NUR 590EBP Proposal Section E Implementation Plan
Best Practices for Implementing Evidence-Based Practice (EBP)/ Guidelines
Studies show that despite EDP being the gold standard in the provision of patient care, several hospitals among other healthcare organizations take up to 17 years to be able to fully adopt the new practice after it has gained substantial evidence showing its safety and effectiveness among patients (Brownson, Fielding, & Green, 2018). To promote the timely and appropriate implementation of best EBP into clinical practice, four key approaches must be followed.
The first step is to fully understand the data and the new practice being implemented. This is mainly because not all data behind EBP can translate to your organization, despite applying to multiple clinical contexts (Stirman, Baumann, & Miller, 2019). An in-depth understanding of the proposed changes helps leaders adapt only the evidence best practice that best suits the healthcare organization.
The second step is to consider the available resources concerning the data behind the evidence best practice. This will help leaders modify the new practice to fit the resources which are available within the organization (Osborne, 2017). Consequently, this approach will also help in the adoption of strategies that can help reduce costs while optimizing the outcome.
The third step is to establish patient-centered goals. It is important to ensure that the new practice does not only benefit the hospital in promoting the rate of productivity but must also enhance patient-centered care. For instance, when implementing strategies to help inappropriate polypharmacy among the elderly, it is important to focus on approaches that will help reduce multiple uses of prescription drugs, while at the same time ensuring that the patient achieves the treatment goals (Cadogan et al., 2018).
The last step is to identify the organization’s preferences and educate staff members about the new practice. This will help the change leader evaluate the possibilities of adoption and retainment of the new practice among staff members (Osborne, 2017). When the change is fully accepted by the staff members, the process of implementation can then be initiated.
Strategies for Overcoming Barriers in Implementing Evidence-Based Practice
According to most research findings, the most common barriers to EBP implementation include resistance, time and knowledge, and inadequate finances. To be able to overcome these challenges, several strategies will be utilized. The first strategy is to engage appropriate stakeholders. This will help in building trust which will enable the project leader to learn from their experience and provide effective input. The stakeholders will also help in identifying outcome measures (Brownson, Fielding, & Green, 2018). The second strategy is to seek administrative support. The administration will be able to provide insight on other similar projects and how certain techniques were utilized in promoting the implementation of such projects. The administration will also help in promoting a supportive culture among employees to reduce resistance levels. The last strategy is to carry out substantial background research and involve staff members in the implementation process. This will help identify gaps within the current practice and come up with appropriate and readily acceptable EBP such as the 10 items of MAI (Cadogan et al., 2018).
Formative Evaluation Plan
The formative evaluation plan aims at fostering the development and improvement of the plan before initiating the implementation step. The evaluation plan will also consider the summative approach in assessing whether the expected results of the project have met the stated goals, by collecting feedback and presenting them to the stakeholders (Stirman, Baumann, & Miller, 2019). The formative evaluation plan will involve completing need assessment questionnaires, conducting implementation analysis, and performing progress analysis. In the implementation of the 10 items MAI into practice, prescribers will be utilized as the main source of feedback (Cadogan et al., 2018).
The need assessment questionnaires will be filled by involved stakeholders regarding the areas of improvement, potential barriers, and facilitators to promoting the change. The implementation analysis will involve assessment of the fidelity to the implementation strategy and the clinical intervention being proposed. Progress analysis on the other hand will focus on monitoring the progress towards implementation and improvement of the set goals during the intervention (Brownson, Fielding, & Green, 2018). The feedback for the evaluation process will include semi-structured interviews with stakeholders, focus groups, structured surveys, electronic health records, charts, document reviews, and management information systems. Feedback will also be collected by direct observations through site visits.
Plan for Formative Evaluation in this Pandemic Situation
The Covid-19 pandemic has led to several changes in the protocol of how healthcare services are being provided. In the same case, the methods in which formative evaluation will be conducted must be modified to meet the current standards of practice. For instance, reducing contact among people is very crucial in curbing the spread of the virus (Osborne, 2017). As such, face-to-face interviews will be avoided. Instead, feedback will be collected through social media and online platforms such as the use of Emails. Consequently, video conferences will be preferred to conduct discussions rather than crowded conference rooms. However, for those who will be forced to be involved directly with the evaluation process, protocols such as vaccination will be applied.
During week 2, in a simulated scenario when your formative evaluation plan reveals not all of the staff have implemented the evidence-based intervention. What is your next step?
