The Change Initiative Assignment

The Change Initiative Assignment

The change initiative being proposed is the use of outreach intervention to reduce the infant mortality rate in the target community. The change initiative supports the focus population because the outreach intervention seeks to improve behaviors such as eating habits, alcohol intake, smoking, and attendance of pre-natal and post-natal care for pregnant and nursing mothers (Lasssi et al, 2016). The outreach intervention will include educating the target population about adopting the proposed lifestyle modifications and care-seeking behaviors. According to Lasssi et al (2016), outreach interventions have been shown to be effective in promoting care-seeking behaviors and healthier practices among communities. The proposed change supports my role as a nurse practitioner in that; nurse practitioner has the role of promoting health in the community and being advocates.  According to DeNisco& Barker (2016), nurse practitioners play the role of advocating for the initiatives that can improve the health outcomes of the community. The Change Initiative Assignment

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Infant mortality is amenable to outreach intervention because communities are supposed to be involved in improving their health outcomes. In the proposed outreach intervention, community health workers, health campaigns and home-based care will play an important role in achieving infant survival goals in the target area. In addition, outreach educational interventions have been shown to be effective in promoting care-seeking behaviors and healthier practices in communities such as attending pre-natal and post-natal clinics; smoke cessation; adopting healthy eating; and quitting alcohol during pregnancy and during the lactation period (Lasssi et al, 2016). 

PICOT Statement

In infants aged 0-12 months (Population) do outreach interventions (Intervention), compared to no intervention (Comparison) lower infant mortality rate (outcome) within the first year (Timeline).

Topic 1 DQ 2

EBP plays a significant role in improving the health outcome of critically ill patients in my specialty (MICU). Therefore, EBP has been used to implement guidelines that support interventions meant to improve patient outcomes. In addition, the EBP has been used to implement multiple evidence-based protocols in the MICU. For example, EBP has been used to implement insulin therapy for tighter blood glucose control in the MICU. For instance, the implementation of blood glucose (BG) control was based on numerous randomized controls and is significantly associated with improved survival (Afessa et al, 2017). This is why the MICU has implemented tight BG control protocols which normally depend on the liberal usage of insulin drips in patients who are critically ill. Generally, EBP has specifically been useful in MICU to improve the length of stay, length of mechanical ventilation, including the mortality rate. Even though there are barriers to implementing evidence the MICU unit overcomes the barriers by adopting local and international protocols and guidelines based on the latest available evidence (Aslakson et al, 2017).

Similarly, EBP plays a significant role in mental health specialty. Advanced registered nurses in mental health specialty adhere to research-based manual or guidelines during care delivery. In addition, PMHNP design systems, carry out research and manage quality assurance program aimed to improve patient outcomes (Fisher & Happell, 2019). For example, an advanced nurse practitioner also uses research to appraise and evaluate the crisis intervention techniques, stress management, safety guideline in inpatient psychiatric units, psychodynamic therapies, and other psychotherapies. For instance, cognitive behavioral therapy is an intervention that is evidence-based is widely used in mental health.    Topic 2 DQ 1

Some of the issues that may affect the implementation of the project include the lack of a strong working relationship with the community. That may hinder the efficacy of the project because it might be difficult to reach a sufficient number of the target population (Almufleh et al, 2015). Generally, setting up and implementation of community-based projects can take a lot of time and this may end up adversely affecting the community relationships (Almufleh et al, 2015). Secondly, there may be conflicts with the local leaders who may demand so much bureaucracy before the project implementation. The staff members may also fail to support the proposed intervention. Lastly, there may be an issue of resources and finances where the project’s needs may surpass the planned resources and budget.

