NUR 590 Benchmark – EBP Project: Framework or Model for Change

Selected Model or Framework for Change

Stages for Model or Framework

Application of Model or Framework to Proposed Implementation

Concept Map for Model or Framework

Application of Theoretical Framework in Decision Making (C.1.2)

Required Sources

Thesis Development and Purpose

Argument Logic and Construction

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Paper Format (Use of appropriate style for the major and assignment)

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

A Sample Answer For the Assignment: NUR 590 Benchmark – EBP Project: Framework or Model for Change

Title: NUR 590 Benchmark – EBP Project: Framework or Model for Change

Abstract  

Diabetes mellitus type 2 is one of the health problems affecting many people in America and the world. Individuals from ethnic minorities are highly affected by it in America. This includes those from African American backgrounds, who are highly vulnerable to the disease. Effective management of diabetes mellitus type 2 is dependent on the readiness of the patients to embrace the desired lifestyle and behavioral modifications. The adherence to treatment among African American patients with diabetes mellitus type 2 is significantly low. Consequently, this proposed project aims at utilizing health information technologies to improve the level of adherence among them within a period of six months.  

 

Evidence-Based Practice Project 

Section A: Organizational Readiness Assessment 

Culture is an important element that determines how change is implemented in an organization. It determines the manner in which people make decisions that contribute to organizational success. Organizational culture should be facilitative in nature. Further, it should allow the use of new approaches to implementing organizational strategies. The phenomenon should also be flexible to ensure that new interventions are used to enhance the realization of the set organizational goals. Besides, the employees should take responsibility for the decisions they make in undertaking their assigned tasks. They should also have the freedom to try innovative ways in which the goals of their organization can be achieved. Therefore, this essay examines the readiness of my organization to embrace the proposed change. It also refines the developed PICOT statement and summarizes research articles relevant to it.  

Analysis of Readiness Assessment 

Organizational culture and readiness assessment for this project was done using a tool developed by Cameron and Quinn (2011). According to the tool, assessment of organizational culture and readiness is done with a consideration of six main dimensions of organizational culture. The dimensions include dominant characteristics, organizational leadership, and management of the employees, organizational glue, strategic emphases, and criteria of success. Each of these dimensions has four questions that are scored based on the prevalent conditions. For instance, an alternative is scored 55 if it has very similar characteristics with the organization, 20 if somewhat similar, five if similar, and zero if dissimilar. An average is then computed to determine organizational readiness and culture. The analysis tool by Cameron and Quinn (2011) was selected because of its focus on multiple aspects of organizational culture and readiness. It also allows for the determination of the improvement initiatives that can be adopted to enhance organizational readiness for change.  

The outcomes of the readiness and culture assessment revealed that my organization is ready to embrace the proposed change. The organization has an overall score of 90% in its readiness and cultural assessment. The organization had the highest scores in areas that included criteria for success, strategic emphases, management of employees, and organizational characteristics. There were moderate scores in dominant characteristics in the organization. The organization scored poorly in organizational glue. It had a number of strengths that demonstrated its readiness to embrace change. They included people sharing information freely, being ready to take risks, leadership exemplifying excellence in facilitating development, and utilization of teamwork to get organizational tasks done. A few potential barriers to change were identified. They included the lack of formal rules related to implementing change, resource inadequacy to create new changes, and lack of efficient processes that improve resource use. However, these obstacles will be addressed by ensuring that the proposed intervention addresses the critical needs of the organization, optimizing opportunities brought by the intervention, and aligning the intervention with the expectations of the organizational stakeholders.  

Conclusion 

Organizational readiness assessment should be undertaken prior to implementing evidence-based interventions in the clinical settings. The assessment provides insights into the organizational strengths as well as areas of weaknesses that will enhance the implementation process. It also guides in the adoption of measures that will manage anticipated forces that hinder the implementation process. Therefore, the right tool should be selected to obtain the most accurate information on the readiness of an organization to embrace the evidence-based practice.  

Section B: Problem Statement and Literature Review 

The utilization of evidence-based practice in nursing practice has gained significant popularity in the modern world. Health organizations and training institutions have recognized that evidence-based practice has significant benefits to patients, healthcare providers, and institutions of healthcare. The development of evidence-based practice interventions relies on the utilization of best-available evidence on the provision of care. Therefore, this section of the project explores the problem statement and reviews the literature relevant to my PICOT statement. The PICOT statement for the evidence-based intervention is as follows: 

In African American patients with type 2 diabetes, will the use of health information technologies compared to no use increase adherence to treatment within a period of six months? 

Problem Statement 

Diabetes is one of the health problems facing a significant proportion of the American population. According to the American Diabetes Association, about 26 million people in America live with diabetes. The number of people with pre-diabetes is estimated to be 79 million. These statistics imply that one in every three adults in America will have diabetes by the year 2050. The cost implication of diabetes in America is enormous. It is estimated the cost of diagnosed diabetes in the state has risen as seen from the fact that it was $346 billion in the year 2012 (American Diabetes Association, n.d.).  

Diabetes largely affects African Americans when compared to people from other ethnicities. The difference could be attributed to factor such as socioeconomic status that increases disparities in access to the needed healthcare services. The disease burden among African Americans is also high when compared to other ethnicities. The high rate of disease burden among them is attributed to factors such as their lack of or poor access to as well as adherence to medications (Canedo et al., 2018).  

