Application 2: Laying the Foundation for New Approaches to Practice

As frequently noted in the literature, there is often a gap between research evidence and practice. This is not a new phenomenon; however, with the rapid growth of knowledge, it is essential that nurses hone their ability to identify this gap, determine best practices based on the evidence, and then apply this evidence to practice through the development of new approaches. In order for that to transpire, nurses must be skilled in leading change efforts so that adoption of new practice approaches can be successful.

For your EBP Project in Week 2 (Application 1 [SEE ATTACHED FILES] ), you identified an issue in your practicum setting in which the outcome is different from what would be expected according to the research literature. This week continue to explore current research literature looking for new evidence to address the problem. In addition, you build on the work you began in this week’s Discussion and select an evidence-based practice model ( The Iowa Model of Evidence-Based Practice to Promote Quality Care” Or you can use the Johns Hopkins Model) and change theory (USE THE THEORY OF PLANNED BEHAVIOR) or framework that will support your efforts.

To prepare for Application 2 address the following:

• How      current is the science underlying the practices related to your EBP      Project issue?
• Consider      possible causes of the difference in outcomes from what would be expected      according to the research literature.
• Evaluate      the effect the EBP Project issue is having in practice.
• Using      the Walden Library and other credible sources, locate current research      evidence of new practices that are effective in addressing the issue.
• Use      the GRADE model presented in the      Guyatt et al. (2011) article to evaluate the research evidence (see      attached file for the article)

The full Application 2 is due by Day 5 of this week. Instructions for how to prepare for previous sections of this Application have been provided in Week 4.

To complete:

Write a 3- to 5-page paper, in APA format with a minimum of 6 scholarly references. PLEASE CITE OFTEN. include the following level one headers as numbered below:

1) Introduction

2) A brief summary of the currency of the science underlying the practices used to address your EBP Project issue

3) Possible causes of the difference in outcomes from what would be expected according to the research literature

4) The effect the EBP Project issue is having in practice

5) Current research evidence on new practices for addressing the EBP Project issue

6) A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue

7) Summary

PLEASE FOLLOW THE EXACT FORMAT IN THE GRADING RUBRIC. WRITE THE HEADERS EXACTLY AS IN THE GRADING RUBRIC AND ADD AN INTRODUCTION AND SUMMARY. INSERT MY PIICOT QUESTION IN THE BEGINNING OF THE PAPER.

• Please do not go       over 5 pages. Being concise, but scholarly       and well-cited is a skill. Make sure each word is needed and refrain from       using unnecessary verbiage.  CITE OFTEN
• Use       level 1 APA headers for each component of the assignment! See assignment       directions and grading rubric for components graded and note the items in       blue should be your headers. 
• You will need a theory to guide your work. For more information on theories… (for mine, please use the theory of       planned behavior that you chose on the first assignment).
• You will need to EBP model to frame your course-related (6410) EBP project EBP models give you steps       for proceeding in a logical manner. I would recommend you look up the       following article to help you.
  • Schaffer, M. A.,  Sandau, K. E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: Overview and practical applications.  Journal of Advanced Nursing, 69(5), 1197-1208.  doi:10.1111/j.1365-2648.2012.06122.x        (see attached article)

P.S. I’M ATTACHING THE PREVIOUS PAPER TO HELP REFRESH YOUR MEMORY AND ALSO SEE THE CORRECTIONS THE PROFESSOR MADE SO THAT YOU DON’T REPEAT THE SAME MISTAKES. I DIDN’T GET A GOOD GRADE ON THAT PAPER, PLEASE PAY CAREFUL ATTENTION TO EACH AND EVERY INSTRUCTION HERE. I NEED AN ‘A’ ON THIS PAPER TO MAKE UP THE FIRST ONE.

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

REQUIRED READINGS

  

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. & Stillwell, S.B. (2011). Evidence-based practice step-by-step: Implementing an evidence-based practice change. American Journal of Nursing, 111(3), 54-60.

Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322. (See attached file).

Pryse, Y., McDaniel, A., & Schafer, J. (2014). Psychometric analysis of two new scales: The evidence-based practice nursing leadership and work environment scales. Worldviews on Evidence-Based Nursing, 11(4), 240-247.