The stakeholders who could help include the management and some community organizations that have effectively worked with the community in the past. The management could help in adding more resources and finance to the project in case we run a shortage of finances and resources. On the other hand, the community organizations that have partnered with the community before could help in establishing links with the community. Lewin’s change theory can be very valuable in helping implement the proposed intervention. According to Hossein & Emami (2014), Lewin’s theory can be effective in addressing resistance to change. Therefore, the resistance forces such as the staff members who are not supporting the proposed intervention can be convinced by the change agents (Hossein & Emami, 2014). The Change Initiative Assignment

Topic 2 DQ 2

One of the strategies to use as an advanced practice nurse is to interpret the rigor of research articles using the levels of evidence as to the guide. This is because the levels of evidence normally act as the standard through which the nursing field can examine the rigor of research to ensure that the findings of the research are valuable and reliable and thus can be applied in nursing practice. As Pinkowski (2018) explains lack of a robust standard regarding research evidence can lead to practitioners arriving at independent decisions regarding the quality of research which can put patients at risk if the research findings are embedded in nursing practice. Therefore, as an advanced practice nurse, I will ensure that I always compare the research I review to the levels of evidence and at the same time conduct a comprehensive research critique of the literature relevant to my practice by identifying the indicators of strong empirical strategies to research.

Moreover, I will ensure that I use the latest evidence-based articles. In this case, I will only use research articles that are less than 5 years old in order to ensure that my nursing practice is informed by the most recent research evidence. It is also important to ensure that I use studies from medical and nursing journals and avoid using textbooks or secondary sources. Finally, I will try as much as possible to select evidence-based research articles that have a comparable patient population and ensure that the evidence-based article center on nursing interventions (Pinkowski, 2018).

Topic 3 DQ 1

The levels of evidence for practice include; level 1: evidence obtained from systematic review of all pertinent randomized controlled trials or any evidence-based clinical practice guideline whose basis is on systematic review of randomized controlled trials; level II: evidence that is gotten from well-designed randomized controlled trials; level III: evidence that is gotten from controlled trials minus any randomization, quasi-experimental; level IV: evidence that is gotten from cohorts and case-control studies; Level V: evidence that is gotten from systematic reviews of qualitative studies and descriptive studies; level VI: evidence that is obtained from single qualitative study or one descriptive study; level VII: evidence that is obtained from reports of expert committees or opinion of authorities (Horntvedt et al, 2018). The Change Initiative Assignment

The levels of evidence are important regardless of the research method used because the levels of evidence are used as the reference point when examining the rigor of any research in order to ensure that the study findings can be applied to practice and generalized to the general population. In addition, the levels of evidence are used in critiquing the available literature and therefore they are important when conducting any research. Finally, the levels of evidence are useful in identifying the most rigorous research articles and the richest evidence to use when conducting any research (Horntvedt et al, 2018).

Topic 3 DQ 2

Factors that should be assessed during the critical appraisal of quantitative studies are the direct or indirect indicators of validity, reliability, as well as applicability that are embedded within the hierarchy of the evidence levels for quantitative studies. Indicators of related to reliability, validity, and applicability in research consist of the size of the sample, sampling plan, procedures used in sampling, eliminating or reducing any sources of bias, in addition to the accuracy of the statistical tests (Horntvedt et al, 2018). When the sample size is adequate, this improves the reliability of the study findings and thus their applicability. On the other hand, indicators such as reducing bias, the accuracy of the statistical tests and sampling plan and procedures affect the validity of the study findings and thus affect the applicability of the findings.

Generally, it is important to assess these factors because failure to assess them may produce faulty findings that cannot be applied to practice. For example, small sample size may not allow the findings to be generalized because the sample is not representative. Similarly, if the bias during sampling, or data collection, is not assessed, this may affect both the internal and external validity and thus generate unreliable findings. It is also important to ensure the accuracy of data analysis and statistical tests in order to generate accurate findings. Finally, when assessing the quality and reliability of a study, it is essential to use randomly assigned trials as this allows the effective review of the literature (Horntvedt et al, 2018).

