NUR 590 Topic 2 Discussion Question 2

NUR 590 Topic 2 Discussion Question 2

Sample Answer for NUR 590 Topic 2 Discussion Question 2 Included After Question

Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.

A Sample Answer For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

As with any project implementation its best to envision any potential issues before they arise. Therefore, I anticipate a few potential issues with the proposed implementation of my project. The first foreseen issue identified for the proposed implementation of my evidence-based project are financial concerns and will continue to be an ongoing concern. I was able to identify a couple of strategies to help with the financial concerns including executive leadership engagement in the process. Being fully transparent with the executive leadership team regarding the implementation plan including cost and methods of saving will aid in gaining their support. Another financial strategy would be to develop a team of subject matter experts/educators on the Physician Orders for Life-Sustaining Treatment (POLST) program utilizing the system Respecting Choices Model within the system. With the development of the program within the system there will be a reduction in further cost to outside resources.

The second foreseen issue is a lack of clinician buy in to the program and change management. In order to address this area education, engagement, and communication are necessary strategies. The education will include up-to-date best practices, refresher courses, audit, and review. The engagement strategies include ensuring confidence in their work, standardized workflow, ensuring collaboration and stakeholder involvement. The communication strategies include ongoing updates on education and engagement opportunities, events, current POLST literature, and development of newsletter.

NUR 590 Topic 2 Discussion Question 2
NUR 590 Topic 2 Discussion Question 2


The third foreseen issue is lack of quality of the POLST process and order sets. Quality of the work is a multifactorial problem; in that it relies heavily on the first two foreseen issues. “The quality of POLST documentation is only as good as the conversations that precede it” (Abbott, 2019, p. 297). Therefore, if there is a lack of financial support or clinician buy in, ultimately leading to a reduction in POLST quality.


Research on POLST implementation is actively being reviewed and updated therefore in order to  ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.


NUR 590 Topic 2 Discussion Question 2 Reference

Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine73(3), 294–301.

A Sample Answer 2 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

The only issue I see with the proposed implementation of my project is allowing both nurses and patients the time to get used to the implemented process. Most organizational change initiatives fail because we apply strategies that are not tailored for the structure of the concerned organization. I work at the VA in Lancaster and our structure is a healthy one. Changing a healthy structure requires trust, clarity, and integrity. Employees are accountable for what they do. If they need skills, they can get trained or ask support to their managers. Anyone in the organization, not only managers, is likely to ask questions like: “When will you be ready?” or “Have you tested the quality of your realization?” Everyone is accountable to their colleagues. Here are the guidelines to follow to identify the most appropriate change approach. It decomposes the movement from the current state to the future state in five steps (Cavarec, 2014):

  • Formulate change
  • Plan change
  • Implement change
  • Manage transition
  • Sustain change

Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles (Silver et al., 2016).

Investments in new clinical practices do not stop with their developers; enormous effort and resources are directed to introducing new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the establishment of knowledge brokers, evidence-based practice committees or teams and identifying opinion leaders and champions who will support the practice excellence (Virani et al., 2009).

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NUR 590 Topic 2 Discussion Question 2 Reference

Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.

Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2016). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology : CJASN11(5), 916–924.

Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly, 12(1), pp 89- 96

A Sample Answer 3 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

I do foresee issues with the proposed implementation of my project, including financial difficulties. My project focuses on the importance of continuous CPR during defibrillation. For many decades the focus of CPR was identified in order of importance; airway, breathing, circulation. Recently the American Heart Association announced that circulation would overtake as the number one priority during cardiopulmonary resuscitation  (American Heart Association., n.d.). This means that early and continuous high quality compressions are seen to improve circulation and perfusion during CPR to help increase patient outcomes. Clark et al., 2019 reports that interruptions in chest compressions greater than 10 seconds have been associated with adverse outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting not only nurses but also physicians  onboard with the new evidence based practice poses a huge barrier in implementation. It is very difficult to change people’s ways of practice, especially if they have been practicing for an extended period of time. This will require a large amount of education and support from leadership and clinical education to encourage the staff to buy-in to this new practice. In addition, the research I collected identified that ECG devices and the LUCUS device were found to be the most beneficial to perform continuous compressions during defibrillation in simulation studies. These devices are extremely expensive and may not be an option, nor an opportunity for small rural community hospitals. In this instance, those small community hospitals will be unable to deliver the most up to date evidence based practice care to patients due to the inability to afford the equipment needed. THis is not just a barrier to the implementation process but also a barrier in providing the most quality care to the patient.

