Lewin’s Change Theory has three concepts that includes “driving forces,” “restraining forces,” and “equilibrium.” As the driving force implies, there are forces that push or cause things to change, shifting the equilibrium. Restraining forces fight against the driving forces which also causes shifts in equilibrium. Equilibrium can be described when no changes occur due to equal amount of force applied. There are three stages in his theory and that is “unfreezing,” “change,” and “refreezing.” Unfreezing is getting out of the rut of behaviors that are not healthy or productive. This requires fortitude to break out of the individual mindset and group conformity. This can be accomplished by either increasing the driving forces that direct behaviors away from the current norm or by decreasing the restraining forces that negatively affect movement away from equilibrium. A third alternative would be a combination of both. The change stage is producing growth and moving to a new level. It is evidenced by new thought, feeling and/or behavior changes. The refreezing stage is making the new patterns set as the new normal. Once they are “frozen,” it helps to prevent falling back into old unhealthy patterns (Change Theory, 2011).

Imogene King: Goal Attainment Theory has an emphasis on interaction theory vs systems theory. The concepts are based on an open system framework that honors nursing as a major system within the health care system, and places high emphasis on interpersonal processes. In the conceptual framework are three systems; the Personal (individual), Interpersonal (individuals interacting with each other) and the Social where groups of people in a community or society share common goals, interests, and values and is studied as a whole vs isolated parts. The practice of nursing is differentiated from other healthcare professions in that interpersonal systems are in place and this is reflected in the nurse-client relationship. The individual is viewed as a spiritual being, rational thinker, and records own history through own language, and expresses individual needs, wants, and goals. Humans have three fundamental needs: access to health information, illness prevention, care in times of illness. Health is dependent on continuous adjustment to stressors in the internal and external environments with use of ones resources to achieve maximum potential (Gragera, 2013).

Theory for EBP Project

The Goal Attainment Theory seems to be the best fit for the Capstone project. Results of screening and referrals develop into IHPs and IEPs that are tailored to the individual’s needs. This would seem to fit best with engaging the entire intraprofessional team in working with the student and the family in implementing interventions.

Theory Used by Mentor 

“I suppose I engage some level of nursing theory with each response in the work setting, protocol development, policy revision, and the like. When looking at the two theories you shared, I would probably most closely align myself with Imogene King’s Goal Attainment Theory. Nursing is a major system within the health care system, with vast and significant impact on individuals, families/groups, and communities (local, regional, national, and world)” (P. Anderson, personal communication, August 19, 2019).

“I’ve consistently landed on the historical (and I think still relevant) dimensions of health: physical, social, emotional, intellectual, spiritual. The individual, embracing, reflecting, and continuously balancing these five dimensions, can engage in self-responsibility and decision-making relative to the three fundamental needs identified in King’ theory:  health information, illness prevention, and care in times of illness ~ expressing needs, wants, and goals” (P. Anderson, personal communication, August 19, 2019).

Change Theory. (2011). Retrieved from http://currentnursing.com/nursing_theory/change_theory.html

Gragera, Jen. Imogene King: Goal Attainment Theory. (2013). Retrieved from https://www.slideshare.net/jen316/imogene-king-23548267

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Re: Topic 5 DQ 2  Technology is integral to successful implementation in many projects,   through either support or integration or both. Name at least one   technology that could improve the implementation process and the   outcomes of your EBP project. Do you plan to use this technology? If   not, what are the barriers that prevent its use?

ANSWER BY ANNE
 

Technology Support/Integration That Can Improve EBP Project

In the Nelson presentation (2015), one of the research questions put forth was, “Can a centralized, telephone-based model of early childhood developmental screening and care coordination improve quality of care for young children and their families” (Nelson, 2015). There are 211 Call centers that cover over 90% of the US population. In a LA based 211 developmental screening, over 11,000 early childhood screenings and coordinated care have been coordinated with appropriate services. The 211 potential advantages include time availability, standardized and validated online screening tools, extensive resource directory that includes care coordination, data collection and dissemination, continuity of care, and coordination with clinical settings. Of the children screened over 90% received some kind of referral. As the presenter reported, the American Academy of Pediatrics recommends universal screening and surveillance at every well visit, screening at 9, 18, and 24-30 months, autism-specific screening tool at 18 and 24-30 months, and prompt referral to evaluation and intervention services. The impact of early screening and intervention has evidence pointing to the improvement in developmental, social, educational, and health outcomes. Society benefits with a pronounced ROI in every dollar invested (Nelson, 2015).

