NUR 590 Evidence-Based Practice Project Proposal Presentation

Sample Answer

Introduction

Welcome to this presentation on the proposed evidence-based practice (EBP) project. As the healthcare industry struggles to address cost and access problems, nursing professionals should embrace their role as change leaders through evidence-based interventions.

This role obligates nurses to identify clinical problems affecting specific populations and implement appropriate interventions. Older adults encounter many health problems, and a decline in functional performance is common among those with type 2 diabetes.

The purpose of this presentation is to describe how to implement an intervention (twice-weekly physical exercise program) to improve functional fitness/performance and independence in this group. Focus areas include organizational culture and readiness, literature supporting the intervention, change model to guide project implementation, the implementation plan, and the evaluation plan.

Organizational Culture and Readiness

EBP succeeds in organizations with a culture that is ready for change. As a result, change leaders should evaluate the organizational culture to determine its readiness and potential barriers to successful implementation.

A detailed analysis of variables such as leadership, shared values, and internal relationships demonstrates a clan culture in the organization. According to Ghiasi et al. (2022), a clan culture is associated with high internal focus and flexibility. Its people-centered and flexible nature supports innovation to a significant degree.

Other success factors regarding culture include friendly leaders encouraging change and promoting interprofessional collaboration. Importantly, the nursing environment values employee participation and teamwork, crucial when introducing new ideas for optimizing cost-effectiveness and patient satisfaction.

Organizational readiness for change determines how seamless or challenging the implementation process will be. According to Vax et al. (2021), organizational readiness denotes stakeholders’ willingness and perceived capacity to adopt new practices.

Given this, high readiness implies quick adoption of EBP practices since they introduce positive change in healthcare. After assessing readiness using the Organizational Readiness to Change Assessment (ORCA) tool, it emerged that the implementation site is ready for change due to a high score (92.8%) in critical determinants like leadership support, facilitation, and the overall context.

According to Kononowech et al. (2021), the ORCA tool assesses readiness by examining the strength of evidence supporting change, organizational context, and facilitation in terms of culture and leaders’ ability to help people change their behaviors. To maximize readiness, leaders should foster a culture of innovation and teamwork through action plans that accelerate the adoption of new practices.

Problem Statement and Literature Review

Healthcare professionals and leaders should prioritize issues that increase costs, clinical visits, and the overall management burden. Although population aging is a global phenomenon, the resultant physical decline and functional capacity loss is a genuine healthcare concern.

According to Wickramarachchi et al. (2023), muscular strength declines at 12%-14% per decade after 50 years of age. Causes include loss of muscle mass, changes in the sensory system, and decreased aerobic capacity. Older adults with type 2 diabetes are at a high risk of this physical decline, resulting in accidental falls, fractures, body pain, and poor mental health due to constant fear of falls.

These issues further increase healthcare costs due to increased clinical visits, necessitating programs that promote physical activity to enhance balance, muscle strength, and endurance.

The decline in functional capacity and independence among older adults is a severe healthcare problem hampering life quality and increasing the risk of other health problems. According to Wickramarachchi et al. (2023), functional capacity loss and independence decline are risk factors for accidental falls among older adults.

The authors recommend muscle-strengthening activity programs, underscoring the value of regular physical exercises. To determine the risk of falls and functional disabilities, Wickramarachchi et al. (2023) suggest a strength test (hand grip and leg test) for screening older adults.

Zarco et al. (2021) found that reduced physical and cognitive function causes cardiovascular and mental health problems. They also increase the risk of Alzheimer’s disease. In this study, the authors evaluate the value of essentrics, a guided physical exercise program for strength and flexibility training.

Type 2 diabetes is associated with accelerated metabolic aging, causing many physical problems, such as functional decline and physical disability. Among older adults, health problems that co-occur with type 2 diabetes intensify physical impairment.

As Ahmad et al. (2022) stated, the adverse health effects of these body changes include a high risk of falls and poor quality of life. Lifestyle interventions, mainly physical exercises and modification of risk factors, are highly recommended in this study.

According to Motamed-Jahromi and Kaveh (2021), functional decline generates disability in basic activities of daily living (BADLs), such as self-care. Other adverse outcomes include hampering life quality and an overall decline in social and mental health. The authors recommend regular physical activity that prioritizes mobility exercise and functional training.

Change Management Model

Effective EBP implementation requires a systematic process guided by a change model. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model fits the proposed project since it is procedural and easy to follow.

