Discussion responses to class mates
Que 1 – Why is understanding the healthcare system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course preceptor that you will take into consideration for your own change project.
1 – The overall understanding of the health care system is exponentially important in embracing evidence-based practice for systematic approaches to healthcare changes in our healthcare system. this is especially important and necessary for the focus for the change project for diabetes care. The most current method in addressing diabetic care needs has had very little focus on education and early prevention for the care and needs of the diabetes disease. Type 2 diabetes is a serious problem in the U.S. and self-management is critical to control the disease. (Shaw,2016) This has been an ongoing issue and a very determining factor to being able to implement more education and prevention versus managing the challenge of diabetes. Along with healthy habits including diet and exercise, this has made an impact on better care and management of diabetic care. Current guidelines recommend long-term weight loss of 5% to 7% of body weight and 150 minutes of at least moderate-intensity physical activity per week for most patients with prediabetes and diabetes (Koenigsberg & Corliss, 2017)This proves the theory and aspect that we as caregivers need to assess and be able to thoroughly provide the necessary treatment goals as well as better methods of management. From my interaction with my preceptor there are standards of care that they have introduced and follow to better manage the ability to manage diabetes as there are not any specific global standards in place. Implemented standards of care for the change project are as follows;
Checking A1C every three months for patients who have A1C > 7.0
Checking A1C every six months for patients who have A1C < 7.0
Regularly scheduled lab assessment of lipids and kidney function
Annual diabetic foot exam, and more often and risk factors are identified
Annual urine microalbumin screening to further assess kidney function
These change standards are coupled with the varying focus and complement the standard blood glucose level checks. Educating patients on keeping a relevant checklist and follow up are essential to effectuate change and utilization of evidence-based practices for nursing care and the needs of patients managing their diabetic care needs.
Koenigsberg, M. R., & Corliss, J. (2017). Diabetes Self-Management: Facilitating Lifestyle Change. American family physician, 96(6), 362370.
Shaw, Ryan. Grantome. 2016. From Episodic to Real-Time Care in Diabetes Self-Management. Retrieved from https://grantome.com/grant/NIH/R15-NR015890-01A1
2- It is important to understand the health care system at a local level when planning an EBP implementation because proper understanding leads to knowledge of barriers, available resources, population health care needs. Using knowledge from the local-level health care system can help standardize and support practice changes for a larger scale (Warren et al., 2016).
A piece of anecdotal evidence that comes from the course preceptor that I will take into consideration for my change project is that telehealth can provide the same or better quality of health care than traditional clinic visits. And that telehealth opens up a new specialty called telenursing. Telenursing is a whole new way of connecting us to patients. It helps increase access to care, patient adherence, monitoring patient safety, technological advancements, and allowing healthcare providers to network with one another.
Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The Strengths and Challenges of Implementing EBP in Healthcare Systems. Worldviews on Evidence-Based Nursing, 13(1), 1524. https://doi.org/10.1111/wvn.12149
3 – When making an evidence-based practice change, it is important to consider what is offered locally before implementing changes. Understanding your resources and what is available. knowing the resources that are available in the community will allow researcher to know where change needs to be made and in what ways a change could make things better. The first step is to know the community and what are their needs. while some communities may want to focus on diabetes because that has the highest prevalence in that area, other communites may need teaching of ways to avoid high blood pressure or how to fight cancer. The topic that would make the most impact and what services are already being offered within the community.
Yesterday after talking with my preceptor, she made a few good points, that timimg was important and assessing the patients readiness to learn. She said before starting to teach a patient, it’s best to communicate with them to make a connection with them, and they will be more willing to accept your teaching. We want them to feel apart of this teaching, make them aware of their current situation. There are many community leaders who are willing to fund project that are about the betterment of their communities. The communities must invest in technology to get access to information, recongnize the barriers, finding ways to deal with them.
Woods A. (2013). Implementing evidence into practice. 2013 Nursing career and education directory. Volume 43, Number 1 pp.4-6
4 – Each health care system is unique in the care they provide based of the unique needs of the community they serve. Understanding those needs allows the health care system to provide targeted and specific care. As an example, the health care needs for a family living in a rural town in Idaho will be drastically different from the family living in a densely populated area of New York. Health care systems must be aware of the needs of their community and be committed to providing evidence-based practices (EBP).
