executive leadership in the process. Transparency with the executive leadership team about the implementation plan, including costs and cost-cutting measures, will help you gain their support. Another financial strategy would be to put together a team of subject matter experts/educators for the Physician Orders for Life-Sustaining Treatment (POLST) program, which would use the Respecting Patients system.
The second foreseen issue is a lack of clinician buy in to the program and change management. In order to address this area education, engagement, and communication are necessary strategies. The education will include up-to-date best practices, refresher courses, audit, and review. The engagement strategies include ensuring confidence in their work, standardized workflow, ensuring collaboration and stakeholder involvement. The communication strategies include ongoing updates on education and engagement opportunities, events, current POLST literature, and development of newsletter.
The third foreseen issue is lack of quality of the POLST process and order sets. Quality of the work is a multifactorial problem; in that it relies heavily on the first two foreseen issues. “The quality of POLST documentation is only as good as the conversations that precede it” (Abbott, 2019, p. 297). Therefore, if there is a lack of financial support or clinician buy in, ultimately leading to a reduction in POLST quality.
Research on POLST implementation is actively being reviewed and updated therefore in order to ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence Reference
Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine, 73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021
The only issue I see with the proposed implementation of my project is allowing both nurses and patients the time to get used to the implemented process. Most organizational change initiatives fail because we apply strategies that are not tailored for the structure of the concerned organization. I work at the VA in Lancaster and our structure is a healthy one. Changing a healthy structure requires trust, clarity, and integrity. Employees are accountable for what they do. If they need skills, they can get trained or ask support to their managers. Anyone in the organization, not only managers, is likely to ask questions like: “When will you be ready?” or “Have you tested the quality of your realization?” Everyone is accountable to their colleagues. Here are the guidelines to follow to identify the most appropriate change approach. It decomposes the movement from the current state to the future state in five steps (Cavarec, 2014):
- Formulate change
- Plan change
- Implement change
- Manage transition
- Sustain change
Threats to sustainability can be identified at the start of a project as well as when it is ready for implementation. One example is the National Health Service Sustainability Model, which is used to identify issues that affect the long-term success of quality improvement projects. Process control boards, performance boards, standard work, and improvement huddles are tools that can help sustain improvement (Silver et al., 2016).
Investments in new clinical practices do not end with their developers; enormous effort and resources are devoted to bringing new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the formation of knowledge brokers, evidence-based practice committees or teams, and the identification of opinion leaders and champions to support practice excellence (Virani et al., 2009).
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American Heart Association . (n.d.). CPR Facts and Stats. cpr.heart.org. https://cpr.heart.org/en/resources/cpr-facts-and-stats.
Clark, L. R., McDannold, R., Mullins, M., & Bobrow, B. (2019). Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA. Circulation, 140(Suppl_2), A458-A458.
The first issue with every proposed implementation of many projects is that people avoid change due to fear of failure to adapt to the new system, losing the comfort zone and lack of confidence in the choice, or maybe a previous bad experience when workflow changes. Lack of communication might be another problem that makes the project fails. I should be more vigilant with this problem with effective communication, timely and transparent methods of communication to ensure that all stakeholders are involved in the process ((Project.2021). The availability of a workforce is another problem. For project success, it is vital to assess the available workforce to determine if additional staff and skillsets are required to complete the project. As a leader, ensure that the project stakeholders are on the same page and have a clear vision by inviting them to the project plan to shape and provide feedback actively.
An evidence-based approach involves an ongoing, critical review of research literature to determine what information is credible, and what policies and practices would be most effective given the best available evidence. It also involves rigorous quality assurance and evaluation to ensure that evidence-based practices are replicated with fidelity and that new practices are evaluated to determine their effectiveness( nicic.gov).
Projects: (2021). 9 Project management Challenges and How to Overcome them. https://kissflow.com/project/project-management-challenges.
National Institute of Corrections. (n.d). Evidence-based Practices (EBP). https://nicic.gov/projects/evidence-based-practice-ebp.
From an institutional standpoint, I do not foresee any issues with implementing my EBP Project because the nurses are already engaged in patient education and have the resources to implement the project. However, patient compliance and adherence may prove to be problematic. According to Pan et al (2019), noncompliance with treatment regimens is primarily responsible for uncontrolled blood pressure among patients diagnosed with hypertension.