Literature Review 

The management of diabetes is mainly achieved with the use of pharmacological and non-pharmacological interventions. Patients with diabetes type 2 are prescribed oral hypoglycemic drugs that help them in controlling the level of blood glucose. There is also the use of lifestyle and behavioral modifications. Patients with the disease are required to maintain active physical exercise and take special diets to ensure that the level of blood glucose is regulated (Reusch & Manson, 2017). Effective management of diabetes type 2 depends largely on the level of patient adherence to these treatment methods. Accordingly, patients should ensure that the medications are taken during the right time, dosage, and frequency. They also have to adhere to the lifestyle and behavioral medications that will ensure effective management of the disease.  

However, evidence has consistently revealed that adherence to diabetic medications is lower in African Americans when compared to individuals from other ethnicities (Elsous, Radwan, Al-Sharif, & Abu Mustafa, 2017). The lack of or poor level of adherence to medications and lifestyle modifications increases the disease burden among this population. According to Elsous, Radwan, Al-Sharif, and Abu Mustafa (2017), the lack of or poor adherence to treatment for type 2 diabetes arise due to factors such as patient-related, therapy, social, disease, healthcare system, and disease-related factors. It is therefore important that healthcare providers explore the available interventions that can be utilized to increase the level of adherence to treatment by this population. 

Health information technologies promise to increase the level of adherence to treatment by African American patients with type 2 diabetes. A research conducted by Conway and Kelechi (2017) revealed that the use of health information technologies such as mHealth and eHealth could increase the level of awareness among patients with diabetes type 2. They can be used to provide information related to the importance of adherence, scheduling clinical visits, and danger signs that patients should report if experienced. The use of health information technologies is also associated with enhanced satisfaction with the treatment by the patients. These technologies could improve the rate of adherence to treatment among them (Bailey et al., 2019). A study that was performed by Yoshida et al. (2018) revealed that the use of health information technology led to improved adherence to treatment by patients with type 2 diabetes, as evidenced by the reduction in the level of HbA1c. It, therefore, proves evident that the use of health information technology can improve the level of adherence to treatment by African Americans with type 2 diabetes.  

Research Used to Support PICOT  

A research conducted by Yoshida et al. (2018) was used to support the PICOT statement for this project. The research is a meta-analysis that was conducted with the aim of determining the effect of health information technologies on glycemic control in patients with type 2 diabetes. The researchers used 34 studies that were analyzed for the effect of the intervention. The results revealed that the use of health information technologies led to a clinical and statistical reduction in the level of HbA1c. However, it has the limitation of not using study participants to validate the effect of the intervention. Despite this weakness, the researchers proved that the use of health information technology could improve adherence to treatment in patients with type 2 diabetes. 

The other research is that conducted by Bailey et al. (2019). The research was a pilot study that investigated the use of electronic health records based strategy to enhance adherence to medication in patients with diabetes. The researchers used 100 patients who were administered with the intervention. The intervention included the use of electronic health records that provided them with support alerts on medication risks, medication summaries, outreach for concerns of the patients, and monitors for medication use by the patients. The outcomes of the research revealed that the intervention resulted in a high rate of satisfaction among the patients on the use of the intervention to increase medication adherence among them. The study had a limitation in the sense that it used a small number of participants, making it hard to generalize to a wider population. Despite this, it shed light on the manner in which health information technology can improve adherence to treatment in patients with diabetes type 2. 

The last research that supports my PICOT is the one by Conway and Kelechi (2017). The study was an integrative review that investigated the use of digital health to improve medication adherence in patients with hypertension or adult diabetes. Articles for the review were obtained from databases that included Scopus, EBSCOhost, and PubMed. The results from 13 studies that were included in the review revealed that there is somewhat benefit in the use of digital health to improve adherence to treatment in patients with diabetes and hypertension. This study is associated with a weakness that includes its lack of using human subjects. However, it points towards a possibility of improved adherence to treatment with the use of digital health.  

Conclusion 

The review of the available literature has shown that the use of health information technologies can improve adherence to treatment among African American patients with diabetes mellitus type 2. It can be seen from the research that there is scarcity in evidence on the use of health information technologies in the management of diabetes. Few studies have also investigated the impact of the intervention in African American patients. Therefore, the proposed intervention will address this gap in knowledge by investigating the effect of the intervention among African American patients with diabetes mellitus type 2.  

Section B: Problem Statement and Literature Review 

The utilization of evidence-based practice in nursing practice has gained significant popularity in the modern world. Health organizations and training institutions have recognized that evidence-based practice has significant benefits to patients, healthcare providers, and institutions of healthcare. The development of evidence-based practice interventions rely on the utilization of best-available evidence on the provision of care. Therefore, this section of research explores the problem statement and review of literature relevant to my PICOT statement. The PICOT statement for the evidence-based intervention is as follows; 

In African American patients with diabetes mellitus type 2, does the use of health information technologies result in improved glycemic control within eight months when compared to its no use?  

Problem Statement 

Diabetes is one of the health problems facing a significant proportion of the American population. According to American Diabetes Association, about 26 million people in America live with diabetes. The number of people with pre-diabetes is estimated to be 79 million. This statistics implies that one in every three adults in America will have diabetes by the year 2050. The cost implication of diabetes in America is enormous. It is estimated the cost of diagnosed diabetes in the state has risen as seen from the fact that it was $346 billion in the year 2012 (American Diabetes Association, n.d.).  

Diabetes largely affects African Americans when compared to people from other ethnicities. The difference could be attributed to factor such as socioeconomic status that increases disparities in access to the needed healthcare services. The disease burden among African Americans is also high when compared to other ethnicities. The high rate of disease burden among them is attributed to factors such as their lack of or poor access to as well as adherence to medications (Canedo et al., 2018).  