Topic 4 DQ 1

Some of the barriers likely to hinder the implementation of evidence-based practice include lack of adequate time to read and critique evidence and lack of the required skills to identify and locate evidence, especially using a computer and the associated technology. According to Khammarnia et al (2015), lack of time is the most common barrier to implementation of evidence-based practice for nurses. This is because nurses are so busy with care provision and sometimes workload overwhelms them and thus they may not have adequate time to participate in the implementation of EBP. In addition, resistance to change by the staff members is also among the most common barriers to adoption of evidence-based practice (Khammarnia et al, 2015). This is because at times nurses may not be willing to have the practices they are so much used replaced by new practices that they have learned a new. Khammarnia et al (2015) explain that behavior change may be a challenge and this is the main reason nurses resist change because they are used to doing things the old ways. Therefore, it is important for the nurse leaders to ensure there is an adequate number of EBP mentors at the bedside who can work together with nurses to assist them in learning the proposed change and the associated skills and implement the change consistently.  Other barriers to implementation of EBP include lack of human resources such as staff shortage, lack of access to internet especially during work, heavy workload, as well as lack of access to databases that have nursing journals (Khammarnia et al, 2015). The Change Initiative Assignment

Topic 4 DQ 2

Ethical issues are an important issue for nurses or other healthcare practitioners who have an interest in utilizing research findings. As a result, it is important for practitioners to confirm if the research articles explain what the researchers did in safeguarding and protecting human subjects who took part in the studies. Such studies should always ensure that informed consent was sought from the study participants and that their confidentiality and privacy was protected (Fisher & Happell, 2019). In addition, the human must be protected from any risk or susceptibility that may arise during the study. For example, a study that is performed under the sponsorship of educational institutions will essentially follow the essential human subject review procedures. Nonetheless, these procedures may not be sufficient for an individual in the vulnerable group because the aim is the procurement of informed consent in order to take part in the study. This can be a challenge under various circumstances; therefore, another procedure should be implemented such as making sure that a guardian participates in the decision to take part in the study or that the consent information is designed in a manner that the study participants effectively understand. This will enable them to decline to take part in the study if they so wish (Fisher & Happell, 2019).

Topic 5 DQ 1

The component of implement the evidence-based practice project included the development of the research topic, locating the evidence and retrieving the evidence, developing the research proposal, implementing the evidence-based practice project, and evaluation. The most difficult component was the implementation of the evidence-based practice project. This is because, during this phase, a lot of barriers were experienced. Some of the barriers included lack of adequate time to implement the proposed practice; the allocated time was not enough to ensure effective implementation of the change; lack of enough resources and this caused the project to stall for one week while soliciting for more funds and resources from the organization; and lack of enough support from the colleagues and the administration as well.  According to Harris et al (2015) barriers to change implementation include lack of support from management and colleagues, resistance to change, lack of time due to workload, lack of adequate funds, among other barriers. However, in the evidence-based practice project, there were so many things that went smoothly. For example, the set objectives of the project were achieved. Most important, it was evident that the change was effective in promoting healthy behaviors among pregnant and nursing mothers, a higher number of pregnant and new mother attended pre-natal and post-natal clinics, and above all the infant mortality rate significantly reduced over the study period indicating the efficacy of the implemented project. The advice I would provide to a colleague regarding the implementation process is to ensure there are agents of change who can persuade other colleagues to support the change implementation. This will do away with the unnecessary resistance that may delay and hamper smooth implementation of the evidence-based practice (Harris et al, 2015). The Change Initiative Assignment

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 Topic 5 DQ 2

Lack of support from the practitioners and the target population: During the implementation phase, the organizational staff may be having different values and perspectives regarding the proposed change; this may affect the implementation of the evidence-based practice. For example, the physicians may feel that the proposed change is not good enough and therefore fail to support the change. Similarly, nurses may also prefer the previous way of working and therefore fail to support the change. More importantly, the community where the change is being implemented may fail to cooperate and resist the change; this can be a very significant barrier especially because the outreach intervention involves community participation. This problem can be addressed by having change champions and change agents who are responsible for persuading the staff to support the change and highlighting the importance of the change. Evidence shows that change champions and agents of change during change implementation are effective in convincing staff to support the change (Tacia et al, 2015).

Poor communication: Lack of the necessary communication mechanisms during the implementation of the change can significantly hinder the implementation of the evidence-based practice project. Communication gaps, for example, may lead to some important stakeholders missing important information regarding the change implementation which may hinder effective implementation (Tacia et al, 2015). For example, if the management is not informed promptly regarding the required resources for it may fail to provide the necessary funds and resources to run the project on time and this may hinder project implementation. This problem can be addressed by having a laid down communication mechanism and strategies for the project, even before the start of the project. This will ensure that no communication is missed and all the appropriate stakeholders receive information regarding the project on time.

