NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project<\/p>\n
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/strong><\/a><\/span><\/p>\n 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.<\/p>\n <\/p>\n As with any project implementation<\/a> its best to envision any potential issues before they arise.\u00a0Therefore, 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.\u00a0I was able to identify a couple of strategies to help with the financial concerns including executive leadership engagement in the process.\u00a0Being 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.<\/p>\n The second foreseen issue is a lack of clinician buy in to the program and change management.\u00a0In order to address this area education, engagement, and communication are necessary strategies.\u00a0The education will include up-to-date best practices, refresher courses, audit, and review.\u00a0The 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.<\/p>\n <\/p>\n The third foreseen issue is lack of quality of the POLST process and order sets.\u00a0Quality of the work is a multifactorial problem; in that it relies heavily on the first two foreseen issues.\u00a0\u201cThe quality of POLST documentation is only as good as the conversations that precede it\u201d (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.<\/p>\n <\/p>\n Research on POLST implementation is actively being reviewed and updated therefore in order to\u00a0\u00a0ensure that my proposed evidence-based practice proposal is based on current evidence it\u2019s necessary to regularly search for the most up-to-date literature.<\/p>\n <\/p>\n <\/p>\n Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department.\u00a0Annals of Emergency Medicine<\/em>,\u00a073<\/em>(3), 294\u2013301. https:\/\/doi.org\/10.1016\/j.annemergmed.2018.10.021<\/a><\/p>\n 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: \u201cWhen will you be ready?\u201d or \u201cHave you tested the quality of your realization?\u201d 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):<\/p>\n 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\u00a0et al.,<\/em>\u00a02016).<\/p>\n 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\u00a0et al<\/em>., 2009).<\/p>\n <\/p>\n <\/p>\n Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI\u00ae Global Congress 2014\u2014North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.<\/p>\n <\/p>\n 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.\u00a0Clinical journal of the American Society of Nephrology : CJASN<\/em>,\u00a011<\/em>(5), 916\u2013924.\u00a0https:\/\/doi.org\/10.2215\/CJN.11501015<\/a><\/p>\n <\/p>\n Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly<\/em>, 12(1), pp 89- 96<\/p>\n 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\u00a0\u00a0(American Heart Association., n.d.)<\/em>. 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: \u201cprevious literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival\u201d\u00a0(Clark et al.,2019).\u00a0<\/em>Getting not only nurses but also physicians\u00a0 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.<\/p>\n I would utilize\u00a0<\/em>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.<\/p>\n <\/p>\n American Heart Association . (n.d.).\u00a0CPR Facts and Stats<\/em>. cpr.heart.org. https:\/\/cpr.heart.org\/en\/resources\/cpr-facts-and-stats.<\/p>\n 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.\u00a0Circulation<\/em>,\u00a0140<\/em>(Suppl_2), A458-A458.<\/p>\n 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.\u00a0 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.<\/p>\n 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).<\/p>\n Projects: (2021). 9 Project management Challenges and How to Overcome them.\u00a0https:\/\/kissflow.com\/project\/project-management-challenges<\/a>.<\/p>\n National Institute of Corrections. (n.d). Evidence-based Practices (EBP).\u00a0https:\/\/nicic.gov\/projects\/evidence-based-practice-ebp<\/a>.<\/p>\n From an\u00a0institutional\u00a0standpoint, I do not foresee any issues with\u00a0implementing\u00a0my\u00a0EBP\u00a0Project\u00a0because the nurses are already engaged in patient education and\u00a0have the resources to implement the project.\u00a0However, patient compliance and adherence\u00a0may prove to be problematic.\u00a0According to\u00a0Pan et al (2019),\u00a0noncompliance\u00a0with\u00a0treatment regimens is\u00a0primarily responsible\u00a0for uncontrolled\u00a0blood pressure among patients diagnosed with hypertension.