According to Friberg and Creasia (2023), the JHNEBP model was created in 2002 to fix gaps in evidence utilization in nursing. Its essential components are three and critical to positive changes in patient care. They include the practice question, evidence (search and appraisal), and translation to practice (Dusin et al., 2023).

Utilizing this model implies implementing the proposed change through a step-wise approach and being guided by a model characterized by interrelationships between scientific inquiry, practice improvements, and learning.

The proposed intervention is a two-weekly tailored physical exercise training program to improve functional fitness and independent living among older adults with type 2 diabetes. Given this, the practice question is whether the training program will enhance the participants’ functional fitness and independent living in eight weeks.

The evidence to answer this question has been searched from credible sources and then appraised and rated as the JHNEBP model recommends. Since the evidence (levels 1 and 2) validates and finds such training effective, the last step will be translating the findings to clinical practice. This step involves project implementation, and how it will be done is discussed in the next slides.

Implementation Plan

The project will be implemented in a general practice setting with a clan culture. Such a culture supports team-based innovation and continuous improvements in patient care. The program requires approximately eleven weeks, with eight weeks set aside for conducting the physical exercise initiative.

The program is estimated to cost $1,150 for educational materials, the support team, data collection and analysis tools, and communication. A quantitative research design is appropriate since it allows researchers to collect numerical data and test hypotheses deductively (Bazen et al., 2021).

Surveys (questionnaires) will be used, and data will be collected at baseline, after four weeks, and at the end of the eighth week to facilitate evaluation.
Delivering the intervention is the actual implementation since it denotes executing the desired changes.

The process will begin by identifying eligible participants (older adults with type 2 diabetes) from the clinical records. The next step is obtaining informed consent from these participants, which ensures compliance with the ethical guidelines of research involving human subjects (Laurijssen et al., 2022).

The other main activities will be introducing the participants to the project, providing them with essential educational materials, and training them on how to conduct the twice-weekly physical exercise program. Participants will be further guided on data collection and reporting the progress to the project leader.

The data will facilitate project evaluation and objective deduction of its clinical significance. Patient-provider communication, guided support to inform decision-making, and resource facilitation will be continuous.
Effective EBP implementation is contingent on stakeholders’ commitment, attitude, and knowledge.

Within nursing, stakeholders are the individuals or groups that make crucial healthcare decisions or are directly affected by them (Magwood et al., 2021). In the proposed project, these stakeholders include the organizational leaders who provide resources and guided support, the nursing team, and patients (healthcare consumers).

The busy nature of the leaders and nursing team could be a massive barrier to implementation since it affects their availability. However, open communication and active engagement will be used to earn their support.

Evidence of feasibility regarding the project includes exclusive reliance on internal resources, making it cost-effective. It also aligns with the organization’s values, inferring that it will get much stakeholder support.

Evaluation Plan

When proposing EBP projects, nurses look forward to accomplishing specific health outcomes. Similarly, the proposed project seeks better health outcomes characterized by enhanced functional performance/fitness and independence among older adults with type 2 diabetes.

Active participation in the project and successful completion will improve physical health variables, including flexibility, muscle strength, balance, and body movement. As Wickramarachchi et al. (2023) stated, increasing muscular strength and flexibility helps to prevent balance disorders associated with aging. Preventing these issues will improve the patient’s overall quality of life and reduce their consumption of healthcare services. As a result, it will be pivotal in reducing healthcare spending.

Project evaluation is a comprehensive process that relies heavily on data. This data will be collected using questionnaires to help collect numerical data and quantify the project outcomes. O’Connor et al. (2022) found questionnaires highly valid and reliable since they allow researchers to collect rich and large amounts of data.

The data will then be subjected to inferential statistics by calculating the range (percentage differences in health changes and experiences). To calculate the range, the health statuses will be rated using a scale of 1-4 (no change, struggling, improving, greatly improved), and the total under each column at the baseline, at four weeks, and at eight weeks converted into a percentage.

In case of nonpositive outcomes, a comprehensive outcome evaluation will be conducted to identify the causes of performance gaps to determine whether the project should be redone or modified

The project should be maintained and implemented regularly if it achieves the expected outcomes (clinically significant results). In this case, other patients should be helped to implement it in the future to improve functional performance and independence.