As we began this class, we all set out to find what we could change at the local level that we, as nurses, would be able to affect. Many ideas for change, along with my own, were based off of anecdotal evidence, which are ideas that are picked up in everyday observation. My preceptor and I set out to find a change project at the beginning by looking through journals to find things that we could implement into practice. While there are no end of great ideas in these journals, we began to see there were things in the nursing practice of patient care that we could affect that were specific to the hospital system where my practicum is taking place. After that, we began looking at the problems in front of us and began to generate ideas quickly. My own change project came from a conversation I was a part of, where the statement was made, There seems to be a lot of patients passing the bedside swallow evaluation but then the speech therapist comes in and downgrades their diet and liquids. That statement was not a fact but when we started questioning it and looking at actual numbers, it became obvious that there was in fact a discrepancy, which lead us to evaluate the reasons behind it. Understand how to affect things at the local level through the use of anecdotal evidence, observations or conversations can allow the nurse to create meaningful improvements for the patients they serve.
5 – Understanding the health care system at the local level important to consider when planning an EBP implementation because it gives you an indication of what you can expect as far as demographics and availability of resources. According to my course mentor, when any evidence-based implementation has taken place at the clinic would be changes to manage inventory to better supply and demand for patients, the alteration of a layout to a clinic to see more patients, or utilize more rooms that patients are able to numb in based on EBP from other clinics that have had success with such changes. When discussing with my preceptor about implementation for hand hygiene within our practice we discuss possible barriers to providers not incorporating hand hygiene into their practice and how to implement it during their busy schedules. When implementing training and education is crucial to compliance to reduce the spread of germs from patient to patient when providing care. To promote use of research evidence in clinical and administrative health care decision making, multifaceted implementation strategies are needed (Moloney, Taylor & Ralph, 2016). Implementation strategies also need to address both the individual practitioner and organizational perspective. In addition to a shared vision, effective leadership is needed for change to be successful. The key to transformational change or any change is to have leadership that is able to understand it, support it, explain it, and move the organization to commit to it (Cowell, Gillespie, Cheung & Brown, 2018). Although full schedules, distracting events, fear of change, and apathy are obstacles to change, the real enemy of change is complacency and having the will to change is vital Even groups that seek change may be complacent and not committed to follow through.
Cowell, F., Gillespie, S., Cheung, G., & Brown, D. (2018). How to implement changes to reduce incidence and facilitate early management. Journal of Hand Therapy, 31, 201205. https://doi.org/10.1016/j.jht.2018.01.013
Moloney, C., Taylor, M., & Ralph, N. (2016). Flooded with evidence: using a spillway model to improve research implementation in nursing practice. Australian Journal of Advanced Nursing, 34(1), 2331.
Ques 2 – Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP intervention. Why? Has your preceptor used either theory, and to what result?
6 – One model of change theories is Kurt Lewis three step change theory which is labeled as unfreeze, change, freeze (or re-freeze). Many health care organizations have used Kurt Lewins theory to understand human behavior as it relates to change and patterns of resistance to change. (Sutherland, 2013) The concept is focused on unfreezing a system or process that is in place and introducing change. Once the changes are in place the system or process is essentially re-frozen and the new pathway is in place.
Another change theory model is Lippitts change theory. This involves an external change agent to introduce to effectuate the change accordingly. There are seven stages in this theory and they are diagnose the problem, assess motivation, assess change agent’s motivation and resources, select progressive change objects, choose change agent role, maintain change, terminate helping relationships. This theory can be used in nursing to effect change. (Classroom, 2018)
Both change theories would be applicable however, the change theory that best fits for implementing the evidence-based practice in nursing would be the Lewis change theory. The main reason this change theory fits best for the evidence-based practice is mostly due to the fact that it is simple. The preceptor has outlined specific examples of implementation of new processes with dealing specifically with diabetic care needs of patients, and instead of simply treating the disease, the preceptor introduced specific steps that allow for more education and understanding of the disease state process for better overall intervention. Since this implementation of change is rather new, it is the best route to continue and update accordingly with additional changes by utilizing the Lewis three step change theory and continued focus on quality improvement with developing new processes for diabetic care needs.
Classroom. 2018. How to Apply Lippitts Theory of Change in Nursing (synonym.com) Retrieved from https://classroom.synonym.com/apply-lippitts-theor…
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