Topic 6 DQ 1

The gaps that were identified during the review include the lack of evidence regarding some of the interventions that might be effective in lowering the infant mortality rate and whose efficacy has not yet been assessed using robust impact assessment methods. The literature review lacked enough evidence to support any known interventions that have been used in combating infant mortality (Lingard, 2018). In addition, the majority of the interventions addressed were not specific and did not provide personalized or patient-centered perspective towards reducing infant mortality. In addition, many studies did not address how racial and ethnic differences lead to disparities when it comes to infant mortality. These gaps may influence the researcher in various ways. One, the researcher may continue with the research without adequate evidence support which may affect the reliability and validity of the research and thus reduce the applicability of the study findings (Lingard, 2018).

Topic 6 DQ 2

Statistically significant findings in clinical research indicate the reliability of the study findings while clinical significance indicates the impact of the findings on clinical practice such as the benefits of the research findings in practice (Ranganathan et al, 2015). Generally, clinical significant mostly depends on the size of the sample where a larger samples size can appear to give statistically significant findings because of being representative of the general population; therefore, even though the findings may be statistically significant, the reader is left with the burden of carefully interpreting the clinical significance of the findings because statistical significance does not always imply clinical significance (El-Masri, 2016). On the other hand, the clinical significance of the research findings mostly depends on the implications of existing practice where the effect size is among the most critical factors that contribute to clinical decisions. Clinical significant is supposed to indicate the level of change if the change can impact the lives of the subjects, cost-effectiveness, the sustainability of the effect, consumer acceptability, as well as the ease associated with the project implementation (El-Masri, 2016). Even though there are established values to indicate the statistical significance of the research findings, this is not the case for clinical significance. In most cases, it is the clinician or the researcher who make a judgment whether the findings are clinically significant or not.  The Change Initiative Assignment

Statistical significance in research can indicate that the study outcome is not due to chance and thus increase the reliability and validity of the study findings. Clinical significance, on the other hand, gives the research a go-ahead to be applied with clinical practice. Generally, findings that are statistically significant and have limited clinical significance may not have any benefit in nursing practice while findings that are clinically significant but lack statistical significance are due to chance and this limits their applicability due to observed size being zero (El-Masri, 2016).

Topic 7 DQ 1

The audience for the EBP proposal includes organizational management, colleagues, and policy makers in the health department.  In the organization, the study findings will be disseminated using flyers, posters and research briefs. Flyers, posters and research briefs provide a brief and visually appealing means to disseminate findings to a wide range of audience (Derman & Jaeger, 2018). In addition, seminars and conferences will be held with the nurses and other healthcare providers within the organization. During these forums, the healthcare providers including the management will be informed about the research findings. The findings will also be published on the organizational website so that any person who is interested in the study can easily access the findings.

For the policymakers, the findings will be mailed to a few selected individuals likely to impact the policy on the issue. In addition, policy briefs will be used to disseminate the findings. According to Derman & Jaeger (2018), research findings are often used to advocate for policy change and advocacy groups along with the legislators used the current research and information during decision-making. The information is presented in the form of the policy brief. Therefore, to target policy makers, advocacy groups and legislators, the findings will be disseminated as policy briefs. The policy brief will be brief and concise and will focus on explaining how the new evidence will influence specific health policy.

The research findings will also be published within a peer‐reviewed journal with suitable recommendations on how the findings can be translated into clinical practice.

Topic 7 DQ 2

In order to ensure that all targeted audiences get the information regarding the research and EBP initiatives, a feedback mechanism will be implemented where the audiences will be asked to give feedback regarding the findings. Discussion forums with the nurses, organizational management and other relevant stakeholders will be held where the study findings will be explained at depth. Moreover, it will be ensured that the findings are pinned on the boardrooms and strategic places where all staff members can access and read the research findings.

In addition, a mass mailing of the summary of the research findings will be done for all target audience. The concept of the bench to bedside to curbside will also be used to ensure that the research findings are translational. There will be a source to collect information at every level of the bedside in order to assess the level of information assimilation and the change as well.