I would utilize The Organizational Readiness to Change Assessment (ORCA) tool to assess the organization’s readiness, capacity, and strength to change and implement this project. For a project this size, I believe this tool would be able to assess all areas of change to determine if the organization is a good fit for the project and vise versa.



American Heart Association . (n.d.). CPR Facts and Stats.

Clark, L. R., McDannold, R., Mullins, M., & Bobrow, B. (2019). Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA. Circulation140(Suppl_2), A458-A458.

A Sample Answer 4 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

The first issue with every proposed implementation of many projects is that people avoid change due to fear of failure to adapt to the new system, losing the comfort zone and lack of confidence in the choice, or maybe a previous bad experience when workflow changes. Lack of communication might be another problem that makes the project fails. I should be more vigilant with this problem with effective communication, timely and transparent methods of communication to ensure that all stakeholders are involved in the process ((Project.2021). The availability of a workforce is another problem.  For project success, it is vital to assess the available workforce to determine if additional staff and skillsets are required to complete the project. As a leader, ensure that the project stakeholders are on the same page and have a clear vision by inviting them to the project plan to shape and provide feedback actively.

An evidence-based approach involves an ongoing, critical review of research literature to determine what information is credible, and what policies and practices would be most effective given the best available evidence. It also involves rigorous quality assurance and evaluation to ensure that evidence-based practices are replicated with fidelity and that new practices are evaluated to determine their effectiveness(

Projects: (2021). 9 Project management Challenges and How to Overcome them.

National Institute of Corrections. (n.d). Evidence-based Practices (EBP).

A Sample Answer 5 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

From an institutional standpoint, I do not foresee any issues with implementing my EBP Project because the nurses are already engaged in patient education and have the resources to implement the project. However, patient compliance and adherence may prove to be problematic. According to Pan et al (2019), noncompliance with treatment regimens is primarily responsible for uncontrolled blood pressure among patients diagnosed with hypertension.

Before implementing change, organizations need to assess readiness for change. Therefore, it is imperative that organizations analyze systems, processes, and more importantly people when conducting change readiness. As cited in Borges & Camila (2020), 70% of organizational change fail due to lack. of employee adoption of the changes. Change readiness assessments can aid in facilitating change by collecting quantitative and qualitative data measurements about where readiness gaps may exist.

Once the change readiness assessment has been conducted, data summarized and reviewed, and issues addressed, change can be initiated. John Kotter’s 8 Step Change Model would be most appropriate because it involves establishing, maintaining, and sustaining change. Kotter’s model states that organizational change is vital to be successful (Kuo & Chen, 2019). The eight steps of change in Kotter’s model are:  create urgency, organize a guiding team, develop a clear and concise vision and strategy, communicate the vision, utilize empowerment to remove obstacles or barriers, create short-term victories, build on the change, and cement changes in culture (Kuo & Chen, 2019).

NUR 590 Topic 2 Discussion Question 2 References

Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach. Journal of Organizational Change Management, 33(5), 667-681. doi:

Kuo, Y. NUR 590 Topic 2 Discussion Question 2L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4).

Pan, J., Wu, L., Wang, H., Lei, T., Hu, B., Xue, X., & Li, Q. (2019). Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine98(27), e16116.