Upon incomplete adoption of the new practice, it is necessary to assess the cause of the situation, come up with appropriate strategies, and promote complete adoption of the change. Feedback will be collected from staff members who will not have adopted the new practice, to find out the reasons behind their lack of participation (Shelton, Cooper, & Stirman, 2018). In most cases, incomplete adoption of change is normally caused by a lack of time or limited knowledge regarding the use of the new approach. As such, it is necessary to work with the employee’s schedule and find an appropriate time to promote education regarding the new practice and its benefits. With a full understanding of the reasons behind the proposed change, and the benefits if implemented, staff members will be more interested to use the new practice and realize the benefits.
What are you learning about project implementation? What issues have you identified? How will you address these? Use these examples as headings or substitute with the same number of examples that are appropriate to your case study project be robust:
- You identify that the staff needs more information about evidence-based practice. What will you do?
Teaching programs will be designed based on the information needed of the staff members regarding evidence-based practice. The teaching programs will utilize effective communication strategies to promote conveying of the knowledge to staff members (Stirman, Baumann, & Miller, 2019). Such strategies include tailoring the message, ensuring that the tailored messages are targeted to audience segments, use of narratives, and framing of the message.
- You identify that staff needs more information about the evidence-based intervention. What will you do?
To promote more information regarding the evidence-based intervention, it is necessary to promote self-initiated background research on the healthcare problem and available interventions use to solve the problem (Brownson, Fielding, & Green, 2018). The staff members will then be provided with brochures and fliers giving background information on the new intervention, and its benefits. Training programs will also be designed to fit the needs of the employees and the patient regarding the new intervention.
- You identify that you need to provide remedial training. How will you accomplish this?
To provide remedial training to staff members, a group of specialists will be involved in assessing the information gap and setting the new training goals. New microlearning approaches will be considered such as short videos to avoid burnouts as a result of long working hours (Stirman, Baumann, & Miller, 2019). Different learning habits will also be involved such as the use of software that has a user-friendly interface especially for the case of the 10 items MAI (Cadogan et al., 2018).
In your simulated Case Study some staff state “I am too busy” or “I do not see a need for change since the ‘way we have always done it’ works fine.” How will you address this?
In this situation, I will have to spare as little time as possible with the employee and try to convince them about the benefits of the new intervention over the current practice. I will provide backup evidence using data and statistics drawn from the organization that has successfully implemented the new approach, and the benefits being realized. I will also give examples of colleges who have already adopted the change and have them explain the benefits from their own experience.
What additional resources may be necessary for a successful implementation?
Additional resources for the implementation of this project will include infrastructures such as computers, wi-fi, and HER software (Shelton, Cooper, & Stirman, 2018). These resources will be used to collect and keep data recorded on the 10 items MAI. Investors may also be needed to help provide adequate finances to support the project.
You have opposition or pushback from the nursing staff about making a change in practice during a pandemic crisis, how would you respond to this pushback?
I will align the needs of the change to the current needs of the pandemic crisis, and explain to them, how this new intervention will benefit the current situation (Stirman, Baumann, & Miller, 2019). With the Covid-19 pandemic, the elderly population is being affected by comorbidities more than ever. This increases the risks of inappropriate polypharmacy, hence the need for the 10 items MAI tool.
Brownson, R. C., Fielding, J. E., & Green, L. W. (2018). Building capacity for evidence-based public health: reconciling the pulls of practice and the push of research. Annual review of public health, 39, 27. DOI: 10.1146/annurev-publhealth-040617-014746
Stirman, S. W., Baumann, A. A., & Miller, C. J. (2019). The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Science, 14(1), 1-10. https://doi.org/10.1186/s13012-019-0898-y
Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual review of public health, 39, 55-76. https://doi.org/10.1146/annurev-publhealth-040617-014731
Osborne, S. (2017). Making evidence-based perioperative practices stick: An introduction to an implementation science approach. ACORN: The Journal of Perioperative Nursing in Australia, 30(4), 53-55. https://search.informit.org/doi/10.3316/informit.317274992620092
Cadogan, C. A., Ryan, C., Gormley, G. J., Francis, J. J., Passmore, P., Kerse, N., & Hughes, C. M. (2018). A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care. Pilot and feasibility studies, 4(1), 1-12. https://doi.org/10.1186/s40814-017-0166-3
In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:
Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
You are required to cite five to 10 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.
