NRS 493 Topic 9 DQ 2 Sustaining change can be difficult, as there are many variables that can affect implementation

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Topic 9 DQ 2

Jun 13-17, 2022

Kitty Gay

Posted Date

Jun 23, 2022, 10:02 PM

Regardless of the information and efforts taken place to promote evidence-based practices (EBP), there may be potential barriers in any organization/hospital/clinic sustaining the practices. One barrier may be uncertainty or a lack of understanding or knowledge due to a pre-formed bias or current understanding may be or become a barrier which ties in with another potential barrier of resistance per Ginex writing, “because we’ve always done it this way” (2018). To this, Ginex informs us that one voice alone is not sufficient to change, create and sustain a change of practice (2018) and continues of the importance therefore for support (internal and external stakeholders) to see it through and continue it. The capstone project this student chose includes interventions which, although utilized in several countries including a retrospective study done in three US hospitals and two hospitals in Honduras which assessed the outcome of patients receiving a multi-medication approach (MMA) including ivermectin and resulted in positive outcomes for patients who received ivermectin/MMA with the standard of care compared to patients only receiving the standard of care (Pascua et al., 2021).

Strategies to overcome barriers is to remain kind and courteous, no jugular veins quivering nor eyes bulging as the information is provided as has been seen on both “sides” of the information. The information speaks for itself. It simply needs a voice. There are already to amazing MDs in our Valley which have utilized early interventions and have saved countless lives in our community and shared some of their information at a County Board of Supervisors meeting with the public (Tyson & Fareed, 2021). They are the key persons who have made a difference since the beginning of Covid-19. Provision of the many resources and studies proclaiming the prophylactic or illness benefits of off-brand medications including Boldescu et al who provided vital antiviral information pre-Covid, regarding ivermectin which was/is proven to be safe, broad spectrum, effective and cost efficient against such viruses as Dengue, Zika Virus, Yellow fever, River Blindness, and elephantiasis (2017). An example via Kerr et al. is the Brazilian city-wide prophylactic provision {if the person and/or their MD approved/desired it} which resulted in city-wide death rates falling (2020). A supplementation that is not often told of is vitamin D which in the study by Abrishami et al. resulted in “significant” differences for Covid-19 positive persons with to have much higher lung-involvement issues if they were vitamin D deficient and subsequently “significantly” less lung involvement when patients had sufficient vitamin D levels (2021). These are brief glimpses of the information that is readily available. It simply needs to be further told, informed and educated about.

Resource

Abrishami. A., Dalili, N., Torbati, P. M., Asgari, R., Arab‑Ahmadi, M., Behnam, B., & Sanei‑Taheri, M. (2021). Possible association of vitamin D status with lung involvement and outcome in patients with COVID‑19: A retrospective study. European Journal of Nutrition. 60, 2249–2257. https://doi.org/10.1007/s00394-020-02411-0

Boldescu, V., Behnam, M., A. M., Vasilakis, N., & Klein, C. D. (2017). Broad-spectrum agents for flaviviral infections: Dengue, Zika and beyond. National Review of Drug Discovery, 16(8), 565-576

Ginex, P. (2018). Overcome barriers to applying an evidence-based process for practice change. Oncology Nursing Society (ONS). ONS Voice. https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

Kerr, L, Cadegiani, F. A., Baldi, F., Lobo, R. B., Assagra, W. L. O., Proenca, F. C., Kory, P., Hibberd, J. A., & Chamie-Quintero, J. J. (2020). Ivermectin prophylaxis used for COVID-19: A citywide, Prospective, observational study of 223,128 subjects using propensity score matching. Cureus, 14(1). doi:10.7759/cureus.21272

Pascua, V. F., Diaz, O., Medina, R., Contreras, B., Mistroff, J., Espinosa, D., Sekhon, A., Paz Handal, D., Pineda, E., Vargas Pineda, M. and Pineda, H. (2021). A multi-mechanism approach reduces length of stay in the ICU for severe COVID-19 patients. PloS one, 16(1). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245025

Tyson, B. & Fareed, G. (2021). Presentation regarding the importance of early intervention for Covid-19 to the Imperial County Board of Supervisors and community. https://imperial.granicus.com/player/clip/2078?view_id=2&meta_id=346679&redirect=true

Raimol Joseph

Posted Date

Jun 19, 2022, 4:42 PM

Replies to Kitty Gay

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time (Wayne, 2021). One potential barrier that may prevent my EBP change proposal from continuing to obtain the same desired results 6 months to a year from now would be the state of the economy at this moment in the United States and inflation that makes money tight for the average citizen therefore the struggle to stay afloat would be twice as hard for those who have low-incomes that causes individuals to focus more on making money so taking on more shifts which decreases their availability to caring for their own health. Another barrier that can be categorized as the main potential barrier is the hospital and governments wariness of allocating money, personnel and resources to this change proposal but to overcome this there must be emphasis on convincing these institutions on the popularity that the hospital or organization would acquire once patients realize the goal of the group is the focus of providing equitable care to all types of people regardless of their financial background is significant (Silva-Perez et al, 2019). Positive international attention and press to the organization would will allow it to flourish. While financially it is a more expensive route, it would be covered if all other hospitals and the government aided in collaboratively contributing to allocating funds for the poor which allows clinics and other healthcare organizations to use money in a more efficient manner by reducing cases of disease. Another barrier is lack of personnel which could be overcome by providing volunteer hours for those who need it which would attract a large amount of students, nurses, and other personnel similar to BSN students who need clinical and volunteer hours.

Silva-Perez, L. J., Gonzalez-Cardenas, N., Surani, S., Etindele Sosso, F. A., & Surani, S. R. (2019). Socioeconomic Status in Pregnant Women and Sleep Quality During Pregnancy. Cureus, 11(11), e6183. https://doi.org/10.7759/cureus.6183

Wayne, G. (2021, July 8). Nursing theories and theorists: An ultimate guide for nurses. Nurseslabs. Retrieved June 7, 2022, from https://nurseslabs.com/nursing-theories/#florence_nightingale

Sharia Jones

replied toRaimol Joseph

Jun 19, 2022, 11:32 PM

Replies to Raimol Joseph

Raimol,

Most people prefer to maintain their existing habits and comfort zones versus venturing into unknown territory. Organizational change comes with a unique share of challenges. Resistance to organizational change occurs due to employees not having a choice,

NRS 493 Topic 9 DQ 2 Sustaining change can be difficult, as there are many variables that can affect implementation

which triggers feelings of lost control and uncertainty. Resistance to change in the workplace can present itself in many ways. Absenteeism, missed deadlines, failed commitments, and a general sense of apathy are all common indicators that members of an organization are not fully invested.

References

Blueprint (2021). 7 Strategies for Overcoming Resistance to Change in an Organization. https://www.blueprintrf.com/strategies-overcoming-resistance-to-organization-change

Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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