Before implementing change, organizations need to assess readiness for change. Therefore, it is imperative that organizations analyze systems, processes, and more importantly people when conducting change readiness. As cited in Borges & Camila (2020), 70% of organizational change fail due to lack. of employee adoption of the changes. Change readiness assessments can aid in facilitating change by collecting quantitative and qualitative data measurements about where readiness gaps may exist.
Once the change readiness assessment has been conducted, data summarized and reviewed, and issues addressed, change can be initiated. John Kotter’s 8 Step Change Model would be most appropriate because it involves establishing, maintaining, and sustaining change. Kotter’s model states that organizational change is vital to be successful (Kuo & Chen, 2019). The eight steps of change in Kotter’s model are: create urgency, organize a guiding team, develop a clear and concise vision and strategy, communicate the vision, utilize empowerment to remove obstacles or barriers, create short-term victories, build on the change, and cement changes in culture (Kuo & Chen, 2019).
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence References
Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach. Journal of Organizational Change Management, 33(5), 667-681. doi: http://dx.doi.org.lopes.idm.oclc.org/10.1108/JOCM-09-2019-0279
Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4). https://doi.org/10.1371/journal.pone.0213496
Pan, J., Wu, L., Wang, H., Lei, T., Hu, B., Xue, X., & Li, Q. (2019). Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine, 98(27), e16116. https://doi.org/10.1097/MD.0000000000016116
As with any change, there is stress on an organization or its employees during the process of change; even good change causes stress to employees because their processes are altered, forcing them out of their comfort zone (Ost et al., 2020). Change has moments of unacceptance in every population, from nursing to the janitor. In my project of teaching a new practice change from EBL to QBL, I anticipate change stress and pushback due to a lack of trust in this new process. The first step in understanding where the population of an EBP project is ready to accept is to use assessment tools such as a SWOT analysis to address readiness (Renalt, 2021). Once barriers have been identified, a plan can be developed to address those barriers and navigate around them. By removing barriers, acceptance of a change is made easier.
A large problem area in an organization is transformation or change. Implementing or using a change management tool such as ADKAR will also aid in the success of a project. ADKAR is an acronym that stands for the following terms: A= beginning with awareness, presenting the issue, why it is a problem, or why a change is needed.
D= creating a desire to become involved in the process, as well as a desire to see how this will improve practice and outcomes. K = providing knowledge or improving knowledge in the process by providing research for staff to understand. A= abilities, or an assessment of the abilities of the nurse involved, such as whether they have the necessary tools, understanding, and equipment. Finally, R = reinforcement or circling back to address issues that arose during the development and re-enforcement of a practice’s usage (Pawl & Anderson, 2017).
As the project leader, you must be aware that there may be pushback. You must also be self-aware in order to assess and create a support system around yourself when “hiccoughs” occur and a process receives a lot of pushback.
Assessing or comprehending your emotions, as well as the intellectual intelligence of those you lead or teach, will assist you in remaining focused and seeking solutions.
Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse, 40(3), 59–63. https://doi.org/10.4037/ccn2020963
Pawl, J. D., PhD, RN, OCN, CNE, & Anderson, L. S., PhD, RN. (2017). The use of change theory to facilitate the consolidation of two diverse Bachelors of science in Nursing programs. Nursing Outlook, (65), 233–239. Retrieved May 4, 2021, from
Renalt, V. (Ed.). (2021). SWOT analysis: Strengths, Weakness, Opportunities and Threats. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main
A potential barrier to implementing my project of addressing nursing occupational stress is obtaining acceptance from the established organizational structure. Nursing is the largest occupation in health care therefore issues that affect nursing affect the healthcare system on multiple levels. Because nursing is a part of virtually every level of a healthcare system, it is critical to have organizational readiness for any changes that are necessary to address the issue of nurse overload and burnout.
Recent studies evaluated the readiness for change regarding nursing related issues in a large private hospital and a government hospital. Per the study, neither hospital indicated that they were ready to include nursing staff on committees that could influence change to factors that contribute to nursing occupational stress, such as committees that plan policy and strategy (Mrayyan, 2020).
Another study evaluated strategies and tools used by members of leadership to implement change within their organization. The study sought to identify which strategies would encourage change and which ones would impede change (Gabutti et al., 2022). Changes to policies and procedures can be an expensive undertaking, so it is beneficial to determine which elements will help facilitate change so that they can be invested in, and which ones will be barriers to change so that unnecessary costs could be avoided (Gabutti et al., 2022).