Literature Review 

The management of diabetes is mainly achieved with the use of pharmacological and non-pharmacological interventions. Patients with diabetes type 2 are prescribed oral hypoglycemic drugs that help them in controlling the level of blood glucose. There is also the use of lifestyle and behavioral modifications. Patients with the disease are required to maintain active physical exercise and take special diets to ensure that the level of blood glucose is regulated (Reusch & Manson, 2017). Effective management of diabetes type 2 depends largely on the level of patient adherence to these treatment methods. Accordingly, patients should ensure that the medications are taken during the right time, dosage, and frequency. They also have to adhere to the lifestyle and behavioral medications that will ensure effective management of the disease.  

However, evidence has consistently revealed that adherence to diabetic medications is lower in African Americans when compared to individuals from other ethnicities (Elsous et al., 2017). The lack of or poor level of adherence to medications and lifestyle modifications increases the disease burden among this population. According to Elsous et al., (2017), the lack of or poor adherence to treatment for type 2 diabetes arise due to factors such as patient-related, therapy, social, disease, healthcare system, and disease-related factors. It is therefore important that healthcare providers explore the available interventions that can be utilized to increase the level of adherence to treatment by this population. 

Health information technologies promise to increase the level of adherence to treatment by African American patients with type 2 diabetes. A research conducted by Conway and Kelechi (2017), revealed that the use of health information technologies such as mHealth and eHealth can increase the level of awareness among the patients with diabetes type 2. They can be used to provide information related to the importance of adherence, scheduling clinical visits, and danger signs that patients should report if experienced. The use of health information technologies is also associated with enhanced satisfaction with the treatment by the patients. This could improve the rate of adherence to treatment among them (Bailey et al. 2019). A study that was performed by Yoshida et al. (2018) revealed that the use of health information technology led to improved adherence to treatment by patients with type 2 diabetes as evidenced by the reduction in the level of HbA1c. It therefore proves evident that the use of health information technology can improve the level of adherence to treatment by African Americans with type 2 diabetes.  

Research Used to Support PICOT  

A research conducted by Yoshida et al., (2018) was used to support the PICOT statement for this project. The research is a meta-analysis that was conducted with the aim of determining the effect of health information technologies on glycemic control in patients with type 2 diabetes. The researchers used 34 studies that were analyzed for the effect of the intervention. The results revealed that the use of health information technologies led to a clinical and statistical reduction in the level of HbA1c. However, it has the limitation of not using study participants to validate the effect of the intervention. Despite this weakness, the researchers proved that the use of health information technology could improve adherence to treatment in patients with type 2 diabetes. 

The other research is that conducted by Bailey et al., (2019). The research was a pilot study that investigated the use of electronic health records based strategy to enhance adherence to medication in patients with diabetes. The researchers used 100 patients who were administered with the intervention. The intervention included the use of electronic health record that provided them with support alerts on medication risks, medication summaries, outreach for concerns of the patients, and monitors for medication use by the patients. The outcomes of the research revealed that the intervention resulted in a high rate of satisfaction among the patients on the use of the intervention to increase medication adherence among them. The study had a limitation in the sense that it used a small number of participants. This makes it hard to generalize to a wider population. Despite this, it shed light on the manner in which health information technology can improve adherence to treatment in patients with diabetes type 2. 

The last research that supports my PICOT is the one by Conway and Kelechi (2017). The study was an integrative review that investigated the use of digital health to improve medication adherence in patients with hypertension or adult diabetes. Articles for the review were obtained from databases that included Scopus, EBSCOhost, and PubMed. The results from 13 studies that were included in the review revealed that there is somewhat benefit in the use of digital health to improve adherence to treatment in patients with diabetes and hypertension. This study is associated with a weakness that includes its lack of using human subjects. However, it points towards a possibility of improved adherence to treatment with the use of digital health.  

Conclusion 

The review of the available literature has shown that the use of health information technologies can improve adherence to treatment among African American patients with diabetes mellitus type 2. It can be seen from the research that there is scarcity in evidence on the use of health information technologies in the management of diabetes. Few studies have also investigated the impact of the intervention in African American patients. Therefore, the proposed intervention will address this gap in knowledge by investigating the effect of the intervention among African American patients with diabetes mellitus type 2.  

 

Section C: Solution Description  

Evidence-based practice is known to be the cornerstone of quality in nursing practice. It guides the nurses in providing care that utilizes the best available clinical evidence on the interventions used to achieve the outcomes of the patients. Nurses should, therefore, play an active role in exploring the available clinical interventions that can be used to promote safety, cost-efficiency, efficacy, and quality in care. Therefore, this section of the evidence-based practice paper explores the proposed solution that will be implemented to improve the health outcomes of African American patients suffering from diabetes mellitus type 2.  

Proposed Solution 

The proposed solution for this project is the use of health information technologies to increase the adherence to treatment among African American patients who have type 2 diabetes. The intervention will entail the use of eHealth and mHealth technologies to remind African American patients about when their refills are due or overdue. They will also be used as source of health information where they learn more about the management of diabetes type 2. They will also use them to interact with their healthcare providers and schedule or cancel clinic visits (Canedo et al., 2018). Studies have been conducted in the past to evaluate the effectiveness of the proposed intervention in improving adherence to treatment in different groups of patients. One of them is the research that was conducted by Bender et al. (2015) to evaluate the effectiveness of speech recognition intervention in improving adherence among patients on asthma-controlled medications. The results revealed that the use of speech recognition phone calls when inhaled corticosteroid was due resulted in improved adherence in the intervention group when compared to the control group. Another study was conducted by Conway and Kelechi (2017) to determine the effectiveness of health information technology in promoting medication adherence in patients with diabetes mellitus type 2. The research revealed that the intervention increased the level of awareness among the patients on medication adherence. Similar outcomes can be seen in studies by Bailey et al. (2019) and Yoshida et al. (2018), where health information technologies led to improved adherence, as evidenced by a decline in the level of HbA1c and quality of life for the patients. Despite the above evidence on the efficacy of the intervention, the evidence is scarce on its use in African American patients suffering from diabetes mellitus type 2. Therefore, the proposed intervention is consistent with current research as it aims at bridging knowledge gaps in healthcare practice.  