A Sample Answer 6 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

As with any change there is stress on an organization or staff in the process of the change, even good change causes stress to staff as their process is changed moving them out of their comfort zone (Ost et al., 2020). In every population from nursing to the janitor, change has moments of unacceptance, In my project of teaching a new practice change from EBL to QBL I foresee change stress and pushback, due to lack of trust in this new process.  Utilizing assessment tools such as a SWOT analysis to address readiness is the first step to understand where the population of a EBP project is ready to accept(Renalt, 2021).  Once barriers are identified one can start to formulate a plan to address those barriers and to navigate around them by removing barriers, acceptance of a change is made easier.

Transformation or change is a large problem area in an organization, Implementing or using a change management tool such as ADKAR also will help in the success of a project. ADKAR is an acronym with the following meanings,  A= starting with awareness, presenting the issue, why it is a problem or why they should be a change.  D= creating desire or want to become engaged in the process, creating a desire of the how this will improve practice and outcomes.  K= giving knowledge or improving knowledge in the process, through providing the research for staff to understand. A= abilities, or assessment of abilities of the nurse involved, do they have the tools, understanding, equipment needed. Finally, R= reinforcement or circling back to address issues that arose in the process after development and re-enforcement of usage of a practice(Pawl & Anderson, 2017).

As the leader of a project understanding there may be pushback, self-awareness is another area needed for assessment and creating a support system around oneself when “hiccoughs” happen, a process has a lot of push back.  Assessing or understanding your emotions and the intellectual intelligence of those you are leading, or teaching will help you to stay focused and look for solutions.

Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse40(3), 59–63.

Pawl, J. D., PhD, RN, OCN, CNE, & Anderson, L. S., PhD, RN. (2017). The use of change theory to facilitate the consolidation of two diverse Bachelors of science in Nursing programs. Nursing Outlook, (65), 233–239. Retrieved May 4, 2021, from

Renalt, V. (Ed.). (2021). SWOT analysis: Strengths, Weakness, Opportunities and Threats. Community Tool Box.

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

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Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource

A Sample Answer 7 For the Assignment: NUR 590 Topic 2 Discussion Question 2

Title: NUR 590 Topic 2 Discussion Question 2

As an advance registered nurse, one is required to be abreast with new research endeavors in order to create, improve as well as increase knowledge with respect to a given study. This implies that nurses need to understand the strategies to critique research by analyzing the relevance of the literature article (LoBiondo-Wood & Haber, 2017). Put otherwise, a nurse is required to select peer-reviewed articles published within the last five years and whose margins of evidence are supported by appropriate study designs. In conjunction to this, nurses should pursue systematic research that yields trustworthy outcomes based on the topic of study. Guided by this argument, a nurse can critique rogue methods of study design and practices used in literature materials to question the validity as well as the reliability of the tools used in the research (Phillips et al., 2014). Nonetheless, an advance registered nurse need to read investigative reports on the topic of research to develop new expertise and approaches that provide answers to enquiries about vacuum that exists on the selected literature material.

As an advance registered nurse, one would critically appraise systematic studies for a given evidence-based practice (EBP). This means that the findings will be synthesized to affirm if they are based on scientific evidence to support a given clinical practice (LoBiondo-Wood & Haber, 2017). Moreover, critical appraisal will be undertaken to ensure that the practice outcomes are not based on quasi trials which might lead to errors during the implementation of a clinical project. However, a nurse will also compare findings of literature research with related articles to broaden the scope of synthesis of evidence from a wide range of studies (Phillips et al., 2014). This will enhance reliability of the outcomes to guide in decisions for implementation.


LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

Phillips, A. C., Lewis, L. K., McEvoy, M. P., Galipeau, J., Glasziou, P., Hammick, M., … & Williams, M. T. (2014). A systematic review of how studies describe educational interventions for evidence-based practice: stage 1 of the development of a reporting guideline. BMC medical education14(1), 152.