Plans for Use and Barriers to Implement

The idea of starting a similar resource would be fantastic. It is an idea that could potentially be integrated into the school district and county for which I work. The same barriers I see from making it happen are the same barriers that the article mentioned, and that is the 211 has limited documentation. The same concerns that plague us now are the same for 211 regarding lag time between referral and service implantation. Eligibility and participation in services are always the big hinderances to making this work, and of course the age-old question of who will pay for this service (Nelson, 2015).

Nelson, B. (2015). Clinical-community partnerships and 2-1-1 technology to improve early childhood

developmental screening and care. [PowerPoint slides]. Retrieved from 

http://www.publichealthsystems.org/sites/default/files/PHS4/PresBioProjInfo_Nov%2019_Nelson%20UC

LA.pdf

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Questions

Technology is integral to successful implementation in many projects,   through either support or integration or both. Name at least one   technology that could improve the implementation process and the   outcomes of your EBP project. Do you plan to use this technology? If   not, what are the barriers that prevent its use?

Anne response

Technology is an important part of ensuring success in implementing change projects. This is especially true in the case of implementing a postpartum hemorrhage bundle. Postpartum hemorrhage is considered a high-risk low-volume event which means it does not occur often, but when it does there is much at stake (Lutgendorf et al., 2017). Technology will be utilized to successfully implement the postpartum hemorrhage bundle. The main way we will use technology is during simulation training. Simulation trainings using the Noelle mannequin offer life-like scenarios in the department where patient care occurs. Using simulation allows staff to work as they would in real life but does not put patient safety at risk. It also allows for debriefing afterward and identifies gaps in the workflow (Lutgendorf et al., 2017). We can also use technology to help us track postpartum hemorrhage data. We are developing a spreadsheet that tracks the number of patients who experienced hemorrhage and need for transfusion. This allows us to validate the effectiveness of our postpartum hemorrhage bundle.

Reference

Lutgendorf, M. A., Spalding, C., Drake, E., Spence, D., Heaton, J. O., & Morocco, K. V. 

(2017). Multidisciplinary in situ simulation-based training as a postpartum 

hemorrhage quality improvement project. Military Medicine, 182(3/4)

e1762–e1766. doi:10.7205/MILMED-D-16-00030

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by carrie

The evidence-based project (EBP) initiative that I am focusing on is developing and implementing a formal unit-based preceptor program. There are many aspects to consider when moving ahead with an evidence-based project (EBP) change, and one must ask how it will affect financial, quality, and clinical aspects.

Financial aspect: The financial aspect to consider for developing a formal unit-based preceptor program is the increased financial expenditures that organizations face with high nurse turnover rates. It costs organizations an estimated sixty-two to sixty-seven thousand dollars pre nurse leaving his or her job (Kovner et al., 2016). A unit-based preceptor program will directly impact the financial aspect because evidence shows that quality preceptorship increases nurse retention, thus decreasing the financial burden on the organization (Kovner et al., 2016).

Quality aspect: The quality aspect to consider for developing a formal unit-based preceptor program is the disruption to work patterns and inconsistency of care that is related to high nurse turnover rates. According to Kovner et al. (2016) increased turnover significantly affects the productivity, unit work patterns, and lowers job satisfaction which can result in decreased quality of patient care and outcomes. The unit-based preceptor program will directly affect the quality aspect of patient care in that when there is a decrease in turnover there will be an increased continuity of care and unit workflow patterns resulting in improved care and outcomes (T. Brock, personal communication, September 3, 2019).

Clinical aspect: The clinical element to consider for developing a formal unit-based preceptor program is how it enhances nursing skills for both the preceptor and the preceptee (T. Brock, personal communication, September 3, 2019). To precept students or new graduate nurses’ preceptors need to know the organization’s policies and nursing procedures which results in increased nursing and critical thinking skills (T. Brock, personal communication, September 3, 2019). A formal unit-based preceptor program will directly affect the clinical aspect in when precepting preceptees, questions often lead to a more in-depth review of literature to find answers and solutions.

Reference

Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J., Brewer, C., & Chacko, T. 

(2016). Estimating and preventing hospital internal turnover of newly licensed nurses: 

A panel survey. International Journal of Nursing Studies, 60, 251-262. 

doi:10.1016/j.ijnurstu.2016.05.003

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