NRS465 Applied Evidence-Based Project and Practicum
Week 4 Discussion
DQ 1
Assess the culture of the clinical site/organization and organizational policies for potential challenges in implementing the nursing practice intervention. Why is understanding the health care system and clinical system at the local level important to consider when planning an EBP implementation? Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
DQ 2
Compare and contrast two change and/or nursing theories. Explain which theory would best support the implementation of your specific evidence-based intervention. Provide rationale for your choice. Gather feedback on applying this theory to your clinical setting from your preceptor and share their insights in your post. Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
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Here are the responses for each discussion question:
DQ 1: Assessing Clinical Site Culture and Policies for EBP Implementation
Assessing the culture and organizational policies of a clinical site is crucial for identifying potential challenges when implementing a nursing practice intervention. Organizational culture encompasses the values, beliefs, and behaviors that influence how care is delivered and how changes are embraced within the healthcare setting (Dodek et al., 2012). A culture that is resistant to change, lacks leadership support, or has poor communication channels can pose significant barriers to implementing evidence-based practice (EBP) interventions. For example, a clinical site that prioritizes tradition over innovation may struggle to adopt new interventions, even if they are supported by strong evidence.
Understanding the local healthcare system and clinical processes is essential for planning EBP implementation because these factors directly affect the feasibility and sustainability of the intervention. Local clinical systems include workflows, staff roles, patient demographics, and existing resources, all of which must be considered to tailor the intervention effectively (Melnyk & Fineout-Overholt, 2019). For instance, an intervention designed to improve patient outcomes in a high-resource urban hospital may not be directly transferable to a rural clinic with limited staffing and resources.
Identifying potential challenges early allows for the development of strategies to overcome them, such as engaging stakeholders, providing targeted education, and aligning the intervention with organizational goals. Additionally, understanding local policies, such as those related to staffing, patient safety, and quality improvement, ensures that the intervention aligns with the organization’s regulations and standards, facilitating smoother implementation and greater acceptance among staff.
References:
Dodek, P. M., Cahill, N. E., Heyland, D. K., & The Canadian Critical Care Trials Group. (2012). The relationship between organizational culture and implementation of clinical practice guidelines: A narrative review. Journal of Critical Care, 27(1), 2-10.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. Wolters Kluwer.
DQ 2: Comparing and Contrasting Nursing Theories for EBP Implementation
Two change theories commonly applied in nursing practice are Lewin’s Change Theory and the Transtheoretical Model of Change. Lewin’s Change Theory, also known as the Unfreeze-Change-Refreeze model, involves three stages: unfreezing existing behaviors, making the change, and refreezing new behaviors to make them permanent (Lewin, 1951). This theory emphasizes the importance of preparing the organization for change, implementing the intervention, and then solidifying the new practices within the organization’s culture.
The Transtheoretical Model of Change, developed by Prochaska and DiClemente, involves stages such as precontemplation, contemplation, preparation, action, and maintenance. This model focuses on the individual’s readiness to change and recognizes that change is a process rather than a single event (Prochaska & DiClemente, 1983). It is often used in health behavior change and can be particularly useful for interventions requiring gradual adoption by staff or patients.
For implementing an evidence-based intervention such as hourly rounding to reduce patient falls, Lewin’s Change Theory may be more suitable. This is because it provides a structured approach to managing organizational change, focusing on engaging stakeholders, modifying workflows, and reinforcing the change until it becomes part of the routine practice. The Unfreeze stage would involve educating staff on the importance of the intervention, while the Change stage would implement the rounding practices, and the Refreeze stage would involve monitoring compliance and outcomes to ensure the new behavior is maintained.
Feedback from my preceptor highlighted that Lewin’s model is practical in clinical settings because it addresses organizational inertia and provides clear steps to facilitate change. My preceptor noted that the structured approach of Lewin’s model aligns well with the goal of embedding new practices into the daily routines of healthcare providers, which is essential for sustained improvement.
References:
Lewin, K. (1951). Field theory in social science: Selected theoretical papers. Harper & Row.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.
