NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

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NUR 590 Topic 3 DQ 2

Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.

The Star Model explains how specific forms of knowledge, such as the systematic review and the clinical practice guideline, are solutions for moving research into practice. It is a model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various phases of EBP in moving evidence into clinical decision making. The clinical scholar model was developed and implemented to promote the spirit of inquiry, educate direct care providers, and guide a mentorship program for EBP and the conduct of research at the point of care.

It began as an interactive, outcomes-oriented educational program for nurses but has evolved into an interdisciplinary educational program for direct care providers (Melnyk, 2019). In my evidence-based practice proposal, the Star Model would be most beneficial. This model reviews current practice and applies knowledge for change. For my proposal, there is a lot of research on both patient and nurse dissatisfaction with the current bereavement process when a patient experiences a miscarriage in the ED. There is not a lot of research on implementation of better practice and protocols. Therefore, the Star Model will allow for me to take the knowledge of the subject and develop a change.

Resource:

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.

Change facilitation requires forethought and intentional planning and execution if a well-supported, sustainable change is going to be made on a larger scale – especially in healthcare. Evidence-base practice models may include theoretical models grouped into evidence-based practice/research utilization and knowledge transformation processes, strategic organizational change theory or knowledge exchange and synthesis for application and inquiry (Melnyk & Fineout-Overholt, 2019). However, it is becoming more widely acknowledged that a formalized approach must be considered to successfully implement these evidence-based models.

Eight different models have been identified as key drivers for evidence-based integration and change management. These include: 1. The Stetler Model of Evidence-Based Practice, 2. The Iowa Model of Evidence-Based Practice, 3. The Model for Evidence-Based Practice Change, 4. The Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP, 6. The Clinical Scholar Model, 7. The Johns Hopkins Nursing Evidence-Based Practice Model, and 8. The Stevens Star Model of Knowledge Transformation (Melnyk & Fineout-Overholt, 2019).

Upon comparing the Stetler Model and Johns Hopkins Model, the Stetler Model has been regularly revised, and involves integrating evidence-base practice information into practical, sustainable day to day standards for patient care. With critical thinking and utilization of both internal and external evidence to support practice change, the Stetler Model hinges on five phases, and multiple steps to identify and support use of evidence, determined by critical thinking (Melnyk & Fineout-Overholt, 2019). A “toolkit” of sorts has been developed to implement consensus guidelines and evidence-base practice change. Upon comparison, the Johns Hopkins Model supports its use by bedside registered nurses with aim to implement research results in an evidence-based practice format.

The key objective is to make it easy for direct caregivers to make change at a grass-roots level, while positively impacting patient outcomes in a meaningful way. A problem-solving approach to address clinical questions, the 18-step process allows for non-randomized control trial designed evaluations and quality improvement initiatives to take place(Melnyk & Fineout-Overholt, 2019).. With mindfulness that registered nurses encounter challenges that require a fix “tomorrow”, with potential use of nonresearch evidence by use of four pathways.

For my PICOT with aim to reduce occurrence of CLABSIs in patients with a central line, I believe either model could be used to implement meaningful change. However, the Stetler model is better suited for a randomized control trial approach, which is the method I believe to be best suited to gain the most sound, valid and reliable results. By way of using critical thinking and various types of evidence (internal AND external), the Stetler model allows for easy implementation of evidence gathered by way of a toolkit and use of consensus guidelines and policy change.

References

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp & Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017).

Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research. The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.

It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).

References:

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12223

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). p. 434-437. Wolters Kluwer Health.

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Two models that facilitate change and are supported by evidence-based practice are Kotter’s Change Management Model and Kurt Lewin’s Change Model. Kotter’s Change Management Model is a standard theory used worldwide that consists of eight stages that focus on the employee’s responses when it comes to change (Kotter, 2019). These eight stages include increasing urgency, building the team, communicating, getting the vision correct, moving things, incorporating change, not giving up, and focusing on short-term goals. Using Kotter’s method allows an organization to achieve successful quantitative and qualitative results while focusing on cost-efficient approaches towards health opportunities, demand for change, and barriers. Kurt Lewin’s Change Model is a standard method that has proven effective management models for change. Lewin’s model has three phases: unfreezing, changing, and refreezing (Hussain et al., 2018).

The model aids organizations in better comprehending organizational and structural change. The two different approaches provide valuable insights into how effective change management occurs. When used together, they tend to balance each other out when it comes to the weaknesses of each method one by one. In the evidence-based proposal, Kotter’s model is a better method when focusing on organizational detail.

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s Change model: a Critical Review of the Role of Leadership and Employee Involvement in Organizational Change. Journal of Innovation & Knowledge, 3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002

Kotter, J. (2019). John Kotter’s Eight Step Change Model. https://portal.ct.gov/-/media/SDE/Turnaround/School-Improvement-Resources/Kotters_model.pdf

The two models that I reviewed are the Iowa Model of Evidence-Based Practice and the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP).