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.
In 1,250-1,500 words, discuss the implementation plan for your evidence-based practice project proposal. When required, create the appropriate form, table, image, or graph to fully illustrate that aspect of the intervention plan and include them in an appendix of your paper. You will use the implementation plan, including the associated documents in your appendices, in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal. NUR-590 Topic 5: Evidence-Based Practice Implementation
Include the following:
- Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Include a draft of the form as an appendix at the end of your paper.
- Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Based on the timeline you created, describe the amount of time needed to complete this project. Include a draft of the timeline as an appendix at the end of your paper.
- Develop a budget and resource list. Consider the clinical tools or process changes that would need to take place. Based on the budget and resource list you developed: (a) describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution; (b) outline the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Include a draft of the budget and resource list as an appendix at the end of your paper.
- Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Provide rationale to support your selection.
- Describe the methods and instruments (questionnaire, scale, or test) to be used for monitoring the implementation of the proposed solution. Include the method or instrument as an appendix at the end of your paper.
- Explain the process for delivering the intervention and indicate if any training will be needed.
- Discuss the stakeholders that are needed to implement the plan.
- Consider all of the aspects of your implementation plan and discuss potential barriers or challenges to the plan. Propose strategies for overcoming these.
- Establish the feasibility of the implementation plan.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.
NUR 590 Topic 7 DQ 1
Propose strategies for disseminating your evidence-based practice project proposal. Consider the necessary stakeholders who need to review or approve the proposal (both internal and external) and what methods you will use to communicate.
Disseminating evidence to stakeholders and decision makers within the organization is crucial to getting the proposed solution implemented throughout the organization. The evidence must have evidence based research that supports the proposed solution and must show how the solution will improve the performance of the organization. After the completion of a research or evidence based project, the information must be disseminated amongst the staff. The purpose behind performing a research project or evidence based project is to create change and to advance patient care. The information that is distributed amongst the staff is quite important. Having a dissemination plan is so vital because there are barriers. The barriers can involve not having the education or information readily available, costs of disseminating the information to staff, and staff being resistant to the new change or information. Using a tool for a dissemination plan will help guide the researcher find all the components necessary to form a formal dissemination plan that specifically reflects the user’s needs and interests (Carpenter, Nieva, Albaghal, & Sorra, 2014). The tool provides six useful components on successfully disseminating the research findings. The components consist of defining the research, identifying target users, working with dissemination partners, communicating the research, communicating the research, evaluating the success of the dissemination process, and developing an action plan (Carpenter, Nieva, Albaghal, & Sorra, 2014). Utilizing the tool will not only provide better outcomes for the researcher but the staff members that are receiving the new information. External Stakeholders would be investors and donors. Internal stakeholders to reach out to would be executive and managers.
Carpenter,D., Nieva, V., Albaghal, T. & Sorra, J. (2014). Development of a Planning Tool to Guide Research Dissemination. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK20603/
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Evidence-Based Practice Proposal – Section E: Implementation Plan Sample Approach
The act of implementing any change within a healthcare facility involves many aspects.
The entire process involves different people, phases, barriers, or obstacles as well as drivers (Sanders et al., 2014). The section focuses on the methods which will be of use in implementing the proposed solution. The solution relates to the problem that had been identified earlier with the hypothesis statement. There are different limitations in connection to the medical intervention of reducing agitation in dementia patients. The leading solution involves the act of behavior change. The use of alternative interventions, therefore, would play a vital role in the healing process. The main ways to reduce agitation would be to involve in alternative therapies, which include both art and music. It will, therefore, be critical to engage in physical exercises by the victims.
Setting and Access to Potential Subjects
Implementation of the recommended solutions will be observed in five main care centers. The recruitment of the subjects to take part in the study will be voluntary. Advertisement will be done for one week to make sure that as many people with dementia find the message. It is required that all the studies which involve human beings as the participants need to have informed consent from all the participants (Barber, 2018). All the old patients who have dementia will be required to offer their willingness to take part in the study by signing the informed consent. The signing of the form will indicate that the patients have been educated on the expectations of the study.
To implement the issue of physical activities in dementia patients, it is important to have a specific time frame. The use of exercises will be essential in reducing agitation in dementia patients. The entire project will take a period of eight weeks.