<\/p>\n Before\u00a0implementing change, organizations need to assess readiness for change.\u00a0Therefore, it is imperative that organizations analyze systems,\u00a0processes,\u00a0and\u00a0more importantly\u00a0people\u00a0when conducting change readiness.\u00a0As cited in\u00a0Borges & Camila\u00a0(2020), 70% of\u00a0organizational\u00a0change fail\u00a0due to\u00a0lack.\u00a0of employee adoption of the changes.\u00a0Change readiness assessments\u00a0can aid in\u00a0facilitating\u00a0change\u00a0by collecting\u00a0quantitative and qualitative data measurements\u00a0about where readiness gaps may exist.<\/p>\n Once the change readiness assessment has been conducted,\u00a0data\u00a0summarized and\u00a0reviewed, and issues\u00a0addressed,\u00a0change can be\u00a0initiated.\u00a0John\u00a0Kotter\u2019s 8 Step Change Model\u00a0would be\u00a0most\u00a0appropriate\u00a0because\u00a0it involves\u00a0establishing, maintaining,\u00a0and\u00a0sustaining\u00a0change.\u00a0Kotter\u2019s model\u00a0states\u00a0that organizational change is vital to be\u00a0successful\u00a0(Kuo\u00a0& Chen, 2019).\u00a0The eight steps of change in Kotter\u2019s model are:\u00a0\u00a0create urgency,\u00a0organize a guiding team, develop\u00a0a clear\u00a0and\u00a0concise\u00a0vision and strategy,\u00a0communicate the\u00a0vision,\u00a0utilize\u00a0empowerment to remove obstacles\u00a0or barriers,\u00a0create short-term victories,\u00a0build on the change, and\u00a0cement\u00a0changes in culture\u00a0(Kuo\u00a0& Chen, 2019).<\/p>\n Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach.\u00a0Journal of Organizational Change Management,\u00a033(5), 667-681.\u00a0doi:\u00a0http:\/\/dx.doi.org.lopes.idm.oclc.org\/10.1108\/JOCM-09-2019-0279<\/a><\/p>\n <\/p>\n Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies\u00a0and effects.\u00a0PLOS One, 14<\/em>\u00a0(4).\u00a0https:\/\/doi.org\/10.1371\/journal.pone.0213496<\/a><\/p>\n <\/p>\n 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.\u00a0Medicine<\/em>,\u00a098<\/em>(27), e16116.\u00a0https:\/\/doi.org\/10.1097\/MD.0000000000016116<\/a><\/p>\n 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).\u00a0In 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.\u00a0\u00a0Utilizing 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). \u00a0Once 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.<\/p>\n 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, \u00a0A= starting with awareness, presenting the issue, why it is a problem or why they should be a change.\u00a0\u00a0D= creating desire or want to become engaged in the process, creating a desire of the how this will improve practice and outcomes. \u00a0K= giving knowledge or improving knowledge in the process, through providing the research for staff to understand.\u00a0A= abilities, or assessment of abilities of the nurse involved, do they have the tools, understanding, equipment needed.\u00a0Finally, 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).<\/p>\n <\/p>\n 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 \u201chiccoughs\u201d happen, a process has a lot of push back. \u00a0Assessing 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.<\/p>\n <\/p>\n Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to<\/p>\n support evidence-based practice.\u00a0Critical Care Nurse<\/em>,\u00a040<\/em>(3), 59\u201363.\u00a0https:\/\/doi.org\/10.4037\/ccn2020963<\/a><\/p>\n <\/p>\n 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.\u00a0Nursing Outlook<\/em>, (65), 233\u2013239. Retrieved May 4, 2021, from<\/p>\n Renalt, V. (Ed.). (2021).\u00a0SWOT analysis: Strengths, Weakness, Opportunities and Threats<\/em>. Community Tool Box.\u00a0https:\/\/ctb.ku.edu\/en\/table-of-contents\/assessment\/assessing-community-needs-and-resources\/swot-analysis\/main<\/a><\/p>\nNUR 590 Topic 2 DQ 2<\/strong>\u00a0<\/strong><\/h2>\n
A Sample Answer For the Assignment: NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/strong><\/h2>\n
Title: NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/strong><\/h2>\n
Reference NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/strong><\/h3>\n
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Reference NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/h3>\n
References NUR 590 Topic 2 DQ 2 Do you foresee any issues with the proposed implementation of your project?<\/h3>\n
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