Carrie Smithson    1 posts   Re: Topic 9 DQ 2         Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of Evidence Based Practice is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. There are barriers that may prevent my Evidence Based Practice change proposal from continuing to obtain the same desired results six months to a year from now. My PICOT statement is, In adults with tobacco dependency (P), would providing teaching/research about tobacco cessation (I) compared to medications to assist in tobacco cessation (C) lead to a decrease in tobacco dependency and better health outcomes (O), after four weeks of intervention/quit date (T)? One barrier is new staff coming on board and not knowing the proper way to educate patients on tobacco cessation. The current staff will receive proper education on how to educate tobacco dependent patients. To assist new staff with the process change, we can create required computer based learning assignments (CBL’s) that have to be completed before coming out of orientation. This will allow all new nurses to be up-to-date on the education process. Another barrier is language. Not only is language a barrier in education, but other forms of communication as well. Upon communicating with a patient who does not speak English, the health care team must first decide what language the patient understands best, and in what way the patient learns best. Once the assessment is completed, the nurse can obtain an interpreter. At our facility, there are interpreters on wheels; this is an IPad that we bring to the patient and an interpreter comes on live to speak to the patient in their specific language. Not only can we use the interpreter, but provide written education in different languages as well. Throughout the education process, it is important to remember communication techniques. A few communication techniques are listening, asking open ended questions, and having an open posture (Elsheikh, 2018). Change initially can be a good thing and take off quickly. It is important to sustain new change through methods like I mentioned above.  Reference  Elsheikh, K. (2018, March 21). 7 Effective Communication Techniques That Will   Make YouExcellent. Retrieved from https://medium.com/better-humans/7-  effective-communication-techniques-  that-will-make-you-excellent-89eb17e60b36

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The largest barrier to change in an ambulatory surgery setting would be resistance to change, as people often create habits or specific ways of performing different tasks, asking a group to change the way they think and perform these tasks, is often a difficult undertaking (Strategies for Nurse Managers, 2002). In the ambulatory surgical setting, time and operating room schedules are very important, at times even dominating the day and taking precedence.Overcoming this barrier effectively would require a variety of different strategies to gain compliance and understanding, however, maintain these standards could prove to be tricky. It is expected that five of the major surgeons who share ownership of the center. They will assist in creating the changes to practice, and how they wish the patients receive this information, as well as providing input into changes to their prescribing habits. Through the months after implementation, stakeholder satisfaction with protocol changes and implementation will be assessed through clinical staff meetings. Another way to overcome these barriers is by gaining support from the administration staff (Ginex, 2018) such as our Director of Nursing. The administration will be able to provide important information through surveys that will provide valuable feedback that nurses are continuing to follow protocol through the post-operative patient surveys. Furthermore, the administration can assist with the coordination of education and informational meetings to follow up on the new changes in practice, and reviews of the evidence that supports these changes, and the reason for implementing these new protocols (Strategies for Nurse Managers, 2002). Nurses will also be consulted in follow up meetings as to their satisfaction with the new protocols taking place, and their opinions, as well as any suggestions they may have to further increase satisfaction to the patients and staff. ReferencesGinex, P. K. (2018). Overcome barriers to applying an evidence-based process for practice change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-changeStrategies for Nurse Managers. (2002). Breaking down resistance. Retrieved from http://www.strategiesfornursemanagers.com/content/31710.pdf

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Anne Kolsky    3 posts   Re: Topic 9 DQ 2  Potential Barriers to Sustained Changes   Population health improvements require action from multiple sources. People are complex and so are responses to changes. Everyone is accountable and delegation can only go so far. Our nation tends to see value in how much money is spent vs taking the sometimes-harder route of making actual changes. It is easier to “throw money” at the problem, then change the root of the problem. Pardon the pun, but we tend to put bandaids on the hemorrhages. We tend to see the problem from our own personal perspectives only. Contributions and partnerships must come from all areas of influence.  Possible Solutions  Multisectoral community health business partnership models maybe a key to making everyone a part of the bigger picture as well as the details. This is a different pathway that shows promise. As the article states, “It is time to move beyond grands and isolated efforts to partnerships with substantial structure, incentives, and financing,” (Kindig & Isham, 2014). Business, education, state and local governments, community developers, and philanthropic organizations must form partnerships to make changes sustainable. Developing a business model is one way to encourage this as the “bottom line” is always a motivating factor. If it can be done without making this the “only” factor and that everyone has a stake in the “business,” then it can work well. HealthPartners is an example of a consumer-driven nonprofit that works in partnership with entities that encourage a unique niche (Kindig & Isham, 2014).  Kindig, D. A., & Isham, G. (2014). Population health improvement: A community health business model that  engages partners in all sectors. Frontiers of Health Services Management, (4), 3. Retrieved from  https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?  direct=true&db=edsgih&AN=edsgcl.553965837&site=eds-live&scope=site

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Creating Culturally Competent Health Care Organizations

Read chapter 9 of the class textbook and review the attached PowerPoint presentation.  Once done present an analysis of the following case study answering the questions below.

Mrs. Li Huan, a 79-year-old Chinese American widow who lives alone in New York City’s Chinatown recently had a cerebrovascular accident (CVA) or stroke. Mrs. Li has right-sided paralysis with partial loss of voluntary movement and sensation in her right arm and leg. Mrs. Li has weak facial muscles, difficulty with speech, and drooling. She experiences numbness and tingling in her arms and legs. Mrs. Li is going to a rehabilitation center known for delivering culturally competent interprofessional care where she is cared for by a team of credentialed health care providers: Dr. Indira Patel, nurse J.J. Johnson, physical therapist Mohammad Abu Said, dietician Maria Gonzalez, and Chinese American herbalist, Chen Minzhe.

(Note: In traditional Chinese culture, a person’s last name or surname is written first, followed by his/her first name. Therefore, the patient’s last name is Li and the herbalist’s last name is Chen. It is proper etiquette to call a person of Chinese background by his/her title, in this case, Mrs. Li and Mr. Chen until the individual gives you permission to use his/her first name. To further confuse matters, many acculturated Chinese Americans are likely to reverse their first and last names in the typical US or Canadian order. Therefore, it is important to ask the patient, “What is your first name? What is your last name?” Note the correct order on the patient’s chart for other members of the team.)

1. How do members of the interprofessional team assess Mrs. Li’s literacy, diet, and medications, including herbal medicines being provided by her herbalist, Mr. Chen?
2. How do the nurse and other members of the team determine if complementary or integrative treatments, such as medicinal herbs, are helpful, harmful, or neutral to Mrs. Li’s recovery?
3. If you were seeking advice or consultation from a traditional Chinese herbalist in your community, how would you locate one?
4. Why do patients seek treatment from alternative and integrative healers?
5. How can credentialed health care providers work collaboratively with Mr. Chen to ensure that prescription medicines and herbs are compatible and that there are no adverse or harmful interactions between various medicines?
6. What strategies would you recommend to promote Mrs. Li’s optimum functioning and health following her CVA? (Andrews & Boyle, Transcultural Concepts in Nursing Care, 7th Edition).

INSTRUCTIONS:

 APA format word document, Arial 12 font attached to the forum ,   If you don’t post your assignment in any of the required forums you will not get the points.  A minimum of 2 evidence-based references besides the class textbook no older than 5 years must be used.   the proper references no older than 5 years in two different days to verify attendance and as well make sure the references are properly quoted in your assignment.  A minimum of 800 words is required.  

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