Why is understanding the health care system at the local level important to consider when planning an EBP implementation?

create a 10 to 15 page proposal (excluding title and reference pages) for the Ashford General Hospital Board of Directors
October 11, 2018
The number of nursing students enrolled in a particular nursing program between the years of 2010 and 2016, respectively, were 563, 593, 606, 520, 563, 610, and 577. Determine the mean (X), median (MD), and mode of the number of the nursing students enrolled in this program. Show your calculations.
October 11, 2018

Why is understanding the health care system at the local level important to consider when planning an EBP implementation?

175 word response with source required175 word response with source requiredQ.Why is understanding the health care system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course mentor that you will take into consideration for your own change project.

Response 1 When planning an evidence-based practice (IBP) implementation, it is important to understand the health care system at the local level because before determining the implementation, we have to start with a problem or cases that need improvement. “EBP is aimed at hardwiring current knowledge into common care decisions to improve care processes and patient outcomes” (Stevens, 2013, p. 3). To me, “Improving process and patient outcomes” means that the health care system might be a contributing factor in the problem itself. When brainstorming with my mentor who have been working in the Army Medical Center for quite some time, she mentioned that the reasons why soldiers do not seek behavioral health help is because it will take three months for them just to get a psychiatrist appointment alone. More over, soldiers are hesitant to seek medical help because by getting help itself, they are in risk of getting medically retired from the military. These health care system issue mentioned by my mentor is consistent with many of the articles I have acquired for my projects.

One other system glitch my mentor mentioned was that some soldiers unfortunately use this reason (being in mental health care) as a way to get out of the military and to get percentage for disability. However, I will not include this issue in my study, because I am focusing on PTSD related to suicide rate, instead of overall behavioral health issues.

Stevens, K., (2013) The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues inNursing, 18, 2, Manuscript 4. doi:10.3912/OJIN.Vol18No02Man04

175 word response with source APA required

Response 2 Evidence-based practice significantly improves the quality and safety of healthcare, enhances patient outcomes, and reduces cost. EBP includes lifelong problem-solving approaches to how healthcare is delivered and integrates the best evidence from high quality studies. When planning an evidence based practice implementation, we must first understand and identify the challenges facing the healthcare system. Inadequate and delayed implementation of current evidence into practice has contributed to medical errors, safety issues, and patient deaths (Harris et al., 2015).

Sexually transmitted infections impose a considerable health burden among college students. Students have reported engaging in a number of high-risk behaviors including: multiple partners, unprotected sex, and using drugs and alcohol during sex. Get Yourself Tested (GYT) is a social marketing campaign developed to promote sexual health discussions, raise awareness, and encourage testing (Garbers et al., 2016). My mentor/preceptor who has been a gynecologist for over thirty years was well aware of this campaign and has helped run the campaign a few times here on campus. Despite the major advertisement of this campaign on campus, many students were unaware of the great benefits it had to offer. Despite numerous efforts of STI education, prevention, and treatment, college students are at higher risk for contracting a sexually transmitted infection. My preceptor mentioned that many of the students that come to her for GYN services are unaware of how STIs are transmitted and many of them lack knowledge regarding sexual health. While conducting my own research, I have found that insufficient knowledge of STIs was the main factor that contributed to the alarming rate of STIs found on college campuses.

Garbers, S., Friedman, A., Martinez, O., Scheinmann, R., Bermudez, D., Silva, M., … Chiasson, M. A. (2016). Adapting the get yourself tested campaign to reach black and latino sexual-minority youth. Health Promotion Practice17(5), 739–750. http://doi.org/10.1177/1524839916647329

Harris, C., Garrubba, M., Allen, K., King, R., Kelly, C., Thiagarajan, M., … Farjou, D. (2015). Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Services Research15, 575. http://doi.org/10.1186/s12913-015-1178-4

175 word response with source APA required

Response 3 In order to provide the best care to the patients in the area, an initial knowledge of demographics and population needs is necessary. Implementing evidence-based practice in a practical way means being able to assess the care that has been provided and make changes to improve the population’s overall health in the future (Leung, Trevana, & Waters, 2014). In my area, the local hospital where my mentor works with the public health district to research the greatest current health care needs in the area. In addition, these reports provide information regarding the current community care provisions and preventions methods. My mentor has experience in implementing EBP by being a part of the diabetes management and education team at the hospital. With the community health data in 2016, approximately 60% of people reported being diagnosed with diabetes, with 30% being diagnosed in the past twelve months (The Baylor Center for Community Research and Development, 2016). In addition, there was significant evidence of admission to the hospital related to diabetes or complications resulting from co morbidities. It also increased the rates of post-operative patients requiring readmission, typically from lack of proper wound healing due to diabetes (The Baylor Center for Community Research and Development, 2016). My mentor works with the hospitals diabetes education team to implement increased teaching on medications and care plans to patients recently diagnosed with diabetes. The greatest need reflected was with those who were recently diagnosed and lacked the education regarding effective management. Most of here education involved glucometer usage and understanding results, and lifestyle changes to help reduce the risk for complications.

By identifying this health need, it also led to the creation of public health education courses for diabetes management. These classes typically occur twice a month at the local health care center or community college for the public to attend. They are led by several of the nurses from the hospitals diabetes education team, including my mentor, and nurse instructors from the community college. Using these resources helps to improve the health of our community and better acknowledge their direct care and educatio needs.