Application to Our Setting 

The proposed intervention is applicable to the clinical setting. Firstly, the organization has been on the search for interventions that will promote excellence in service provision to its clients. It has been looking for ways in which patient-centered and continuous care can be provided to the patients even after their discharge to their homes. The proposed intervention seeks to promote these objectives, hence, its relevance to our hospital. The organization also wants to be the leader in the implementation of evidence-based practice in the region. This implies that it is ready to adopt proposals that would introduce new and innovative ways of providing care in its setting (Mohammadi, Poursaberi, & Salahshoor, 2018). The proposed intervention aims at promoting evidence-based practice, implying its relevance to our hospital. Lastly, the leadership of the organization supports innovation. Employees are encouraged to explore innovate ways of meeting the needs of their patients. They are also encouraged to explore ways of providing care that promote effectiveness and efficiency. Consequently, the proposed intervention aligns with the vision of the organization, hence, its relevance to the firm.  

Organizational Culture 

The organizational culture supports the intervention. Firstly, there is the utilization of teamwork in undertaking different organizational tasks. This implies that the healthcare providers are ready to work collaboratively to ensure that the success of the intervention is achieved. The organization also supports the development of its staff, which includes allowing them to participate in projects that would result in the improvement of processes in the organization (Mohammadi, Poursaberi, & Salahshoor, 2018). The intervention will result in improved processes if found successful, hence, supporting the organizational culture. Lastly, the leadership of the organization support employee autonomy. The employees have the freedom to implement innovative ways of providing care. They are also held responsible and accountable for the decisions they make. Therefore, there is an increased possibility that the organizational culture will support the intervention.  

Expected Outcome 

Based on the PICOT statement for the research, it is expected that African American patients suffering from diabetes mellitus type 2 will be willing to participate in the intervention. It is also expected that the intervention will result in improved adherence to treatment among these patients when compared to the control group (Bailey et al., 2019).  

Method to Achieve the Outcomes 

Two groups of participants will be selected for this intervention. One group will be the intervention group that will receive the treatment while the other one will be a control group. The intervention group will then receive regular updates with the aim of improving their medication adherence while the control group will not (Hansen, Haycock, & Evans, 2016). The two groups will be followed for six months and data from them obtained to determine the effectiveness of the intervention. The outcome data will compare the levels of HbA1C before and after the intervention. One of the anticipated barriers is the fallout of some participants. It will be addressed by ensuring that a close touch is maintained throughout the period of intervention. The other barrier is the unwillingness of the participants to take part in the project. It will be addressed by explaining the importance of the project to the participants. Moreover, a possible limitation of the study includes issues that may occur in having access to people or documents. However, getting access to participants and records will entail collaboration with the appropriate management and services involved.   

Outcome Impact 

The intervention will result in the improvement in the quality of care given to patients with diabetes mellitus type 2. This outcome will be achieved through the provision of patient-centered and continuous care to them. It will also result in an improvement in the efficiency of processes (Greenwood, Gee, Fatkin, & Peeples, 2017). This is attributed to the fact that the technologies will be used for drugs refill and scheduling clinic visits by the patients. It will also enhance the monitoring of the response of patients to treatment.  

Conclusion 

The proposed intervention for the project is relevant to our organization. This can be seen from the readiness of the organizational stakeholders such as the healthcare providers to embrace it. The intervention also aligns with the vision of the organization. Therefore, it is anticipated that the intervention will result in the improvement of outcomes that include quality of care, patient-centeredness, and patient satisfaction with the care being provided to them.  

 

Section D: Change Model 

The success of healthcare organizations is largely dependent on the manner in which evidence-based projects are implemented. It is evident that successful implementation of evidence-based projects in healthcare is largely influenced by active stakeholder involvement in the process. There is also evidence that a change model should be utilized to ensure the success of the process. The model prepares the adopters for the change and ensures the sustainability of the change. Therefore, this section of the research paper explores the change model that will be utilized to ensure the success of my evidence-based project.  

The Selected Model and Its Relevance to My Project 

The implementation of the evidence-based project will utilize the transtheoretical model. Diclemente and Prochaska developed the transtheoretical model of change in 1970 after observing the manner in which smokers quit their smoking habits. The model is suitable for the project because it provides a better understanding of the motives for individual change in behavior and factors that influence it. It also provides insights into the ways in which lifestyle and behavioral change can be promoted through the creation of awareness among the populations at risk. According to the model, behavioral change is not a sudden occurrence or process. It occurs in a series of steps and a cyclical process. As a result, it fits the proposed project, as it will guide the sequential implementation of the change in my institution (Prochaska & Prochaska, 2016). Further, the cyclical nature of change implies that the implementers are able to apply different constructs and behavioral theories to ensure the success of the change; hence, its suitability for the project.  

Stages of Change and their Applicability to the Project 

According to the transtheoretical model of change, there exist six stages of change. They include precontemplation, contemplation, preparation, action, maintenance, and termination. Each of these stages is applicable to the evidence-practice project as discussed below. 

