please respond to the main discussion DQ1 and DQ2 and also respond to the Peers Discussions

DQ1

Why is understanding the health care system at the local levelimportant to consider when planning an EBP implementation? Conductresearch and solicit anecdotal evidence from your course mentor thatyou will take into consideration for your own change project.

DQ2

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

Peer DQ1

Accordingto ( Li, Jeffs, Barwick, Stevens 2018) understanding the healthcare system at the local level is important to consider whenplanning an EBP implementation because our population is growing andchanging and the delivery of our health care system is trying tomeet the needs of the population. Therefore, when you understand thehealth care system, you can better identify the problem, critiquethe evidence, implement evidence-based recommendations, evaluate thechange, and disseminate results. Implementation of evidence isessential for patients to receive the best care possible.Implementation is the fourth step in the EBP process and requiresmoving from a focus on finding and evaluating the evidence toactively using it to produce quality outcomes.

References:

Shelly-AnneLi, Lianne Jeffs, Melanie Barwick, & Bonnie Stevens. (2018).Organizational contextual features that influence the implementationof evidence-based practices across healthcare settings: a systematicintegrative review. Systematic Reviews, Vol 7, Iss 1, Pp 1-19(2018), (1), 1. https://doi-org.lopes.idm.oclc.org/10.1186/s13643-…

Peer DQ2

It enables you to have a quality approach towards the integration ofclinical experts, patients value work effectively when researchevidence is inclusive. Patients value differ from one patient toanother and as a health practitioner you must understand how each ofthem with their expectations. This will led to improved decisionmaking as the desired result is based on the analysis and evaluationof data.

Explanation:

The ability to review and align resources so as to get a desireddecision. Understanding of health care at local levels will enable forcritical analysis of data so as to evaluate their performance. You getto know how their data is and based on research or not and whether theevaluation is being done by competent power. When you realize a defectaddress it to enable for effective evidence based decisions.

Peer DQ3

Itis important to understand the health care system at the local levelwhen planning an EBP implementation. Evidence- based practice ismeant to be the best thing or action to take to that can enhanceproper or normal physiological functioning, to protect, promote,optimize health and abilities, prevent illness and injury,facilitate healing, and alleviate suffering through thediagnosis and treatment of human response, and advocacy in the careof individuals, families, groups, communities and populations (ANA,n d). Any change in the practice of nursing should be able toimprove the present situation better than the previous practices. Itis imperative to understand the present situation, the presentsituation and the expected outcome which is the future situation-after changes are made. To implement EBP, one must know what theexpected accomplishments are, set up standard of knowing if thechange is an improvement or not, and exactly what to do thatwould result in improvement (Institute for Healthcare Improvement,2018) It helps in the

• Planning
• Implementation
• Studyingthe result(Institute for Healthcare Improvement, 2018)

Understandingthe health care system at the local level will help to know theimprovement that is needed. How much of the change needed, to decideif the propose change will work in that environment / system? Italso enables one to know the cost, social impact, side effects fromthe anticipated change and to minimize resistance duringimplementation. (Institute for Healthcare Improvement, 2018)Example, in any health care settings Medicare / Medicaid/ insurance cover most health care health care services, one mustinquire about what services the coverage and payment

Plannedchange in nursing practice is necessary for a wide range of reasons.Understanding and using a change theory framework can help managersor other change agents to increase the likelihood of success. Thisarticle considers three change theories and discusses how one can beused in practice (Mitchell, 2013) Theory of Change calls for acomprehensive description and illustration of how and why a desiredchange is expected to happen in a context, and how these lead todesired goals being achieved. It also involves the OutcomesFramework which provide the basis for identification of activity orintervention that will lead to the outcomes identified asrequirements for attaining the long-term goal (Center for theory ofChange,2018) Example Dogs Trust Worldwide, an internationalNon-Governmental Organization which works to improve canine welfare,apply Theory of Change framework to identify challengesfaced when collaborating with local partners to achieve its mission.Theory of Change approach and its importance to Human BehaviorChange within this. Questions which need to be addressed wereidentified as a conduct of working with partner organizations andacknowledging issues around producing evidence to measure the impactour work has on the ultimate beneficiaries (Karen Reed and Melissa M Upjohn,2018)

References:

AmericanNurses Association(ANA): Scope of Nursing Practice retrieved from https://www.nursingworld.org/practice-policy/scope…

Centerfor theory of Change, 2018: What is Theory of Change retrieved from https://www.theoryofchange.org/what-is-theory-of-c…

KarenReed, & Melissa M. Upjohn. (2018). Better Lives for Dogs:Incorporating Human Behavior Change Into a Theory of Change toImprove Canine Welfare Worldwide. Frontiers in Veterinary Science,Vol 5 (2018). https://doi-org.lopes.idm.oclc.org/10.3389/fvets.2…

Mitchell,G. (2013). Selecting the best theory to implement planned change.Nursing Management – UK, 20(1), 32–37. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…