The Iowa Model was developed by nurses in the 1990’s and then revised in 2015 due to dramatic changes in healthcare (Buckwalter et al., 2017). The revision included translation research and patient engagement (Buckwalter et al., 2017). This model is application oriented and provides a step-by-step guide to the EBP (Evidence Based Practice) process (Buckwalter et al., 2017). This model outlines a multiphase change process with feedback loops. It is widely recognized for its applicability and ease of use by interprofessional teams. It can be used by novice to expert users and can be used in a variety of settings (Buckwalter et al., 2017). Since 2001 there have been over 3900 requests to use the Iowa Model from all 50 states and 130 countries (Buckwalter et al., 2017). It is focused on triggers both problem and knowledge focused. It consists of 11 categories/steps.

These categories/steps include: (Melnyk & Fineout-Overholt, 2019).

1. Identify triggering issues/opportunities: Encourages clinicians to identify questions. Triggers may have data that highlights an area for improvement. Question current practice.
2. Clinical applications: Nurses identify clinically relevant practice questions.
3. State the question or purpose: Includes a clearly stated purpose. Using PPPICO (problem(patient), population, pilot area, intervention, comparison, and desired outcome)
4. Topic Priority: Establish whether it aligns with organizational priorities.
5. Form a team.
6. Assemble and appraise evidence.
7. Sufficient evidence.
8. Design and pilot the practice change.
9. Decide if the change is appropriate for practice.
10. Integrate and sustain practice.
11. Disseminate results

The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is also a model that guides bedside nurses in translating evidence into practice. It was developed by Hospital leadership to accelerate the transfer of new knowledge into practice (Melnyk & Fineout-Overholt, 2019). Bedside nurses evaluated and piloted the model. This model is an open system which can be influenced by both internal and external factors (Melnyk & Fineout-Overholt, 2019) The model starts with an inquiry (question) which leads to a PET (Practice, Question, Evidence and Translation) process (Melnyk & Fineout-Overholt, 2019).

Within each phase there are 19 prescriptive steps (Melnyk & Fineout-Overholt, 2019). The process is linear and may be interactive as the process evolves (Melnyk & Fineout-Overholt, 2019) There are ten tools to support the critical steps and online learning modules. The tools were developed by bedside nurses and contain check box formats, definition, and guidelines for use (Melnyk & Fineout-Overholt, 2019). It is simplified and easy to understand. This model may appeal to Nurse Educators as it has been applied in academic settings. The JHNEBP Model provides a structure for EBP education with mentoring, program planning, execution, and outcomes data collection (Friesen et al., 2017).

In comparing the two models both seem similar in many ways. Both seem widely used and easy to use.  The one that I would choose for my EBP project would be the Iowa Model of Evidence- Based Practice because it talks more about using a pilot unit. For my project I would like to pilot two units to evaluate and then disseminate to the rest of the organization. A number of clinically important topics have been addressed using the Iowa Model, for example prevention of catheter associated urinary tract infections. This was appealing to me since my project goal is to reduce CAUTI (Catheter Associated Urinary Tract Infection) rates and use through patient/family education and empowerment. This model also talks about patient engagement which applies to my project as well (Melnyk & Fineout-Overholt, 2019).

References:

Buckwalter, K.C., Cullen, L., Hanraham, K., Kleiber, C., McCarthy, A.M., Rakel, B., Steelman, V., & Tripp, R.T. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldview on Evidence-Based Nursing, 14 (3), 175-182. https://doi-org.lopes.idm.oclc.org/10.111/wvn.12223.

Friesen, M.A., Brady, J.M., Milligan, R., & Christensen, P.(2017). Findings from a piot study bringing evidence-based practice to the bedside. Worldview on Evidence-Based Nursing, 14 (1), 22-34. https://doi-org.idm.oclc.org/10.111/wvn.12195.

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

There are numerous models that can be utilized in facilitating change. Two examples of such models are the Plan Do Study Act (PDSA) and the Consolidated Framework for Implementation of Research (CFIR). PDSA is a process that consists of four steps which are planning, implementing,evaluating and modifying. Planning involves identification of a problem or an opportunity for improvement, setting goals and selecting an intervention.

The implementation stage involves putting the intervention to practice and the evaluation stage involves assessing the effectiveness of the intervention. The final stage of modification involves making changes based on the results of the evaluation. On the other hand, the CFIR is a framework that identifies key constructs that are important for the successful implementation of an intervention. The framework has five main domains which include intervention characteristics, inner setting, characteristics of individuals, andthe process of implementation (Adamu et al., 2019).

