NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

NUR 590 Topic 3 DQ 2

Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.
The Star Model explains how specific forms of knowledge, such as the systematic review and the clinical practice guideline, are solutions for moving research into practice. It is a model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various phases of EBP in moving evidence into clinical decision making. The clinical scholar model was developed and implemented to promote the spirit of inquiry, educate direct care providers, and guide a mentorship program for EBP and the conduct of research at the point of care. It began as an interactive, outcomes-oriented educational program for nurses but has evolved into an interdisciplinary educational program for direct care providers (Melnyk, 2019). In my evidence-based practice proposal, the Star Model would be most beneficial. This model reviews current practice and applies knowledge for change. For my proposal, there is a lot of research on both patient and nurse dissatisfaction with the current bereavement process when a patient experiences a miscarriage in the ED. There is not a lot of research on implementation of better practice and protocols. Therefore, the Star Model will allow for me to take the knowledge of the subject and develop a 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.

A Sample Answer 3 For the Assignment: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

Title: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

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 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay 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

A Sample Answer 4 For the Assignment: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

Title: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

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 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay 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.

A Sample Answer 5 For the Assignment: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

Title: NUR 590 Benchmark – Evidence-Based Practice Proposal Project Framework or Model for Change Essay

While researching my evidence-based project proposal I have found quite a bit of literature not only supporting the use of my proposed intervention but detailing more effective ways of implementing it in clinical practice. The patient population in my proposal is those who are in the immediate post-operative period from microvascular free flap head and neck surgery as a means to treat and remove oral cancer tumors and graft new skin into place for both cosmetic and functional improvement following the procedure. All that to say that my patient population is one that has undergone a complex, high-risk procedure, and that the surgeons overseeing such can be quite exacting in the treatment plans of those under their care and as a result can be more than a little reticent to change, even if it ends up being for the benefit of those they are caring for. This phenomenon is not surprising, in fact in my research I found that some of the articles discussing the care of these patients the authors even acknowledged that surgeon resistance to research and change has contributed to the slowed growth of the use of evidence-based practice changes in recent years for this population (Al Saied et al., 2020). 

In order to best promote change, those of us working in this area should keep in mind the essential elements for organizational change when bringing it to interdisciplinary discussions: having a strong vision for change, belief in the change and in our ability to implement it, developing solid goals and a well-formulated plan for change, and the most important of all – patience (Melnyk & Fineout-Overholt, 2019). In order to prevent further negative outcomes from occurring in this patient population that could be prevented by the timely and appropriate use of weight-based fluid resuscitation to addressing persistent hypotension, providers caring for this group can work to advocate against stagnation in care innovation, gathering together information supporting the intervention and forming a change project group to enact the implementation within the organization (Vincent et al., 2019). The change team should be made up of those on the surgical team and those caring directly for patients – I believe that a strong collaboration between bedside providers and those directing the plan of care could lead to the timely use of this intervention as well as for accurate, real-time vital sign and flap assessment monitoring to better understand the benefits of its use. 

References 

Al Saied, G., Almutairi, H. M., Alharbi, Y., Almohanna, M., & Almutairi, A. (2020). Comparison Between the Impact of Vasopressors and Goal-Directed Fluid Therapy on the Management of Free Flap Reconstruction of Head and Neck and Monitoring in ICU. Cureus, 12(12), e12108. https://doi-org.lopes.idm.oclc.org/10.7759/cureus.12108 

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