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: A systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802.

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209 (see attached file).

  

A 34-year-old Hispanic-American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

Comment 1

Working in a hospital, or any type of medical facility, is not limited to one type of nurse or nursing education. Nurses with both ADNs and BSNs are typically employed at any number of facilities. Under the proper instruction and motivation, nurses can adequately perform the functions of their positions with ease. However, there have been studies which link patient safety outcomes and nursing education. Research from Weinberg et. al (2012) “links higher proportions of nurses with baccalaureate of science in nursing (BSN) degrees to lower patient mortality rates” (Weinberg et. al, 2012, p. 4). It is likely that nurses who have pursued a higher degree than the ADN simply receive more knowledge about specific interventions and procedures. From my own real-life experiences, I do not really agree with this research. Nurses who are compassionate, caring, meticulous and focus on the needs of the patients will generate positive outcomes for their patients. The contribution of the work environment and the use of interdisciplinary teams are essential to providing adequate patient safety. These factors must also be considered when making assertions regarding patient safety outcomes and nursing education. It is difficult to solely pin the claim that patient safety is lessened by the effects of lower education, separating it from all the other components which can contribute. 

Comment 2

Multiple studies were found that link patient safety outcomes to ADN and BSN nurses.  It is believed that one’s level education have a lot to say on how much he or she knows and how well he or she practices. In a study by Aiken, Clarke, Cheung, Sloane, & Silber (2003), it was concluded that changing the educational background of hospital nurses by increasing the percentage of those having a BSN or higher, would decrease substantially the mortality rate for patients that have surgery in general and for those developing complications.  A growing body of research suggests that hospital having a higher proportion of Nurses with a BSN on staff is linked to better patient outcomes, and other studies supported an association between BSN staffing and outcomes such as lower incidence of pressure ulcers, hospital acquired pneumonia, postoperative deep vein thrombosis and post surgical mortality rate (Robert Wood Johnson Foundation, 2013).

Although most nurses call to the profession are from a caring, compassionate nurse heart and the love for this profession, nurses also need to be prepared and have the knowledge to be able to fulfill this passion to the highest level of expectation. Researches that link patient’s safety and outcomes to ADN and BSN or higher level are based on real life experiences.  Nurses with higher education such as a BSN or higher, communicate better, they are better critical thinkers, problem solvers and are able to better assess and evaluate patients’ situations.  Although I am not done with my BSN, I had put into my current practice so much I have learned from my previous BSN classes. With a BSN level, nurses learn to give better care to patients with chronic illness and most importantly we learn to promote wellness and work toward disease prevention to prevent chronic illness; we learn to apply appropriate method to help our patients understand our teaching; we learn leadership and management skills and many more. BSN level helps nurses deliver care to a higher level while considering actions that impact health care costs and patients’ outcomes. BSN or higher help nurses deliver quality care to the patients to prevent complications and increase outcomes.   

Comment 3

“Nursing is unique among the health care professions in the United States in that it has multiple educational pathways leading to an entry-level license to practice” (Institute of Medicine ,2010). Associate nursing degree (ADN) is designed to be completed within two years. The main focuses are provision of patient care in a safe manner professional and ethical behavior, effective collaboration and application of nursing knowledge. Baccalaureate nursing program (BSN) is designed to be completed within four years. This program is designed to educate nurses with core and upper level courses. Nurses in this program are expected to function in basic leadership capacity after completion (American Association of Colleges of Nursing, 2017)

 Both BSN nurses and ADN nurses are trained to perform certain basic skills like medication administration and wound care for example. In any given situation that involved patient care both nurses are expected to critically think to improve the patient’s outcome. Whether having a BSN degree or ADN degree, saving lives are what all nurses are entrusted to do. Nurses have one of the most well respected professions. We are trained to critically think and administer care in the most severe situations. And almost all the time we rise to the occasion and beyond. As nurses we are always edifying ourselves because technology and medicine are always evolving; this only gives us the opportunity to prepared and produce the best nursing care possible for our patients in treating their illnesse

  

Evaluation Plan

A plan for evaluation should be correlated well with the specific program for which it has been developed. As you continue to work on Assignment 4, it is important to bear in mind that an evaluation plan is distinct from–yet aligned with–the program plan and contains its own goals and objectives.

