NUR 590 Evidence-Based Practice Proposal – Section D: Change Model
Model for Change
Change models are important in facilitating organizational transformations. They guide the implementation of strategies that would contribute to realizing the desired organizational goals. Nurses are responsible for ensuring effective change models in their organizations. Therefore, this paper examines the change model for use in implementing the project and its applications.
The Selected Model
The trans-theoretical model of change will be used in the project implementation. The model guides the implementation of change and decision-making in the process. It also facilitates the identification of the critical factors needed for the successful implementation of change (Faan et al., 2022). The trans-theoretical model proposes that change occurs systematically in a series of steps. They include pre-contemplation, contemplation, preparation, action, maintenance, and termination. The model applies to the proposed project since it will guide its gradual implementation in the organization.
Stages and their Application
As previously stated, the trans-theoretical model evolves in stages. Pre-contemplation, contemplation, preparation, action, maintenance, and termination are some of them. The first step is pre-contemplation, in which the change implementers are unwilling to take any initiatives that would require them to change their current behaviors. They are unaware of the need to alter their current beliefs and practices. As a result, they are oblivious to the need to change their routines (Narimani et al., 2018). This stage of change is appropriate because school-aged children are unaware of the negative effects of their diets and sedentary behaviors on their health. As a result, they are unaware of the importance of engaging in healthy behaviors and practices that will reduce their risk of obesity and its associated complications.
The second phase of the transtheoretical change model is contemplation. Adopters of change are aware of the need for behavioral change at this stage. They are willing to change in order to improve their results. They also look into the strategies needed to get out of their current situation (Edelman & Rnc, 2021). The importance of this stage to the proposed project is that it raises awareness among parents and school-aged children about the dangers of obesity and overweight. They begin to look into healthy lifestyles and behaviors. They also begin to engage in active physical activity in order to lose weight. As a result, their involvement in change initiatives begins at this stage.
The third step in the trans-theoretical model of change is preparation. The adopters of change are ready to implement strategies that would transform their behaviors, beliefs, and practices in this stage. They also participate in identifying additional, effective strategies that would enable them to achieve their desired behavioral change (Butts & Rich, 2021). The applicability of the preparation stage to the proposed project is that children and their parents or guardians have adopted the recommended change initiatives. Nurses also play a proactive role in implementing project initiatives to achieve the desired change. They also promote the environmental transformation to minimize the risk factors for obesity in school-aged children.
Action is the fourth step in the trans-theoretical model of change. The adoption of sustainable interventions characterizes action to promote change. The adopters are highly motivated to engage in activities that would contribute to continuous improvement in their outcomes. The applicability of this stage to the project is that nurses, parents/guardians, and school-aged children will be motivated to engage in activities that minimize the risk factors of obesity. They eat healthy diets and engage in active physical activity to improve their health outcomes.
Maintenance is the fifth stage in the trans-theoretical model of change. The adopters have made the change part of their routine in this stage. They aim to prevent their relapse to old behaviors that had a negative effect on them. The applicability of this stage to the project is that school-aged children and stakeholders, including nurses and parents, will have incorporated dietary modifications and physical activity into their routines. They prevent their relapse into their harmful lifestyles and behaviors. The last stage in the model is termination, where the desired behavioral change has been achieved. The adopters of the change are no longer willing to relapse to their old lifestyles and behaviors (Edelman &Rnc, 2021). Therefore, a safe community for school-aged children has been created.
Models of change are important in the implementation of improvement initiatives in healthcare. The trans-theoretical model of change will be usedto implement the proposed change. It will provide insights into critical factors for successful change. Its effective use is expected to contribute to achieving optimum project outcomes.
Butts, J. B., & Rich, K. L. (2021).Philosophies and Theories for Advanced Nursing Practice.Jones & Bartlett Learning.
Edelman, C. L., & Rnc, E. C. K., Dnsc MPH. (2021).Health Promotion Throughout the Life Span—E-Book. Elsevier Health Sciences.
Faan, P. A. P., Faan, A. G. P., Edd, P. A. S., & Hall, A. (2022). Fundamentals of Nursing—E-Book. Elsevier Health Sciences.
Narimani, S., Farmanbar, R., Mozaffari, N., Nemati, A., Amani, F., &Abbasgholizadeh, N. (2018).Cognitive and Behavioral Processes and Its Stages of Change for Fruit and Vegetable Consumption among Nursing and Midwifery Staff of Ardabil Hospitals, 1395: Application of the Trans Theoretical Model.Journal of Health, 9(2), 182–195. https://doi.org/10.29252/j.health.9.2.182
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.
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.
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.
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.
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