The Baylor Center for Community Research and Development. (April, 2016). Community Health Needs Assessment. Retreived from

http://www.waco-texas.com/userfiles/cms-healthdepa…

Leung, K., Trevana, L., & Waters, D. (2014). Systematic review of instruments for measuring nurses’ knowledge, skills, and attitudes for evidence-based practice. Journal of Advanced Nursing 70(10) 2181-2195.

175 word response with source APA required

Q Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP project. Why? Has your mentor used either theory, and to what result?

Response 4 The two change theories I have selected is Moving and Refreezing. The difference between these two theories are the Moving Theory is a way of increasing production through a change in thoughts, feelings, and behaviors; Refreezing Theory is maintaining a new lifestyle change to prevent returning to old ways (Current Nursing, 2011). S. Kelmen has used both of these theories in developing a weight loss plan that addressed addictive behavior associated with over eating in her women’s health practice (personal conversation, May 8, 2018). First using the Moving Theory in addressing the unhealthy behaviors, thoughts, and feelings that food was filling a void of being unsatisfied or uncomfortable with one’s self (S. Kelmen, personal conversation, May 8, 2018). Feeling associated with being uncomfortable included sadness, anger, self-pity, grief, loneness, and fear (S. Kelmen, personal conversation, May 8, 2018). In order for weight loss to be addressed, uncomfortable feelings needed to be replaced with self-acceptance (S. Kelmen, personal conversation May 8, 2018). Once self-acceptance occurs S. Kelmen could move into the Refreezing theory replacing the false comforts of food (relaxed, calm, satisfaction, and security) with real comforts (intimacy with friends and family, and healthy life) (personal conversation, May 8, 2018). To prevent self-sabotage S. Kelmen implemented 5 principles of change which include:

  1. Alter regular behavior
  2. Reward small accomplishments
  3. Set small attainable goals
  4. Join support groups
  5. Reinforce your faith (personal conversation, May 8, 2018)

In addition, when implementing change it can be stressful and S. Kelmen developed ways to handle stress which included

  1. Exercise
  2. Playtime
  3. Expressing feelings
  4. Daily relaxation
  5. Visualization (personal conversation, May 8, 2018)

According to S. Kelmen, the result of implementing these two theories was a change in behavior helping the patients to realize they had a choice of selecting a healthy behavior over an unhealthy behavior (personal conversation, May 8, 2018).

References

Current Nursing. (2011). Nursing theories. Change Theory. Retrieved from: http://currentnursing.com/nursing_theory/change_theory.html

175 word response with source APA required

Responce 5 Lewin’s Change Theory is the first change theory that was researched. Kurt Lewin’s change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage and refreezing stage. Lewin’s theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change (Change Theory by Kurt Lewin. (n.d.). The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force. This particular theory was the pioneer for other theories to be developed. Most involve some revision of this initial theory. The second theory that was researcher was, Spradley’s Change Theory. This is an eight-step process for planned change based on Lewin’s theory of change. It makes provision for constant evaluation of the change process to ensure its success. The steps are: recognize the symptoms, diagnose the problem, analyze alternative solutions, select the change, plan the change, implement the change, evaluate the change and stabilize the change (Oguejiofo, N. (2018, January 16).

My mentor has never used either one of these theories. I think Spradley’s Change Theory would be the theory that would suit my project best. I think the constant revision or reinforcement of education is what these men need to maintain compliance. We must target the primary reasons why these inmates miss chronic care appointments and do not follow up care and then revise the plan for them.

Reference

Change Theory by Kurt Lewin. (n.d.). Retrieved from http://www.currentnursing.com/nursing_theory/change_theory.html

Oguejiofo, N. (2018, January 16). Change Theories in Nursing. Retrieved from https://bizfluent.com/about-5544426-change-theories-nursing.html

175 word response with source APA required

Response 6 A change agent can be a nurse leader, staff nurse or someone that works with nurses. Change theories are used to bring planned change in nursing. Nurses and nurse leaders must be aware of all the change theories available to select the proper theory that best fits the situation (Oguejiofo, 2018).

Two change theories I will comparing are Lewin’s Three-Step Change Theory and Lippitt’s Phases of Change Theory. For example, Lewin’s Three-Step Change Theory views behavior as a dynamic balance of forces working in opposite directions. Driving forces facilitate change because they push employees in the desired direction. Restraining forces hinder change because they push employees in the opposite direction. Therefore, these forces must be analyzed, and Lewin’s three-step model can help shift the balance in the direction of the planned change. Lewin’ s model is very rational, goal and plan oriented. It doesn’t consider personal factors that can affect change. Lippitt’s Phases of Change Theory is an extension of Lewin’s with a focus on the role and responsibility of the change agent than the evolution of the change itself, exchanging information and ideas throughout the entire process. Lippitt believes that changes are more acceptable if they spread to neighboring systems. The focus on Lippitt’s change theory is on the change agent rather than the change itself. Lewin’s change model attempts to analyze the forces that impact change. (Kritsonis, 2005). The theory that best fits my project is Lippitt’s because it doesn’t just focus on the changes but how important the agent is in implementing change and the exchanging of information and ideas throughout the process. My mentor was unfamiliar with these theories.

Oguejiofo, N. (2018). Change theories in nursing. Retrieved from https://bizfluent.com/about-5544426-change-theories-nursing.html

Kritsonis, A. (2005). Comparison of change theories. INTERNATIONAL JOURNAL OF SCHOLARLY ACADEMIC INTELLECTUAL DIVERSITY, 8(1). Retrieved from http://qiroadmap.org/?wpfb_dl=12

175 word response with source APA required

 

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