This week you integrate the knowledge and discernment you have developed to formulate a plan for how evaluation could be an integral part of your program (see attached file in file section named “Week 9 Discussion”).

To prepare for this week’s section of Assignment 4:

• Keep your own program in mind as your      review the information presented in this week’s Learning Resources.
• Develop an evaluation plan that      includes goals, objectives, and activities. Consider what type of data      will be needed.
• Review your visual representation of      your program plan design (Week 6      [see attached file named “Assignment 2”]) and incorporate your      evaluation plan.
• Revise your Gantt chart (Week 6 [see attached file named “Assignment      2”]) to include your evaluation plan.

The full Assignment 4 is due by Wednesday 1/30/19 before midnight of this week. Instructions have been provided in previous weeks to help you prepare.

By Day 3

To complete:

Write a 3- to 5-page paper in APA format with a minimum of 6 scholarly references. Include the level 1 and 2 headers as numbered below that addresses the following (Please make sure to follow the outline exactly as below):

1) Evaluation Methods (developed in Week 9 [see attached file in file section named “Week 9 Discussion”])

a) Identify an evaluation theory or model that is aligned to your program goal(s) and objectives.

b) Exhibit a performance measurement, monitoring, and evaluation timeline that:

o Demonstrates the appropriate use of performance measurement, monitoring, and summative evaluation

o Distinguishes between the long-term effects of impact evaluation versus short and intermediate health outcomes as a result of the implementation of the program.

2) Evaluation Plan (developed this week [see attached file named week 10 discussion”])

c) Develop an evaluation plan that includes goals, objectives, and activities. Specify the type of data needed.

d) Add your evaluation plan to the visual representation (e.g., table or graph) of your program plan design.

e) Add time line information for the evaluation plan to your Gantt chart.

Note: In addition to your paper, be sure to submit the following (which may be contained in a separate document):

• An updated version of the visual      representation (e.g., table or graph) of your program design that includes      your evaluation plan (See attached file, then revise )
• An updated version of your Gantt      chart that includes your evaluation plan

Be sure to make revisions to these items based on any feedback you received from your Instructor when you submitted them in Week 6 (see attached file).

Required Readings

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

· Review Chapter 4, “Program Planning: The Big Picture”

· Review Chapter 5, “Social Marketing, Program Planning, and Implementation”

As you review Chapter 4, focus on the budgeting information presented on pp. 113–115.

· Chapter 6, “The Importance and Use of Theories in Health Education and Health Promotion”

The authors describe various theories, noting that theories are not universally applicable to every program.

· Chapter 10, “Program Evaluation: Background and Basics”

Chapter 10 outlines steps for designing evaluation during program planning.

Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage. 

An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage.

· Chapter 2, “The Contribution of Theory to Program Planning”

This chapter examines the application of theory in program planning.

· Review Chapter 10, “Performance Measurement, Monitoring, and Program Evaluation”

· Chapter 11, “Impact Program Evaluation and Hypothesis Testing”

· Review Chapter 10 and read Chapter 11 to examine aspects of evaluation essential to program planning.

· Chapter 12, “Budgeting for Financial Control, Management, and Planning”

· Chapter 13, “Developing Line-Item, Functional, and Program Budgeting Systems”

·  Chapter 10, “Performance Measurement, Monitoring, and Program Evaluation”

As you read this chapter, pay attention to the financial functions associated with these forms of evaluation and the data to be collected.

Chapter 12 introduces budgeting as an important part of the planning process, noting that it also serves essential management and control functions for programs. Chapter 13 addresses three systems of budgeting—line item, functional, and program—each of which has a distinct focus.