Peer DQ4

Over the years, the implementation of evidence-based practicehas been embraced in health care settings (Warrenet al., 2016). However, the process of planning forimplementation will need to consider the health care system at thelocal and national levels. It is important to understand the visionand goals of the existing health care system at the local levels toensure that the implemented EBP is in line with the goals and visionof the system. The implemented EBP should help the health caresystem to achieve the desired goals and vision. Without properanalysis and understanding of the local system, the implemented EBPmay fail to meet the goals of the organization hence making itambiguous. Understanding the local system will help to determine theculture and the issues that may be affecting the effectiveness ofthe system in delivering services (Warrenet al., 2016). Therefore, it will be possible to develop EBPthat can help to solve the existing issues and respect the culturethat exists.

The primary aim of the EBP is to meet the needsof the local community hence it is important to understand theseneeds and issues to ensure that the implementation offers a reliablesolution. The understanding of the local system also allows inunderstanding the needs of the leaders to ensure that allstakeholders involved agree with the proposed evidence-basedpractice that is related to the organizational culture and goals.The leaders may be educated or made aware of the importance ofimplementing EBP to motivate them to participate and support thisprocess. Therefore, it can be argued that the understanding of thelocal system is important since it guides the development of theobjectives of the implementation. It helps to evaluate the needs ofthe people, corporate culture and needs in addition to goals tofacilitate the implementation of a well-designed and plannedevidence-based practice.

References

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C.A., Kropkowski, L., & Risch, S. (2016). The strengths andchallenges of implementing EBP in healthcare systems. Worldviewson Evidence‐Based Nursing, 13(1), 15-24

Peer DQ5

It is imperative to understand the healthcare system at the locallevel when planning an EBP implementation because it allows theproject manager to gain better knowledge of the existing policies andchanges in the policies that can be made in the organization when itcomes to new practices in the delivery of healthcare topatients. Meeting the needs of the patient populations is key tothe delivery of high quality patient care (Lyons, 2014). Forexample, the hospital where I work has a very diverse patientpopulation with various needs, so while planning an EBP implementationproject in the organization, it is essential to take the diversepatient population into account and provide culturally competent care.According to Nadeau, Pinner, Murphy, and Belderson (2017),evidence-based practice is the conscientious and judicious use ofcurrent best evidence in conjunction with clinical expertise andpatient values to guide health care decisions. That is why it iscritical to understand the health care system at the local level.

David

Lyons, D. L. (2014). Implementing a comprehensive functional modelof care in hospitalized older adults. MEDSURG Nursing,23(6), 379-385.

Nadeau, K., Pinner, K., Murphy, K., & Belderson, K. M. (2017).Perceptions of a primary nursing care model in a pediatrichematology/oncology unit. Journal of Pediatric OncologyNursing, 34(1), 28-34. doi:10.1177/1043454216631472

Peer DQ6

The two change theories that arediscussed are the Lewin and Rogers change theories. In the movementstage of Lewin and the interest stage of Rogers change theory, thereare assessment and trial stages. These stages also include alteringthe agents to get all accessible information and come up withsolutions regarding the problem. The refreezing stage of Lewintheory corresponds to the adoption stage of Roger change theory. Inthese stages, the expected change is already incorporated in thesystem, and approaches are created to stop the system from revertingto the old practices (Mitchell, 2013). In the unfreezing stage ofLewin change theory, the agents are inspired to make a change andmembers of staff that are affected are made conscious of therequirement to carry out the change. In this stage the issue isrecognized and by use of collaboration selection of the bestsolution is made. The unfreezing stage happens when instability isfamiliarized to the system creating the necessity to make a change.This resembles stage one of Rogers change theory.

The theory that is most suitable tomake a change in the Evidence-Based Practice is the Rogers changetheory. This is because it functions as the theoretical framework inrecognizing the situations that adopt innovation and linked ways ofadoption (Mohammadi, Poursaberi & Salahshoor, 2018). The theoryfacilitates the assessment of how specific clinical actions areimplemented and foster the concentration to be aimed towards thesupposed innovation characteristics that promote implementation. Inthis theory, five traits of implementation are identified ascompatibility, relative advantage, simplicity, trialability, andobservability. These factors are expected to affect implementationin the EBP in a clinical practice.

My mentor has used this theory toimplement change in the EBP projects. The result was that the theoryfacilitated in making an evaluation on the degree of the impact madeby the implementation characteristics. The theory also helped inhighlighting the necessity of intermediary factors like changeagents, opinion leaders and gatekeepers in making the implementation successfull

References

Mitchell, G. (2013). Selecting the best theory to implementplanned change. Nursing Management (through 2013),20(1), 32.

Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R.(2018). Evaluating the adoption of evidence-based practice usingRogers’s diffusion of innovation theory: a model testingstudy. Health promotion perspectives, 8(1), 25.