PLEASE RESPOND TO THIS PEER DISCUSSION POST BELOW 

A successful change requires a person who is well developed in leadership and planning as well a functioning as a change agent (Angel-Sveda, 2012). A change agent is skilled in theory and implementing change. I witnessed this with an educational leader. This educational leader is in charge of most of the department’s education but mostly involved with the orientation portion of education, when candidates are first hired and during their probation period. I was part of a change process, including going into the field (patient home) during orientation observing patient care, documenting, time spent in home, and then coming back to report and review the charting. The change model was implemented to help familiarize ne employees to the work environment as well as reinforce policies for existing employees.

Using one of the change theories in the book or one that you have researched, analyze the change effort that you presented.

The Lewin’s Change Theory: This model describes the change process in three steps; described as “Unfreeze-Change-Refreeze”.

The Unfreeze stage is when the change is anticipated to happen or initialing began; involves supporting staff, feedback, empowerment, and freedom for independent thinking (Coghlan & Brannick, 2003)..  In the case for me the unfreeze stage was when the new employees shadowed the existing employees on their home visits. The existing employees were very apprehensive about this training but reluctantly participated.

The Change stage is when  all the employees are expected to adapt the change and adhere to rules (Coghlan & Brannick, 2003). During this stage many employees reverted back to their old ways, not charting in the home or tracking their miles at the time of the visit; leaving room for error in documentation.

The Refreeze stage is when the change is expected to be followed and evaluation of adherence is need to ensure change is effective (Coghlan & Brannick, 2003). After a few weeks the employees did comply with the change the educator presented but some employees did not and were retrained by having to attend a class reiterating the company policies.  

What went well?

The new employees got hands on experience during orientation, which included, real-time charting, on point questions, and engaging with clients. They also had the opportunity to navigate through the portable computer system before diving into the field alone. Another good outcome was the employees were able to get to know one another during this time and a mentor relationship is usually developed. 

What didn’t go well?

Some existing employees thought the change model was a way to ‘spy’ on them or track their amount of time spent in the home. There was a lot of resistance from employees or many of them declined to participate in the new orientation/training process. 

What would you have done differently if you had been in a leadership position?

I would have explained the need for the change model in the first place.  The educator introduced the change model but did not explain its need or rationale thoroughly. I also would have included high positional workers into the conversation and implementation so other employees knew this was important and required for compliance.

 

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PLEASE RESPOND TO THIS DISCUSSION WITH REFERENCES. 

The rigor associated with research differs between qualitative and quantitative research. In quantitative research a study is rigorous when it is reliable and valid. The researcher must maintain adherence to the procedure during data collection and analysis (Lohfield, 2018). Reliability is the degree to which a research instrument produces consistent results. There are a few different methods to test reliability. Stability reliability is tested using test-retest, where the same concept is is tested with the same instrument over time to see if it yields the same results. Equivalence reliability is tested by inter-rater reliability, which is when two people judge their equvalence, and alternate forms, which is a comparison of two instruments to determine their equivalence. Internal consistency is mainly used with scales as a meausuring concept.  Validity is how accurate an instrument is at measuring what it is trying to measure. There are four types of validity. Face validity is just looking at the instrument to determine if it looks legitamate. Content validity looks to see if the method has all of the main components ncessary to measure whatever is being measured. Construct validity determines whether the instrument measures the theoretical component it is meant to measure. Criterion related validity is used when a score on a test can be used to predict the persons performance in a different situation.

In qualitative research, maintatining trustworthiness is key to a rigorous study. Trustworthiness is the analogous for rigor in qualitative research (Amankwaa, 2016). Trustowrthiness involves establishing credibility, transferability, dependability, and confirmability. the researcher must also have self awareness, because qualitative research involves interpreting findings, and this may be affected by a researchers biases.

To ensure trustworthiness, I think a researcher having a lot of knowledge of themselves and being aware of this when interpreting data would be key to keep their study rigorous. to increase validity, a researcher should make sure they have a very good research tool. To increase reliability, it is best to use a large sample size in the study.

References

Amankwaa, L. (2016). Creating Protocols for Trustworthiness in Qualitative Research . Journal of Cultural Diversity, 23(3), 121-127

Lohfield, L. (2012). Testing the validity of a scenerio based questionnaire to assess the ethical sensitvity of undergraduate medical students. Medical Teacher, 34(8), 635-642.

 

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Workflow Assessment for Health IT Toolkit   Workflow can be defined as a term used to describe the action or execution of a series of tasks in a prescribed sequence (McGonigle, & Mastrian, 2015). 

Workflow tools can help make it easier to redesign workflow and aid in the application of health information technology (U.S Department of Health and Human Services, n.d). 

For the purpose of this discussion three workflow tools were selected which include benchmarking interviews and usability evaluation.  Benchmarking  Benchmarking is a process of evaluating metrics or best practices from other organizations (either related or unrelated to your own) and then applying them to your organization (U.S Department of Health and Human Services, n.d). 

Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others. Benchmarking can stimulate healthy competition, as well as help members of a practice reflect more effectively on their own performance. Benchmarking can be done by reaching out to peers at other facilities and finding out what they do and if it works well. My facility has many other sister and we are the bigger where we encounter most of the problem. The common system that all we use is the point click care.  What I going to do is to contact all the leader of the entire facility sister, so we can have a meeting to debate about each system in place in each facility. I would want to physically see how the design of their system works and if the charting works well. Because nurse has to be involve in and informatics technology process, I would bring with me 2 to 3 clinical managers nurses to see the charting, so they could also see the new idea and give feedback on their feelings about it. Based on the information gathered I would plan a process to implement the new ideas into the charting system at our facility.  

Interviews provide a means of eliciting information from a group of individuals regarding their opinions, behavior, or knowledge (U.S Department of Health and Human Services, n.d). Here the interview involves 2 to more people and during the interview, data are collected and most of the time, it is the interviewee who provide data Here, I will set up an interview with 2 to 3 leaders form the sister facility where I will ask questions about sensitive issues, to determine users’ needs on the systems and to clarify some of my questions question.  

Usability evaluation  A usability evaluation is conducted to determine the extent to which a system is easy to use or “user friendly.” (U.S Department of Health and Human Services, n.d). Here I will determine if the new system is useful to user and if it is easy for to use it before implementation. Here I will determine the goal of my evaluation, what will be evaluated and how? For that I will choose some main staff from each sister facility who will conduct the survey to the rest of the staff to see how easy it is for them to use the informatics system. Based on the result, I will see what the areas of improvement before the implementation.  The article I will be use the information to improve workflow within your organization is:  Improvement of workflow and processes to ease and enrich meaningful use of health information technology (Singh & al., 2014).  In this article the author develop a self-contained workflow toolkit that uses ‘universal visual language’ and recognizes that most practices lack the required expertise and often need external assistance because the current methods (using esoteric charts or various software packages11 that require long and steep learning curves) are alien to health care workers and are, therefore, perceived to be barriers (Singh & al., 2014). It is a well established fact that, in any setting or industry, better management of work processes leads to improved value. Education and training of stakeholders in this management skill needs appropriate tools. The toolkit particularly addresses the ‘system-based practice’ and ‘practice-based learning and continuing improvement’ (Singh & al., 2014). Base on that, I will educate staff by using that pictorial tool for assessing the current and continuing redesigns of future workflows for achieving staff comfort, efficiency, communication, organization, productivity, effectiveness, safety, and satisfaction of patients and staff, all without having to seek outside help.  According to Caspi (2015), it is clear that informatics nurses will continue to be instrumental players in the analysis, implementation, and optimization of advanced information systems and emerging technologies that aim to improve the quality of patient care, while reducing costs.     

Caspi, H. (2015). The significant impact of nursing informatics on workflow, productivity. Healthcare Dive. Retrieved from https://www.healthcaredive.com/news/the-significant-impact…workflow…/387301  McGonigle,  D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of  knowledge (4th ed.). Burlington, MA: Jones and Bartlett  Learning. Chapter 13, “Workflow and Beyond Meaningful Use”     Singh, R. Singh, A., Singh, R., Singh, R. (2014). Improvement of workflow and processes to ease and enrich meaningful use of health information technology. DOI: 10.2147/AMEP.S53307. Retrieved form Walden library.   U.S department of health and human services (n.d.b). Workflow Assessment for Health IT Toolkit.http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

 

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Provide a 3-4 sentence response to the discussion question answer that is provided below. The original question will also be provided.

Response: The list of research and practice is 1) Systematic reviews followed by the following,

2) Randomized control trials (RCT’s), 3) Non-randomized controlled studies, 4) Controlled cohort studies, 5) Uncontrolled cohort studies, 6) Case studies and case series, qualitative and descriptive studies, EBP implementation, and QI projects, and 7) Expert opinion (Melnyk & Fineout-Overholt, 2018).

There are many methods of research. One must start out with a review of the literature in their inquiry. One of the reasons is to see what research has been done as to not duplicate unnecessary research. A review will also help to see where to begin a research study or project. If a project is desired, is there enough evidence with reliability, validity, applicability, and replicability? If the evidence is sufficient, and has been applied to quality improvement and/or EBP projects then it can be possibly considered as expert opinion. Whatever you find in the process at least you can then consider if the research has the necessary information available or whether you may want to find another topic for research. It depends on what your reason is for the search.

Original Question: What levels of evidence are present in relation to research and practice, and why it is important regardless of the method you use?

 

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The responses should be 100 words and should add to the understanding and learning of the topic and should include at least one peer-reviewed journal article reference.

i attached  two students discussion and please response for each one in 100 words and use peer reviewed journal article for each one. i need that after 3 hours 

 

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