Berhane, A., Biadgilign, S., Berhane, A., & Memiah, P. (2015). Male involvement in family planning program in Northern Ethiopia: An application of the Transtheoretical model. Patient Education and Counseling 98, 469–475

Kroelinger, C.D., Rankin, K. M., Chamgers, D.A., Diez Roux, A.V., Huges, K., & Grigorescu, V. (2014). Using the principles of complex systems thinking and implementation sceice to enhance maternal and child health program planning and delivery. Maternal Child Health Journal, 18, 1560–1564. doi 10.1007/s10995-014-1586-9

Silverman, B., Champney, J., Steber, S., & Zubritsky, C. (2015). Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers. Evaluation and Program Planning 51,17–26 doi.org/10.1016/j.evalprogplan.2014.12.002

Smith, T.L., Barlow, P.b., Peters, J.M., & Skolits, G.J. (2015). Demystifying reflective practice: Using the DATA model to enhance evaluators’ professional activities. Evaluation and Program Planning, 52, 142–147.

Albert, D., Fortin, R., Herrera, C., Riley, B., Hanning, R., Lessio, A., & Rush, B. (2013). Strengthening chronic disease prevention programming: The toward evidence-Informed practice (TEIP) program evidence tool. Preventing Chronic Disease, 10,1–9

Baron, K., Hodgson, A., & Walshe, C. (2015). Evaluation of an advance care planning education programme for nursing homes: A longitudinal study. Nurse Education Today, 35, 689–695.

Schmitt, C.L., Glasgow, L., Lavinghouze, S.R., Ricker, P.P., Fulmer, E., McAleer, K., & Rogers, T. (2016). Measuring infrastructure: A key step in program evaluation and planning. Evaluation and Program Planning, 56, 50–56 doi.org/10.1016/j.evalprogplan.2016.03.007

Gaskin, J., Rennie, C., & Coyle, D. (2015). Reducing periconceptional methylmercury exposure: Cost-utility analysis for a proposed screening program for women planning a pregnancy in Ontario, Canada. Environmental Health Perspectives, 123(12), 1337–1344 doi.org/10.1289/ehp.1409034.

Palumbo, M.V., Sikorski, E.A. & Liberty, B.C. (2013). Exploring the cost-effectiveness of unit-based health promotion activities for nurses. Workplace Health & Safety, 61(12), 514–520.

U.S. Small Business Administration. (n.d.). Writing a business plan. Retrieved December 12, 2011, from http://www.sba.gov/category/navigation-structure/starting-managing-business/starting-business/writing-business-plan

The “Writing a Business Plan” section of this website introduces elements of a good business plan, which is an essential document for any program. Investigate the information presented. In addition, see the “Preparing Your Finances” section for information on break-even analysis and other budgeting-related matters.

Robbins, L.B., Pfeiffer, K.A., Weolek, S.M., & Lo, Y. (2014). Process evaluation for a school-based physical intervention for 6th and 7th grade boys: Reach, dose, and fidelity. Evaluation and Program Planning, 42, 21–31 doi.org/10.1016/j.evalprogplan.2013.09.002

Schalock, R.L., Lee, t., Verdugo, M., Swart, K., Claes, C., van Loon, J., & Lee, C. (2014). An evidence-based approach to organization evaluation and change in human service organizations evaluation and program planning. Evaluation and Program Planning, 45, 110–118. 

Moore, H.K., Preussler, J., Denzen, E.M., Payton, T.J., Thao, V., Murphy, E.A. & Harwood, E. (2014). Designing and operationalizing a customized internal evaluation model for cancer treatment support programs, Journal Cancer Education, 29, 463–372 doi10.1007/s13187-014-0644-8

Redwood, D., Provost, E., Lopez, E.D., Skewes, M., Johnson, R., Christensen, C., Sacco, F., & Haverkamp, D. (2016). A process evaluation of the Alaska Native colorectal cancer family outreach program. Health Education & Behavior, 43(1), 35–42 doi: 10.1177/1090198115590781

Robbins, L.B., Pfeiffer, K.A., Weolek, S.M., & Lo, Y. (2014). Process evaluation for a school-based physical intervention for 6th and 7th grade boys: Reach, dose, and fidelity. Evaluation and Program Planning, 42, 21–31 doi.org/10.1016/j.evalprogplan.2013.09.002

Optional Resources

Ahmad, F., Roy, A., Brady, S., Belgeonne, S., Dunn, L., & Pitts, J. (2007). Care pathway initiative for people with intellectual disabilities: Impact evaluation. Journal of Nursing Management, 15(7), 700–702.