In the implementation stage, resources are needed to make work easier. The process means that a budget must be provided to cater for the costs of resources required. The implementation stage is one of the most expensive stages and has found many of the change projects failing as a result of failing to collect all the required resources. In the process of implementing the proposed solutions to reduce the rate of agitation in dementia patients, the following resources will be necessary. The first important resources will be the physical trainers who will be in charge of the physical exercises, the physical facilities needed for training, medical doctors as well as dieticians.
Methods and Instruments for Monitoring the Implementation
The main item that will be used to evaluate the implementation of the recommended solution will be the use of a questionnaire. These questionnaires will be administered to the patients after every one month. The method is preferred since it offers an easy time to analyze. It is also a familiar method with the staff and the leadership of many healthcare organizations. The use of the questionnaire will also be vital since it will lower the cost of the study. The price will be reduced since the amount used to photocopy the papers will be limited (Yarosh, Markopoulos & Abowd, 2014). Many of the respondents have, in most cases, filled a questionnaire earlier in their life or have heard of it. Since they are required to put a tick or an X against the given question, it is easily coupled with simple questions about their progress. Another benefit is that the response will be honest as it is filled individually and in private.
Process of Intervention Delivery
The delivery of the proposed solution will be on the use of an integrated approach (Hill, Jones & Schilling, 2014). The primary interventions to be used include behavior change, nutritional education, as well as involvement in physical activities. The participants will be educated on eating healthy for the exercises as well as the type of activities to take part in to avoid straining. All the participants will take part in the intervention without leaving anyone behind. Simple tasks will be chosen at first, which will progress with advanced exercises with time to strengthen their muscles and regain the lost energy. Training and education on what to do and what not to do are essential before rolling out the exercise.
Data Collection Plan
In the entire period of eight weeks that the study will be running, data will be collected continuously in the data collection phase through the use of a questionnaire. The participants will be the source of information regarding their progress after being subjected to the intervention.
Each week, the participants will fill the form of the results obtained after they were subjected to physical exercises. The results will indicate the effectiveness of the intervention in reducing the rate of agitation within the first two to three hours. The collected data will then be entered into excel spreadsheets. The other step will involve interpretation and analysis when the study is done. The questionnaire used for data collection will be similar to the one used in the monitoring of the implementation. NUR-590 Topic 5: Evidence-Based Practice Implementation
Strategies to Deal with Challenges
The main challenges in the study include the high costs of training and lack of physical training materials. Many sick people fail to afford healthy food due to their price. During the exercising period, the patients will be required to eat healthily an issue that will cost the amounts of money. Partnering with producers of organic food in the study will help in obtaining the menu at a relatively lower price or even for free. Many hospitals do not have the required physical training facilities more so free ones. Partnerships with institutions of higher learning will be effective as many of them have the best facilities for training in their sports departments.
Feasibility of the Implementation Plan
The entire project will incur different costs more so during the implementation phase. Some of the costs incurred include the physical trainer fee. It would be cost-effective to hire trainers as opposed to paying them since the study will be limited to a short period. The following are some of the costs that will be incurred in the course of the implementation. The other issue relates to the subsidy for the healthy food required by the patients during the study period. The presence of healthy, subsidized food will help the participants take part in physical activities. The subsidy will help manage the costs of the project since a healthy diet cannot be afforded by many people (Allcott, Diamond & Dubé, 2017). There will be a need to have a data storage device that will store the data collected over the eight week time when the study will run. Plan for Maintenance, Extension, Revision, and Discontinuation of the Proposed Solution
The decision involved to extend, maintain, and revise, or even to discontinue the intervention is taken based on the collected data. The questionnaire administered to the participants forms the basis of the decision making process. The success of the data collection method used to give positive feedback is essential to enable reaching the primary decision.
Allcott, H., Diamond, R., & Dubé, J. P. (2017). The geography of poverty and nutrition: Food deserts and food choices across the United States. National Bureau of Economic Research.
Barber, B. (2018). Research on human subjects: Problems of social control in medical experimentation. Routledge
Hill, C. W., Jones, G. R., & Schilling, M. A. (2014). Strategic management: theory: an integrated approach. Cengage Learning
Sanders, T., Nio Ong, B., Sowden, G., & Foster, N. (2014). Implementing change in physiotherapy: professions, contexts and interventions. Journal of health organization and management, 28(1), 96-114
Yarosh, S., Markopoulos, P., & Abowd, G. D. (2014, February). Towards a questionnaire for measuring affective benefits and costs of communication technologies. In Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing (pp. 84-96). ACM