NUR-590 Topic 4: Theoretical Frameworks and Models for Change
Models of change are important in the implementation of new initiatives in healthcare settings. The models provide insights into the strategies that should be utilized in the implementation of change. They also provide information about the outcome data that will be used for evaluation purposes. Therefore, this section of the project examines the model of change that will be utilized in the implementation of the change.
Selected Model and Relevance
The trans-theoretical model of behavioral change will be utilized in the project. DiClemente and Prochaska developed the trans-theoretical model in the 1970s following their examination of the ways in which smokers quit smoking and the factors that influenced the process. The model examines the decision-making by individuals to embrace change and behaviors that are needed to influence the process. The trans-theoretical model recognizes the fact that behavioral change is a cyclical process. Individuals embrace change through a series of steps that will determine the sustainability of change. The trans-theoretical model is applicable to the proposed project because it provides insights into the determinants of change. It also enables the determination of success of the strategies implemented at each stage of the project (Cavaiola & Smith, 2020). Lastly, it provides step-wise approach to implementing and determining the level of adoption of change in an organization.
Stages of the Model and Application to the Proposed Implementation
Change in the trans-theoretical model occurs in steps. The steps include precontemplation, contemplation, preparation, action, maintenance, and termination. Each of the steps of the trans-theoretical model is applicable to the proposed change initiative. The first step in the trans-theoretical model is pre-contemplation. Pre-contemplation is the phase where the people have no plans of taking action to improve their situation. Their lack of awareness about the negative effect of their behaviors makes it hard for them to determine a need for change in their daily routines. This stage is applicable to the proposed initiative. Nurses are not aware of the need for the adoption of evidence-based strategies to reduce the rate of catheter-associated urinary tract infection (Gellman & Turner, 2019). As a result, the do not have any intentions to take action in any near future.
The second stage in the trans-theoretical model is contemplation. This is the phase where people become aware of the negative effect of their current behaviors. As a result, they are willing to take action in the near future. The adopters also explore the benefits as well as risks of changing their behaviors. There is however a high degree of ambivalence among them. The applicability of this step to the proposed initiative is that nurses will be aware about the need for evidence-based interventions to prevent and reduce the rate of catheter-associated urinary tract infections (Hagger et al., 2020). Nurses begin to explore the benefits of interventions such as meatus cleaning with 0.1% Chlorhexedine when compared to their usual practice of using normal saline. Nurses place emphasis on both the benefits as well as risks of behavior change.
The third stage of the model is preparation. This is the phase where the adopters of change are ready and willing to take actions related to the change within a short period. The adopters implement small steps that would contribute to the desired behavioral change. They believe that the change will have benefits to them and their daily routines (Gellman & Turner, 2019). Nurses are ready to adopt the proposed initiative in this step. They start implementing the initiative in small scale to determine its effect on patient outcomes. Nurses believe that the implementation of the initiative would result in positive outcomes in care.
The fourth step in the model is action. This step is characterized by the recent change in behavior of the adopters. The adopters intend to continue implementing the change initiative. They modify their practices and behaviors to support the change. Nurses in this stage have considered the use of the initiative in their daily routines. They have realized the benefits of the intervention in reducing the risk and rate of catheter-associated urinary tract infections (Anisman, 2021). As a result, they are willing to explore additional ways in which the success of the change initiative can be achieved.
Maintenance is the fifth stage in the trans-theoretical model. The adopters of the change have sustained their behaviors that support the change. They work towards adopting behaviors that will prevent relapse. The nurses in this step have sustained the use of the initiative in patient care. They explore ways in which they can prevent the use of normal saline prior to insertion of urinary catheter. Termination is the last phase where the adopters do not have any intention to relapse to their traditional behaviors. The change has been incorporated into the organizational culture (Cavaiola & Smith, 2020). In this case, the use of the proposed initiative has been incorporated into the organizational culture, hence, the strengthening of excellence in patient care.
Differentiate between the following models for applying evidence-based practice: Stetler model, Iowa model, model for evidence-based practice for individual practitioners, and ARCC model.
Describe the obstacles or barriers to implementing evidence-based practice.
Explain why patient values and clinical judgment must be considered before applying the evidence in clinical decision making for an individual patient.