For the evidence-based practice intervention that involves reduction of falls using a combination of interventions, I would use the PDSA cycle. The model is preferable because it is practical and straightforward and ideal for small scale and incremental changes such as combining interventions to reduce falls. The model allows for continuous monitoring of the effectiveness of the intervention and making relevant changes to the intervention as the process continues. While both PDSA and CFIR are effective in facilitating change, PDSA is simpler and more straightforward because it allows for the monitoring of the changes and making relevant changes (Dixon-Woods, 2019). This is good for change management as its aloes the researchers to rectify a mistake and tackle any barriers that they can encounter making the change more effective.

References

Adamu, A. A., Uthman, O. A., Gadanya, M. A., & Wiysonge, C. S. (2019). Using the Consolidated Framework for Implementation Research (CFIR) to assess the implementation context of a quality improvement program to reduce missed opportunities for vaccination in Kano, nigeria: A mixed methods study. Human Vaccines & Immunotherapeutics, 16(2), 465–475. https://doi.org/10.1080/21645515.2019.1654798

Dixon-Woods, M. (2019). How to improve healthcare improvement—an essay by Mary Dixon-Woods. BMJ, l5514. https://doi.org/10.1136/bmj.l5514

I agree with you that numerous models are available to facilitate change. Therefore, stakeholders choose their suitable models based on the nature of change process. Plan Do Study Act (PDSA) and the Consolidated Framework for Implementation of Research (CFIR) are some of the models that can facilitate change. Single or numerous frameworks can be used in deploying transformation.

PDSA is a process that consists of four steps which are planning, implementing, evaluating and modifying (Brau et al., 2019). Every step of the model is important in facilitating and implementing change. Any omission or inaccuracy in these steps interfere with change implementation. As a result, stakeholders prioritize all steps of PDSA. Planning involves identification of a problem or an opportunity for improvement, setting goals and selecting an intervention (Sagun & Prudente, 2021). Adequate time is directed towards planning since planning is the foundation and vital in guiding other phases of PDSA. Poor planning expose the change to various challenges in the future. Therefore, stakeholders use right strategies and information to improve on their planning activities.

References

Brau, R. I., Gardner, J. W., Webb, G. S., & McDonald, J. K. (2019). Teaching plan‐do‐study‐act (PDSA) in a supply chain context: A paper football in‐class activity. Decision Sciences Journal of Innovative Education, 17(1), 6-32.  https://doi.org/10.1111/dsji.12171

Sagun, R. D., & Prudente, M. (2021). Applying the plan-do-study-act (PDSA) action research model to re-structure the science classroom conforming to the metacognitive orientation standards. Educational Action Research, 1-17. https://doi.org/10.1080/09650792.2021.1894964

Two models that can be used to facilitate evidence-based practice (EBP) change include the Iowa Model of Evidence-Based Practice to promote quality care and the Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP. The Iowa Model guides clinicians through the process of identifying, implementing, and evaluating an EBP change with incorporated feedback loops (Buckwalter et al., 2017; Dang et al., 2019). The feedback loops help to ensure that the project is moving forward and does not need to go back to a previous step.The model was designed for interprofessional teams and uses a basic problem-solving approach to simplify the process of implementing EBP change (Dang et al., 2019).

The ARCC Model provides a framework that guides both individuals and organizations through implementation, evaluation, and sustainment of EBP changes. One unique feature of this model is the focus on EBP mentors who are developed within the healthcare system to help mitigate common barriers to the implementation of EBP (Dang et al., 2019). This model also uses cognitive behavior therapy (CBT) to change behaviors and emotions related to EBP.

Both of these models include the steps of identifying a relevant clinical issue, synthesizing current research on the issue, developing and implementing a plan for EBP change, and evaluating the results of the EBP change. Both of these models also incorporate interprofessional teams in the EBP change process. In contrast, the Iowa Model includes feedback loops that allow for checking in with the team throughout the process and pivoting or adjusting as needed to ensure the best plan is developed and implemented, which the ARCC Model does not. The ARCC Model places a strong emphasis on the development and utilization of EBP mentors to promote the success and sustainability of the practice change, which the Iowa Model does not.

The Iowa Model fits the needs of my EBP proposal best. This model has been widely used since the 1990s and has been revised in response to feedback from use of the model by numerous healthcare organizations, thus showing it is a valid and reliable model (Buckwalter et al., 2017). This model is simple and was developed specifically for use by clinicians who wanted to incorporate EBP into patient care, which is appropriate for the practice change I am proposing in the intensive care unit. This model also allows for reflection and adjustment at each step, which is essential when working in a hospital setting where change is constant. In addition, this model utilizes an interprofessional team, which will be an essential part of my EBP proposal.

References

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223

Dang, D., MeInyk, B. M., Fineout-Overholt, E., Yost, J. Cullen, L., Cvach, M., Larabee, J. H., Rycroft-Malone, J., Schultz, A. A., Stetler, C. B, & Stevens, K. R. (2019). Models to guide implementation and sustainability of evidence-based practice. In B. M. MeInyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice. (4th ed., pp. 378-427). Wolters Kluwer.