This article is an example of an impact evaluation.

Gard, C. L., Flannigan, P. N., & Cluskey, M. (2004). Program evaluation: An ongoing systematic process. Nursing Education Perspectives, 25(4), 176–179.

This article discusses the use of accreditation standards and site visits as a plan for ongoing evaluation for a nursing program.

Graff, J. C., Russell, C. K., & Stegbauer, C. C. (2007). Formative and summative evaluation of a practice doctorate program. Nurse Educator, 32(4), 173–177.

Milne, L., Scotland, G., Tagiyeva-Milne, N., & Hussein, J. (2004). Safe motherhood program evaluation: Theory and practice. Journal of Midwifery & Women’s Health, 49(4), 338–344.

This article identifies and evaluates the different approaches to program evaluation related to safe motherhood.

Centers for Disease Control and Prevention. (2007). Chronic disease indicators [Data set]. Retrieved from https://www.cdc.gov/cdi/.

This site allows you to search and compare different regions for specific chronic disease indicators.

Hulton, L. J. (2007). An evaluation of a school-based teenage pregnancy prevention program using a logic model framework. Journal of School Nursing, 23(2), 104–110.

This article describes the use of the logic model to develop, implement, and evaluate a nursing intervention in a school setting.

Johnson, S. S., Driskell, M., Johnson, J. L., Prochaska, J. M., Zwick, W., & Prochaska, J. O. (2006). Efficacy of a transtheoretical model-based expert system for antihypertensive adherence. Disease Management, 9(5), 291–301.

This article introduces the use of the transtheoretical model and stages of change as applied to interventions aimed at medication adherence for patients with hypertension.

Rogers, L. Q., Shah, P., Dunnington, G., Greive, A., Shanmugham, A., Dawson, B., & Courneya, K. S. (2005). Social cognitive theory and physical activity during breast cancer treatment. Oncology Nursing Forum, 32(4), 807–815.

The social cognitive theory is utilized to examine associations with physical activity in breast cancer patients. This article posits that the social cognitive theory can be used as a mediator for intervention evaluation with this population.

W. K. Kellogg Foundation. (2004). Using logic models to bring together planning, evaluation, and action: Logic model development guide. Battle Creek, MI: W. K. Kellogg Foundation. Retrieved from http://www.wkkf.org/resource-directory/resource/2006/02/wk-kellogg-foundation-logic-model-development-guide.

This report offers a guide for the use of the logic model in program planning and outcome-oriented evaluation for nonprofit projects.

Dirubbo, N. E. (2006). Break-even analysis: Can I afford to do this? Nurse Practitioner, 31(7), 11.

This article briefly explains break-even analysis and its use in initiating new programs.

McBryde-Foster, M. J. (2005). Break-even analysis in a nurse-managed center. Nursing Economic$, 23(1), 31–34

This article explains how break-even analysis can be used in a nursing environment and how to apply it for program proposals.

U.S. National Library of Medicine. (2008). HTA 101: IV. Cost analysis methods. Retrieved from http://www.nlm.nih.gov/nichsr/hta101/ta10106.html

· Published by the National Institutes of Health, this site offers an explanation of the types of cost analysis including comparison of cost-utility, cost-effectiveness, and cost-benefits.

Required Media

Laureate Education (Producer). (2011). Design and evaluation of programs and projects [Video file]. Baltimore, MD: Author.

“Performance Measurement, Monitoring, and Evaluation” (featuring Dr. Donna Shambley-Ebron, Dr. Melissa Willmarth, and Dr. Debora Dole)

You may view this course video by clicking the link or on the course DVD, which contains the same content. Once you’ve opened the link, click on the appropriate media piece.

In this week’s videos, Dr. Donna Shambley-Ebron, Dr. Melissa Willmarth, Dr. Debora Dole discuss evaluation for programs.

As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.

1. Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
2. Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
3. In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
4. A minimum of three scholarly references are required for this assignment.