Precontemplation: Precontemplation is the first stage of change in the transtheoretical model. The stage is characterized by the adopters not willing to take any action to change their situation. Their lack of willingness is attributed to their low level of awareness associated with their behaviors that are producing negative outcomes to their lives. As a result, they often underestimate the benefits of changing their behaviors and focus more on the disadvantages of changing their behaviors or lifestyles. This stage applies to the proposed change initiative. The African American patients with diabetes type 2 are not aware of the importance of adhering to their prescribed treatment. They do not understand that their lack of or low adherence to treatment has an adverse outcome on their health (De Chesnay & Anderson, 2019). Consequently, they hold strongly to misinformed information related to the effective management of the disease.  

Contemplation: This is the second stage in the transtheoretical model. The adopters of the change in this stage are willing to adopt the desired lifestyle and behavioral change. They are also aware of the negative consequences of their behaviors on their health. As a result, they begin exploring the practical solutions that can be adopted to change their circumstances. They also consider the benefits as well as risks of the need for behavioral change. Despite this awareness, they might be reluctant to embrace the desired changes for healthier lives (Hayden, 2017). This stage applies to the proposed intervention. The African American patients become aware of the negative consequences of poor adherence to recommended treatment. They begin to explore the available interventions that can be adopted to improve their adherence. However, ambivalence among them might still hinder the adoption of the desired lifestyle and behavioral modifications to increase their level of adherence to treatment.  

Preparation: The adopters in this stage are willing to take action for their health problem within a shorter period (usually 30 days). They begin exploring small steps that will ensure that they successfully embrace the needed change. The steps help them in guiding the adoption of new healthy behaviors or lifestyles that will promote their health and wellbeing (Potter et al., 2016). This stage is also applicable to the proposed change. The adopters of the change are aware of the negative consequences of a lack of or poor adherence to treatment. As a result, they take small steps that will promote their adherence in the end. The proposed intervention will be embraced by a majority of the population to achieve their desired health goals.  

Action: The adopters in this stage have experienced a recent change in their behavior. They are willing to progress with the adoption of the recommended interventions to promote further behavioral change. As a result, they modify their problematic behaviors by acquiring new healthy behaviors that will promote their health (Hayden, 2017). The African American patients with diabetes type 2 will have sustained their behavioral change for a substantial period (six months) at this stage. As a result, they constantly seek new behaviors that will increase their adherence. They put the recommendations from the health information technologies into their daily routines.  

Maintenance: The adopters in this stage have had more than six months of continuous behavioral and lifestyle change. As a result, the focus of the adoption of change is the prevention of relapse to earlier behaviors. Motivators need to be provided to ensure sustainability in the change process (Potter et al., 2016). The African Americans with diabetes type 2 have shown significant dedication to behavioral and lifestyle changes in this stage. Therefore, they need to be motivated to focus more on their success in order to prevent relapse to their earlier behaviors.  

Termination: This is the last stage in the model where the adopters are no longer willing to relapse to their earlier behaviors. Sustainability in the change process has been achieved (Little, Sillence & Joinson, 2016). The African American patients will have successfully embraced the change in this stage. They are not willing to relapse to unhealthy behaviors that contributed to poor or lack of adherence to treatment among them. Consequently, health promotion is achieved in this phase.  

Conclusion 

The transtheoretical model is the most appropriate for the proposed change. It will provide a stepwise approach towards the implementation of change. Its successful use will minimize the risk of resistance from the adopters. It will also ensure the sustainability of the desired interventions to promote lifestyle and behavioral change among the adopters. Therefore, it proves effective for the proposed change in this project.  

 

Section E: Implementation Plan 

The realization of the goals of an evidence-based project largely depends on the manner in which implementation of the strategies is done. There should be effective and efficient utilization of resources for the goals of the change project to be achieved. The stakeholders should also be actively involved to ensure that incidences of resistance to change are minimized as possible. The managers of the change process should also embrace interventions that address actual and anticipated issues with the implementation process. Therefore, this research paper explores the implementation plan that will be utilized in ensuring the success of the proposed intervention.  

Setting and Access to the Potential Subjects 

The proposed intervention targets the utilization of health information technologies to improve adherence to treatment by African American patients with diabetes mellitus type 2. Therefore, the project will be conducted in the hospital. The hospital is the most appropriate setting for the intervention due to the large number of African American patients with diabetes that seek the care they need. The hospital also has the required resources, such as human resources, that will ensure the successful implementation of the project. Therefore, as shown by Stanhope et al. (2019), the optimum outcome of the project is expected due to adequate resource availability in the area of intervention implementation. The potential subjects for this intervention will be African American patients suffering from diabetes mellitus type 2 and have low or lack of adherence to treatment. They will be obtained from the diabetic clinic within the hospital, where they usually come for their clinics and follow-up visits. The potential subjects will be approached, informed about the intervention, its significance, and informed consent obtained from them. Their participation will be voluntary. Consequently, it would be necessary to obtain consent from them. The informed consent form that would be utilized is attached in the appendix section (Appendix A). 

Time Needed for the Intervention 

Successful implementation of evidence-based projects requires adequate allocation of resources, including time. Time is an essential component of every project (Trohcim, 2020). Creating a timeline is an effective tool in analyzing data, clarify key events and sequences (Macfarlan, 2018.). Adequate time should be allocated to ensure that potential issues that might affect the implementation process are addressed. It also allows for the determination of potential harm that is associated with the intervention. Therefore, the duration for the intervention will be nine months. The timeline for the implementation is attached in the appendix section of this research (Appendix B).   

