NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?

Sample Answer for NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project? Included After Question

NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project

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NUR 590 Topic 2 DQ 2 

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 DQ 2 Do you foresee any issues with the proposed implementation of your project?

Title: NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?

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.

 

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.

 

Reference NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?

 

Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine, 73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021

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).

 

Reference NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?

 

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 : CJASN, 11(5), 916–924. https://doi.org/10.2215/CJN.11501015

 

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

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. cpr.heart.org. https://cpr.heart.org/en/resources/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. Circulation, 140(Suppl_2), A458-A458.

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( nicic.gov).

Projects: (2021). 9 Project management Challenges and How to Overcome them. https://kissflow.com/project/project-management-challenges.

National Institute of Corrections. (n.d). Evidence-based Practices (EBP). https://nicic.gov/projects/evidence-based-practice-ebp.

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).

References NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?

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: http://dx.doi.org.lopes.idm.oclc.org/10.1108/JOCM-09-2019-0279

 

Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4). https://doi.org/10.1371/journal.pone.0213496

 

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. Medicine, 98(27), e16116. https://doi.org/10.1097/MD.0000000000016116

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 Nurse, 40(3), 59–63. https://doi.org/10.4037/ccn2020963

 

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. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main

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NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project? 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.

Also Read:  NUR 590 Topic 2 DQ 1 Compare two organizational readiness tools