Change Agent

To purpose and use evidence-based practice in promoting positive outcomes, change is inevitable. As much as “change is vital to progress in evidence-based nursing practice, there are many complexities associated with transforming plans into action and attempts at change often fail because change agents take an unstructured approach to implementation” (Mitchell, 2013). I believe I can be a change agent by “carrying out a calculated, purposeful and collaborative effort to guide others to move from a process focus to an outcome focus” (Mitchell, 2013).

Relationship to the area of practice

I work in an acute care setting where most of the patients have a therapeutic indication for indwelling urinary catheters (IUC). We have a CQI team which I am part of, as a change agent and member of the CQI, it is my responsibility to see that to the pre-assessment and monitoring of patient on IUC. IUC must have a physician’s order, then a urinary catheter assessment bundle must be filled and signed by two registered nurses after assessing the patient and reviewing his or her chart for allergies to latex or silicone and a therapeutic/appropriate indication for the IUC.  Afterward, placement must be done by two nurses with an utmost degree of hand hygiene and sterility. After the catheter placement, a daily assessment is done by the CQI team to identify indications for continued use or discontinuation of the IUC. The CQI team always make sure CDC guideline for CAUTI prevention is followed at all time. Although this process of IUC use was resisted by many, the change was implemented and still in place.

The rationale behind the change from a process focus to an outcomes focus.

Shifting from process to outcome focus especially on the nursing and care of patients is imperative. While a process focus will only explain whether the “procedures, activities or services have been performed rightly and implemented as intended, an outcome focus will explain the results and determines whether the intended outcomes are achieved” (Center for Disease Control and Prevention, n.d). Outcomes focus thus helps to determine the degree to which the nursing care rendered helps to meet the goal and provide evidence-based practice for use thus improves patient care, safety, and recovery.

 1. Is there an abstract with a list of keywords preceding the research paper?  

• Cover page?
• Page numbers?
• Indented paragraphs?
• 1” margins?
• A total of 5 pages, not including the cover page, abstract and references page?

 2. Introduction: Is the thesis clear?  What is it?  

 Does it appear soon enough in the paper?

• What questions does the thesis promise to answer? There are usually three, sometimes two, sometimes four or more.
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1. Introduction: Is there some background given in the introduction that gives you some idea of why this topic is important or timely or relevant?  What is it?
2. Introduction: Is there an engaging first sentence?  
   • Is it an interesting fact, 
   • alarming statistic, 
   • question, 
   • quote, 
   • story
3. Introduction: Is there any terminology you need defined sooner to better understand the discussion that follows?
4. Body: In which paragraphs has each of the thesis questions been answered?

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1. Body: Evidence: Has evidence been given to back up the claims made the research paper?  Since the research paper is required to have four sources, you should find at least four different sources cited in APA style as in-text citations (also called parenthetical citations).

 i.   

 ii.   

 iii.   

 iv.   

Body: Evidence: What type of evidence is each of the above – data, studies, expert opinion?          

1. Body: Evidence: Is there enough evidence given to be convincing?  Could it be improved? 

 i.  How? 

updated statistics, any statistics, an explanation for conflicting statistics

a quote from an expert, 

a more credible source, a primary source, 

a case history or example

1. Body: Evidence: Are the in-text citations done properly in APA style? 
   • Were you able to easily match up the in-text citation with the first word(s) in the References page?
2. Body: Evidence: In each paragraph, does the writer explain how each piece of evidence is pertinent to the thesis?   If not, where? 
   • Remember paragraph structure:

 i.   Topic sentence

 ii.  Support sentences

 iii.  Closing sentence to help integrate the information in the support sentences with the topic sentence and with the paper’s thesis.

1. Body: Evidence: Are there any in-text (parenthetical) citations missing for quotations, expert opinion or data?  Where?  

 i.  Were there any citations given for paraphrasing? Where?

                           ii.   Are there any claims made that don’t have evidence for them? That are based solely on the writer’s opinion? 

1. Body: Evidence: Are the cited sources credible and convincing?  
   • Do any of the quotations or opinions or data need a signal phrase 

 i.  to explain who the author is and why the author is credible 

 ii.  or where the data comes from?  

1. Body: Is there a logical progression of ideas? 
   • Did each idea help support the thesis, or is something missing that would help you better understand the writer’s points?
   • Are there transitions missing that would help you understand how an idea, paragraph or sentence is connected to the one before it? Where?
2. Body: Are there any sentences that are too long and convoluted to be easily understood? Where could they be broken down into more than one sentence?
3. Are there any personal pronouns (“I, me, mine, you/your”)? Where?
   • If “you/your/yours“ is used, is it being used strategically to directly address the reader? 
   • Is it always clear who” they” are or what “it is? If not, where? 
4. Conclusion: Is there a conclusion? 
   • What does the conclusion do? What type of conclusion is it? 
     • Does it ask something of the reader? Of some other group or institutions? 
     • Does it make a recommendation or give advice? 
     • Does it inform the reader of proposed or possible solutions to a problem? 
     • Is it a call to action? Tor awareness, education? 
     • Does it speculate about the future? 
     • Or does it make an observation based on what has been learned in the course of reading the research paper?  
5. Conclusion: Are you left with any questions about the subject/argument?
6. No more than 20% of the paper is quotes (80/20 rule).
7. References: Is there a References page in proper APA style?
   • Is the heading bold and centered?
   • Is the list alphabetized?
   • Are hanging indents used?
   • Are there at least four sources?
   • Are about half of them primary? 
   • Are the names of the publications included in primary source citations?
   • Is each electronically accessed source followed by a doi: or URL?

you may work off the essay provided. add to it. this needs to be done within 4 hours!

Select an infectious disease and research the CDC website for: 

A. Information about the disease using the natural history of disease;from point of disease causing agent contact to full manifestation, or only the epidemiolic triangle model by including outbreak characteristics.

B. Identify an occurrence of the disease by searching the Internet for recent reports of this disease,

C.) Compare that episode or occurrence with information from the CDC website. How closely did that outbreak resemble the case definition? Explain the purpose of the CDC case definition.

Seasonal Affective Disorder

Part 2- Turning in your final treatment plan and Analysis  

The final treatment plan will include the primary diagnosis, diagnostic testing recommended by National Guidelines. Medications, interventions, education, labs, follow up, referrals. After completing the treatment plan include the following sections in a large area called ANALYSIS:

1. Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology.

2. Additional analysis of the case: This includes national guidelines that were or should have been used to make diagnosis or treatment and review how they applied or how care was unique but based in guidelines.

3. Follow-up/Referrals: This means how the patient was doing when seen a second time if this applies. This would be their response to your plan of care. OR when Follow up will occur and what actions will be taken on the follow up visit. Referrals if indicated.

4. Quality: Include anything that should have been considered in hindsight or changes you would make in seeing similar patients in the future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient.

5. Coding and Billing. Any or all CPT and ICD-10 codes that should have been used (List them and name them only.