Resources Needed 

A number of resources will be needed for the successful implementation of the proposed intervention. One of them is experts in the implementation of the project. They will include nurses, nurse managers, physicians, and laboratory technologists. Nurses and nurse managers will be involved in undertaking activities such as health education, monitoring, follow-up, and data collection from the subjects. The physicians will be responsible for determining suitable treatment methods for the participants. Laboratory technologists will be needed to perform lab works to determine the effectiveness of the intervention. External trainers will also be required to guide the implementation of the intervention. A data analyst will also be needed to analyze the obtained data. The intervention also requires health information technologies such as mHealth and eHealth for use in the intervention. It will also require training materials such as writing materials and training funds for successful implementation. According to Shirley (2020), the project resources should be utilized in an efficient way to ensure the optimum realization of the set goals. Therefore, plans to monitor the use of these resources will be developed prior to the implementation of the project. The resources needed for the intervention have been included in the appendix section of this paper (Appendix C). 

Methods 

The data for this intervention will be collected using questionnaires. Questionnaires will be administered to the subjects to obtain objective data on their experiences with the intervention. Data on each of their clinical visits will also be obtained. This will include data on glycemic control and quality of life with the use of the intervention. Questionnaires are effective for this intervention due to a number of reasons. Firstly, they allow the acquisition of extensive data from the subjects. The extensiveness implies that rich data concerning the intervention will be obtained from them (Glasper & Rees, 2016; Patten, 2016). The analysis of the collected data is also easy when questionnaires are used. This is attributed to the specificity of the questions that the subjects are asked (Goodman, 2017). The use of questionnaires also allows the acquisition of data from a large number of people with ease. This is attributed to the fact that they can be self-administered, making it easy and cheap for data collection (McCormack et al., 2017). The questionnaire that will be used for this intervention is attached in the Appendix section (Appendix D).  

Process of Delivering the Intervention 

As shown earlier, the intervention will be administered among African American patients with diabetes with a history of low or poor adherence to the prescribed treatment. The participants will be obtained from the diabetic clinic where these patients come for their regular clinical checkups. Prior to conducting this intervention, approval will be sought from the ethics committee for the university and the hospital. The prospective participants will be approached, informed about the intervention, explained about the importance of the intervention, and informed consent obtained from them. The selection of the participants will take into consideration a pre-developed inclusion and exclusion strategy. Those who agree to participate in the intervention will be included. The participants should also be aged above 18 years with an African American background. There should also be a history of poor or low adherence to treatment among them. Lastly, the subjects should be literate. The exclusion criteria will include those who do not consent, subjects less than 18 years, illiterate, not from African American background, and those to be admitted for further management.  

The selected subjects will then be assigned into control and intervention groups. The control group will not be administered with any intervention. The intervention group will receive the treatment. The treatment will entail those in the intervention group being provided with tablets that will act as a source of information and reminders for them. They will also receive alerts reminding them of the timely intake of the medications and participation in regular exercises (Bailey et al., 2019). The tablets will provide them with information such as the importance of adherence to treatment, exercise plans, and signs and symptoms of hypo and hyperglycemia. They will use the tablets to schedule their medication refill, clinic visits, and conference with their healthcare providers when they need clarifications on the management of the disease. Baseline data will be obtained from the subjects in both groups during their scheduled clinical visits. Training will be provided to the nurses and other stakeholders involved in the project. The training will aim at instilling nurses with the knowledge and skills that would be required for successful implementation of the project.  

Data Collection Plan 

The data from the intervention will be collected using self-administered questionnaires and lab values for blood glucose during the clinic visit by the subjects. The subjects in the intervention group will be administered with questionnaires to obtain information concerning their subjective experiences with the intervention. Questionnaires are effective for this project since they will allow for the acquisition of in-depth data from the participants (Aurini, Heath & Howells, 2016). Laboratory investigations such as blood glucose levels will be obtained to determine the effect of the intervention on glycemic control. The data will be managed by storing it in a locked cabinet in the nurse managers’ office. Data analysis will be performed using SPSS version 21. Descriptive statistics will be used to analyze the demographic data of the subjects. The obtained results will be used to infer the effectiveness of the intervention in the management of diabetes mellitus type 2 in this population. A statistician will be hired to perform data management and analysis.  

Strategies to Address Barriers, Challenges, and Facilitators 

One of the strategies that will be adopted to address the challenges or barriers to the implementation of the project is training. Training will increase the level of knowledge and awareness among the implementers and adopters of the intervention. As a result, it will minimize the risk of resistance to change among them. The other intervention is embracing open communication. There will be a free flow of information among those involved in the project. Open communication will enable them to express their ideas, opinions, and concerns related to the project. The last intervention will be facilitating the implementation process through coaching and mentoring. The nurse manager and the appointed leaders of the team will monitor the adoption process to identify any potential challenges that need to be addressed. An external trainer will also play the role of coaching and mentoring throughout the implementation process (Ruegg et al., 2019). Therefore, these interventions will ensure the successful implementation of evidence-based intervention.  

Feasibility of the Implementation Plan 

Successful implementation will require the use of significant financial resources to achieve the outcomes of the interventions. However, it will be necessary to obtain adequate financial support for the successful implementation of the project (Shirley, 2020). It is estimated that the project will cost the organization approximately $69, 000. This cost will cover the purchase of the necessary materials, training, data collection, analysis, presentation, and management of unforeseen events. The budget for the project can be located in the appendix section (Appendix E). 