Gabutti et al. (2022), identified nine different domains that influence a hospital’s organizational readiness to change. The nine domains consist of internal and external cultural influences, internal hierarchical structures, and financial influences, to name a few. A strategy that can be used to create and sustain beneficial change is to find and emulate organizations that are similar in structure and purpose that have implemented change successfully (Gabutti et al., 2022).
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence References:
Gabutti, I., Colizzi, C., & Sanna, T. (2022). Assessing Organizational Readiness to Change through a Framework Applied to Hospitals. Public Organization Review, 1–22. Advance online publication. https://doi.org/10.1007/s11115-022-00628-7
Mrayyan M. T. (2020). Nurses’ views of organizational readiness for change. Nursing forum, 55(2), 83–91. https://doi.org/10.1111/nuf.12393
I agree with you that nursing is the largest occupation in healthcare. Therefore, any form of interference in nursing activities disrupts healthcare system. Therefore, healthcare providers ensure that they have effective nursing practice. Also, employing competent healthcare workers has enabled healthcare organizations to guarantee exceptional nursing practice (Bezerra, 2020). Healthcare experiences continuous evolution. Therefore, nurses and healthcare facilities whether private or public are expected to be ready for change. Unfortunately, readiness for change is a weakness of different healthcare institution.
Some healthcare workers are resistance to change due to the unknown fear. Incompetence among other healthcare workers scare them to embrace change. Therefore, poor readiness for change has slow down the effort to incorporate change in healthcare environment (Lira et al., 2020). Most healthcare organizations and providers entrust their leadership in readying healthcare workers and related stakeholders for change. Perfect nursing leaders understand best strategies of implementing change. Changes to policies and procedures can be an expensive undertaking, so it is beneficial to determine which elements will help to facilitate change.
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence References
Bezerra, I. M. P. (2020). State of the art of nursing education and the challenges to use remote technologies in the time of corona virus pandemic. Journal of Human Growth and Development, 30(1), 141-147. http://dx.doi.org/10.7322/jhgd.v30.10087.
Lira, A. L. B. D. C., Adamy, E. K., Teixeira, E., & Silva, F. V. D. (2020). Nursing education: challenges and perspectives in times of the COVID-19 pandemic. Revista brasileira de enfermagem, 73(suppl 2), e20200683. https://doi.org/10.1590/0034-7167-2020-0683
I foresee a few issues/ barriers with the implementation of my project. My innovation includes communication via the EHR/telehealth by sending photographs or videos to healthcare providers to improve infant safe sleep practices and reduce sudden unexpected infant death (SUID) rates among African American populations. One issue with this implementation includes mothers/parents not responding to prompts to send photos/videos of their infant sleep practices.
One randomized controlled trial by Canty et al. (2020) that looked at the effectiveness and feasibility of this kind of innovation. They found that photograph submission rates were lower than they expected throughout the study. This could be because the first couple of months of an infant’s life is an especially busy time for parents, so communicating with researchers and responding to their prompts was not a priority at the time (Canty et al., 2020). One strategy to improve photo/video submission rates could be having the prompts for submission be made by a primary care provider/OB-GYN, instead of a separate research group, like was the case in this study.
A strategy to help create readiness for change within an organization where this implementation will occur, like an OB-GYN clinic, would be to assess the nurses’ and providers’ commitment to change. Change initiatives and the implementation of new innovations often fail within an organization when those in charge of implementing the change are not committed (Olafsen et al., 2020). Making sure that the nurses and providers who will be enrolling mothers into this patient portal program, prompting parents for photos/videos, analyzing the infant sleep spaces, and providing personalized feedback are passionate about this innovation and reducing the incidence of SUID is essential to the success of its implementation.
NUR 590 Topic 2 DQ 2 Discuss how current research or literature will be used to ensure that change is based on current evidence References
Canty, E. A., Fogel, B. N., Batra, E. K., Schaefer, E. W., Beiler, J. S., & Paul, I. M. (2020). Improving infant sleep safety via electronic health record communication: A randomized controlled trial. BMC Pediatrics, 20(1), 1-9. https://doi.org/10.1186/s12887-020-02369-2
Olafsen, A. H., Nilsen, E. R., Smedsrud, S., & Kamaric, D. (2020). Sustainable development through commitment to organizational change: The implications of organizational culture and individual readiness for change. Journal of Workplace Learning, 33(3), 180-196. https://doi.org/10.1108/JWL-05-2020-0093