It should be extended if positive results are visible, but better outcomes can be achieved by improving some areas. A revision would be necessary if there are visible issues on how, where, and when the project was implemented. A suitable example of such a revision is adding another exercise component, such as endurance training. The project should be discontinued if the patients are no longer interested in it or there lacks adequate resources to sustain it.

Conclusion

In conclusion, it is crucial to highlight the major points of this presentation. As nursing professionals, everyone has a role in embracing and supporting EBP to enable progressive changes in practice. Such changes are accomplished by proposing and implementing projects that improve outcomes, such as a twice-weekly physical exercise program.

This project will enhance functional performance and independence among older adults with type 2 diabetes. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model will facilitate systematic, stepwise implementation through its three steps of practice question, evidence, and translation to practice.

Organizational leaders, the nursing team, and patients are the primary stakeholders. Data collection, analysis, evaluation, and other research design essentials will be quantitative.

References

• Ahmad, E., Sargeant, J. A., Yates, T., Webb, D. R., & Davies, M. J. (2022). Type 2 diabetes and impaired physical function a growing problem. Diabetology, 3(1), 30-45. https //doi.org/10.3390/diabetology3010003
  
• Bazen, A., Barg, F. K., & Takeshita, J. (2021). Research techniques made simple an introduction to qualitative research. Journal of Investigative Dermatology, 141(2), 241-247. https //doi.org/10.1016/j.jid.2020.11.029
  
• Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting a scoping review. BMJ Open, 13(5), e071188. https //doi.org/10.1136/bmjopen-2022-071188
  
• Friberg, E. E., & Creasia, J. L. (2023). Conceptual Foundations-E-Book the Bridge to Professional Nursing Practice. Elsevier Health Sciences.
  
• Ghiasi, A., Lord, J., Banaszak-Holl, J., Davlyatov, G., Hearld, L., & Weech-Maldonado, R. (2022). Organizational culture and high Medicaid nursing homes financial performance. Journal of Long-Term Care, (2022), 142–153. https //doi. org/10.31389/jltc.115
  
• Kononowech, J., Hagedorn, H., Hall, C., Helfrich, C. D., Lambert-Kerzner, A. C., Miller, S. C., Sales, A. E., & Damschroder, L. (2021). Mapping the organizational readiness to change assessment to the Consolidated Framework for Implementation Research. Implementation Science Communications, 2(1), 19. https //doi.org/10.1186/s43058-021-00121-0
  
• Laurijssen, S. J., van der Graaf, R., van Dijk, W. B., Schuit, E., Groenwold, R. H., Grobbee, D. E., & de Vries, M. C. (2022). When is it impractical to ask informed consent? A systematic review. Clinical Trials (London, England), 19(5), 545–560. https //doi.org/10.1177/17407745221103567
  
• Magwood, O., Riddle, A., Petkovic, J., Lytvyn, L., Khabsa, J., Atwere, P., … & Tugwell, P. (2022). PROTOCOL Barriers and facilitators to stakeholder engagement in health guideline development A qualitative evidence synthesis. Campbell Systematic Reviews, 18(2), e1237. https //doi.org/10.1002/cl2.1237
  
• Motamed-Jahromi, M., & Kaveh, M. H. (2021). Effective interventions on improving elderly’s independence in activity of daily living a systematic review and logic model. Frontiers in Public Health, 8, 516151. https //doi.org/10.3389/fpubh.2020.516151
  
• O’Connor, S. (2022). Designing and using surveys in nursing research a contemporary discussion. Clinical nursing research, 31(4), 567-570. https //doi.org/10.1177/10547738211064739
  
• Vax, S., Farkas, M., Russinova, Z., Mueser, K. T., & Drainoni, M. L. (2021). Enhancing organizational readiness for implementation Constructing a typology of readiness-development strategies using a modified Delphi process. Implementation Science IS, 16(1), 61. https //doi.org/10.1186/s13012-021-01132-0
  
• Wickramarachchi, B., Torabi, M. R., & Perera, B. (2023). Effects of physical activity on physical fitness and functional ability in older adults. Gerontology & Geriatric Medicine, 9, 23337214231158476. https //doi.org/10.1177/23337214231158476
  
• Zarco, E. P. T., Aquino, M., Petrizzo, J., Wygand, J., & McGorry, A. (2021). Perceived benefits of a guided exercise program among older adults. Gerontology and Geriatric Medicine, 7, 23337214211060147. https //doi.org/10.1177/23337214211060147