Plans to Revise, Extend, or Discontinue 

The project will be revised if the outcomes do not show a clear association of the effect of the intervention on glycemic control. It will be extended if the desired sample size was not met during the subject selection process. It will be discontinued if the subjects report any adverse events associated with the intervention. It will also be discontinued if all the subjects express their willingness to pull out of the project (Shirley, 2020).  

Conclusion 

The implementation of the proposed intervention would be a rigorous process. It will focus on ensuring that the right subjects for the intervention are recruited. It will also ensure that methods of data collection that optimize the outcomes are utilized. The obtained data will be used to determine whether the intervention was effective or not. Therefore, the outcomes will inform whether the intervention can be implemented in clinical use to promote evidence-based practice.  

Section F: Evaluation Process 

Evaluation is an important process in the implementation of evidence-based interventions. According to Singh, Chandurkar and Dutt (2017), evaluation entails the systematic acquisition, analysis, and interpretation of the implications of an intervention on observed data. The process can focus on either process or outcomes of the evidence-based intervention. Process evaluation determines whether the implementation was done according to the plan or not. Outcome measures examine whether the pre-developed goals and objectives of the program were met or not. Through this data, project evaluation team determines whether the allocated resources were used effectively or not. They also determine the extent in which the stakeholders were involved in the process. Therefore, this section of the evidence-based intervention explores the evaluation process that will be utilized.  

Methods used in Collecting Outcome Data 

The outcome data for the proposed intervention will be collected using self-administered questionnaires. The questionnaires will contain closed ended questions to increase the objectivity of the outcome data. Questionnaires are preferred for collecting the outcome data due to a number of reasons. Firstly, the amount of data obtained using them is extensive. The subjects can be asked a wide range of questions concerning their experiences with ease. They also promote anonymity of the subjects. This increases the accuracy of the outcome data obtained from them. Questionnaires also have high validity and reliability. They can test the specific variables in the intervention (Patten, 2016). Therefore, they make them the most suitable tools for obtaining the outcome data for the intervention.  

Outcome Measures and How the Measure Extent of Achieving the Objectives of the Project 

According to Bowden and Manning (2016), outcome measures refers to the determination of the effects of the intervention on the target population. It examines whether the goals, outcomes, and objectives were met at the end of the program. The outcome measures in the proposed intervention are varied. They include glycemic control, patient satisfaction, improved adherence to treatment and quality of life, and lifestyle and behavioral change. It is anticipated that these outcomes will result in the empowerment of African American patients, hence, their health and wellbeing. The outcomes measure for this project will determine whether the project objectives are achieved or not in a number of ways. Firstly, their realization will imply that the objectives of the intervention were met. Secondly, their realization will imply that the allocated resources were used efficiently for the realization of the objectives of the intervention. Lastly, a lack of realization of any of the outcome measures will point towards process inefficiency that must be addressed to ensure that the set objectives of the intervention are met (Monsen, 2018).  

Measuring and Evaluating Outcomes 

Outcome measurement focuses on the determination of whether the intervention actually produced the expected results. Outcome measurement will focus on both the gross as well as net outcomes of the intervention. Gross outcomes encompass all the effects or results that are observed after the implementation of the intervention. They will be measured based on the observed differences in the outcomes of the control and the intervention groups. Net outcomes on the hand will focus on the results that are directly attributed to the intervention. This will include the determination of outcome measures such as glycemic control and adherence to the prescribed treatment (Monsen, 2018). Therefore, as argued by Lau and Kuziemsky (2016), the outcomes of the intervention will be evaluated with a consideration of aspects that include validity, reliability, and applicability. The focus of the evaluation will be to ensure that the intervention is likely to produce similar results repeatedly for reliability to be achieved. Validity will be maintained by ensuring that the tools of evaluation measure the project outcomes that is should measure. Lastly, applicability will entail evaluating whether the methods used in the project are transferrable to other clinical settings.  

The Implications for Practice and Future Research 

The proposed intervention will contribute positively to practice by providing insights into the ways in which adherence to treatment can be improved using health information technologies. The intervention will also bridge the knowledge gap in practice. It is evident that studies have tried to explore the use of health technologies to improve adherence to treatment by patients. However, there is scarcity in evidence concerning its use in patients from African American origin. Therefore, the proposed intervention will not only bridge the knowledge gap in evidence but also influence policy change in health organizations. It will also provide the basis for future research. This is attributed to the identified areas of potential research that can be conducted to increase the use of health technologies in improving adherence to treatment among different groups of patients.  

Conclusion 

Evaluation is an important process in the implementation of evidence-based practice interventions. It provides insights into the effectiveness of the adopted interventions in delivering outcomes that promote health. It also aids in the creation of quality improvement initiatives that focus on improving the delivery of healthcare services to the vulnerable. Therefore, it is anticipated that the proposed process of evaluation will provide significant insights into the effectiveness of the intervention in promoting adherence to treatment among African American patients with diabetes mellitus type 2.  

 

 

 

References 

American Diabetes Association. (n.d.). Diabetes in African American Communities Advocacy Fact Sheet. Retrieved on 12th March from http://main.diabetes.org/dorg/PDFs/Advocacy/fact-sheet-advocacy-african-american.pdf  

Bailey, S. C., Wallia, A., Wright, S., Wismer, G. A., Infanzon, A. C., Curtis, L. M., … & Hornbuckle, K. (2019). Electronic health record–based strategy to promote medication adherence among patients with diabetes: Longitudinal observational study. Journal of medical Internet research, 21(10), e13499. 