The findings will also be written as clinical summary statements, presented during various hospital committee meetings and will be also presented during any continuing educational in-service. The research council will be used to facilitate communication of the research findings and circulation of the findings to the entire organization. Finally, a thank-you letter, along with the summary of study findings will be sent to each person who in one way or another participated in the study (Derman & Jaeger, 2018).  The Change Initiative Assignment

 Topic 8 DQ 2

There are various strategies that I will integrate into my practice based on this course in order to promote evidence-based practice. One strategy is to always ensure that I am in a position to access a rich library and databases that have nursing and medical journals. The rationale for accessing such libraries and databases is because they are normally rich in the latest evidence appropriate for nursing practice. Another strategy is to advocate for the availability of working with computers and searching the internet during work. This is because computers and the internet are an integral part of research because they are useful in locating and retrieving evidence (Farokhzadian & Batool, 2017).  Therefore, I plan to use computers and the internet more in the workplace to locate any evidence that may advance improvement in healthcare. Finally, being the champion in research is another strategy that can help in the adoption of evidence-based practice. A champion is a person accessible to nurses and the leadership and can answer questions regarding practice change. Being a champion will give me an opportunity to be read widely in my area of research in order to encourage the adoption of EBP. Finally, I plan to always carry out a critical analysis of any research evidence and compare to the hierarchy of levels of evidence whenever I am in the process of implementing evidence-based practice. This is to ensure that the evidence is reliable and valid before being implemented (Farokhzadian & Batool, 2017).

References

Afessa B, Gajic O, Mark K, Edward S, Rolf H & Steve P. (2017). Impact of introducing multiple evidence-based clinical practice protocols in a medical intensive care unit: a retrospective cohort study. BMC Emerg Med. 7(10).

Aslakson R, Cheng J, Galuska D, Smith T & Peter P. (2014). Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions. J Palliat Med. 17(2), 219–235.

Almufleh A, Tori G, Laura T, Mary C, Ahmed A & Paul K. (2015). Role of community health outreach program “living for health”® in improving access to federally qualified health centers in Miami-dade County, Florida: a cross-sectional study. BMC Health Serv Res. 15(181).

Derman R & Jaeger F. (2018). Overcoming challenges to dissemination and implementation of research findings in under-resourced countries. Reprod Health. 15(1), 86.

El-Masri M. (2016). Statistical versus Clinical Significance in Nursing Research. Canadian Journal of Nursing Research. 1(2).

Fisher J & Happell B. (2019). Implications of evidence-based practice for mental health nursing. Int J Ment Health Nurs. 18(3), 179-85.

Farokhzadian J & Batool P. (2017). Strategies of Integration of Evidence-Based Practice in the Clinical Settings. MJ Open. 7(1).

Harris C, Marie G, Allen K, Kelly C, Dina F, Malr T et al. (2015). Development, implementation, and evaluation of an evidence-based program for the introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Services Research. 15(575).

Hossein M & Emami M. (2014). Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran. Int J Health Policy Manag. 1(4), 279–285.

Horntvedt M, Anita N, Fermann T & Serinsson E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC Med Educ. 18(172).

Khammarnia M, Haj M, Amani Z, Shahab R & Fatemeh S. (2015). Barriers to Implementation of Evidence-Based Practice in Zahedan Teaching Hospitals, Iran, 2014. Nurs Res Pract. 2015(2015), 357140.

Lasssi Z, Kumar R & Bhutta Z. (2016). Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank.

Lingard L. (2018). Writing an effective literature review. Perspect Med Educ. 7(1), 47–49.

Pinkowski J. (2018). Educating nurses on how to critique research reports. J Nurs Res Pract. 2(2), 32-34.

Ranganathan P, Pramesh C & Buyse M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspect Clin Res. 6(1), 169-70

Tacia L, Karen B, Pheley A & Lehto R. (2015). Identifying barriers to evidence-based practice

adoption: A focus group study. Clinical Nursing Studies. 3(2).

Abstract

APPENDICES

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The Change Initiative Assignment