Bender, B. G., Cvietusa, P. J., Goodrich, G. K., Lowe, R., Nuanes, H. A., Rand, C., … & Wamboldt, F. S. (2015). Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment: a randomized clinical trial. JAMA pediatrics, 169(4), 317-323. 

Bowden, J., & Manning, V. (Eds.). (2016). Health promotion in midwifery: principles and practice. CRC Press.  

Cameron, K. S., & Quinn, R. E. (2011). Diagnosing and changing organizational culture: Based on the competing values framework. John Wiley & Sons.  

Canedo, J. R., Miller, S. T., Schlundt, D., Fadden, M. K., & Sanderson, M. (2018). Racial/ethnic disparities in diabetes quality of care: the role of healthcare access and socioeconomic status. Journal of racial and ethnic health disparities, 5(1), 7-14. 

Conway, C. M., & Kelechi, T. J. (2017). Digital health for medication adherence in adult diabetes or hypertension: an integrative review. JMIR diabetes, 2(2), e20. 

De Chesnay, M., & Anderson, B. (2019). Caring for the Vulnerable. Jones & Bartlett Learning.  

Elsous, A., Radwan, M., Al-Sharif, H., & Abu Mustafa, A. (2017). Medications adherence and associated factors among patients with type 2 diabetes mellitus in the Gaza Strip, Palestine. Frontiers in endocrinology, 8, 100 

Glasper, A., & Rees, C. (Eds.). (2016). Nursing and healthcare research at a glance. John Wiley & Sons. 

Goodman, M. S. (2017). Biostatistics for clinical and public health research. Routledge. 

Hansen, J., Haycock, C., & Evans, E. M. (2016). Evidence-based practice integration designed to optimize patient care and outcomes to achieve the triple aim. Journal of Patient-Centered Research and Reviews, 3(3), 221-222. 

Hayden, J. (2017). Introduction to health behavior theory. Jones & Bartlett Learning.  

Lau, F., & Kuziemsky, C. (2016). Handbook of eHealth evaluation: an evidence-based approach.  

Little, L., Sillence, E., & Joinson, A. (Eds.). (2016). Behavior change research and theory: psychological and technological perspectives. Academic Press.  

McCormack, B., van Dulmen, S., Eide, H., Skovdahl, K., & Eide, T. (Eds.). (2017). Person-centred healthcare research. John Wiley & Sons. 

Monsen, K. A. (2018). Intervention effectiveness research: Quality improvement and program evaluation. Cham, Germany: Springer.  

Patten, M. L. (2016). Questionnaire research: A practical guide. Routledge. 

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book. Elsevier health sciences. 

Prochaska, J. O., & Prochaska, J. M. (2016). Changing to thrive: Using the stages of change to overcome the top threats to your health and happiness. Simon and Schuster. 

Reusch, J. E., & Manson, J. E. (2017). Management of type 2 diabetes in 2017: Getting to goal. Jama, 317(10), 1015-1016. 

Singh, K., Chandurkar, D., & Dutt, V. (2017). A practitioners’ manual on monitoring and evaluation of development projects. Cambridge Scholars Publishing. 

Stanhope, M., Faan, R. D., Lancaster, J., & Faan, R. P. (2019). Public Health Nursing E-Book: Population-Centered Health Care in the Community. Mosby. 

Yoshida, Y., Boren, S. A., Soares, J., Popescu, M., Nielson, S. D., & Simoes, E. J. (2018). Effect of health information technologies on glycemic control among patients with type 2 diabetes. Current diabetes reports, 18(12), 130.  

 

Appendices 

Appendix A: Informed Consent 

Hello, my name is X. I am conducting an evidence-based project that aims at increasing adherence to treatment in patients with diabetes mellitus type 2. The intervention will entail the utilization of health information technologies to promote adherence among this group of patients. Your participation in the intervention is voluntary. You have the right to agree or decline to participate in it. There is no financial reward for your participation. The only benefit is that the data you provide will assist healthcare providers in the management of the condition in vulnerable populations.  

Appendix B: Timeline 

	January	February	March	April	May	June	June
Participant recruitment
Training
Implementation
Monitoring and follow-up
Data collection
Data analysis
Communication of findings

 

Appendix C: Resources Needed 

Resources Needed

Time

Training

Trainers

Nurses

Nurse managers

Physician

Pharmacist

Laboratory technologist and data analyst

Training materials

Appendix D: Intervention Questionnaire 

Demographic Data 

1. How old are you? 

18-30 years 

31-40 years 

41-50 years 

Above 51 years 

1. What is your level of education?  

Primary  

Secondary 

College 

University  

1. What is your marital status? 

Single 

Married 

Divorced 

Widowed  

1. How long have you suffered from diabetes mellitus type 2? 

Less than one year 

One to three years 

Three years to five years 

Over five years 

1. What is your experience with the use of health information technologies to enhance adherence> 

Very satisfied 

Satisfied 

Neutral  

Dissatisfied  

Very dissatisfied  

1. The questions below ask the level of experience with your use of health information technology. Please provide responses that best describe your perception. 

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Health information technology has made me take medications on time
Health information technology has improved my blood glucose monitoring
Health information technology has improved my knowledge on diabetes management
Health information technology has improved my participation in decision-making on my health needs
Health information technology has made it easy for me to order medication refill, schedule clinical visits, and contact my healthcare provider
I will use health information technologies in the future

Appendix E: Budget 

Item	Cost ($)
Purchase of training materials	10, 000
Training	30,000
Purchase of tablets	10, 000
Data analysis and presentation	900
Management of unforeseen events	10, 000
	69000

Appendix F: Conceptual Model for Change