NUR 699 Organizational Culture and Readiness Assessment

NUR 699 Organizational Culture and Readiness Assessment

Evidence-Based Practice Proposal

Health care practice requires progressive changes to maintain the required performance benchmarks at optimal levels. After using evidence to propose a practice change, the next step involves implementation, which is critical for successful change. The current proposal involves using Sentara’s Asthma Disease Management Program to improve asthma treatment. In such projects, the organization should be determined to support the practice change. This paper examines the organizational culture and readiness and provides a summary of research used to support the PICOT statement.

Section A: Organizational Culture and Readiness

Through anecdotal interviews, the organizational culture survey examines how leaders understand the EBP proposal’s rationale, perception of benefits, readiness to support, and a baseline evaluation of whether stakeholders understand the project’s vision. Regarding scores, heat maps produced through data analysis revealed that the organization’s administration supports the proposal to ensure that the community can better manage asthma. The administration’s perception was another high-scoring area since the executives were categorical that the proposal aligns with the overall organization’s health goals. However, departments partially understand their roles in making the project succeed.

From this analysis, possible project barriers include internal resistance considering that some departments are inadequately informed about their roles in the change process. Besides lack of resources and strategic problems, resistance to change is among the key barriers of change in health care organizations (Mathieson et al., 2019). Change facilitators include project sponsors to ensure that the community receives education and necessary materials as required. On survey category scores, high administration support shows an organization that believes in the progressive improvement of health practice through gradual change. Low performance in departmental awareness can be attributed to lack of information which can be addressed by engagement, communication, or in-service training. To improve outcomes, it is vital to integrate clinical inquiry into the organization. Clinical inquiry can be integrated by providing the necessary resources and a supportive environment that infuse health care staff with a spirit of inquiry. Doing so ensures that the staff can raise questions, challenge current practices and status quo, and develop innovative ways of solving problems.

Section B: PICOT Statement and Literature Review

PICOT Proposal

In adolescents with asthma, Sentara’s Asthma disease management plan can help to increase asthma control in ten weeks. The education program is change-driven and is among the most practical interventions required to increase compliance with asthma medications and encourage adolescents and their caregivers to adopt comprehensive behavior and lifestyle changes. However, the project can only achieve the desired outcomes if implemented and supported by adequately informed change agents. Accordingly, life coaches certified in asthma disease management will be the change agents due to their advanced knowledge about health and family and community resources. Thus the following PICOT statement will form the basis of the present project: In adolescents with Asthma (P), does Sentara’s Asthma Disease Management plan (I), compared to no education (C), increase the control of asthma (O) in 10 weeks (T)?

Literature Review

Literature supporting the need for change is extensive and examines various aspects of asthma and illness management at the community level. Stridsman et al. (2017) performed cross-sectional population-based studies that were a decade part. After comparing 3,327 adolescents in 2003 and 2,345 adolescents in 2013. Stridsman et al. (2017) found that asthma adversely affects adolescents’ daily life patterns, including school attendance and physical education and the severity of effects increases over time. Illness management was found to be challenged by some triggers, including air quality, fragrances in the immediate environment, and stress. In response, educating adolescents on how to overcome such situations can improve outcomes to a profound extent. On limitations, two questions asked in 2003 were omitted in 2013, implying that there was a gap in the analysis. Asthma triggers also change over time.

A scoping review of literature by Sullivan and Thakur (2020) examined how structural and social determinants of health impact illness management. Adolescents from minority racial/ethnic groups were found to be the most affected group due to poor housing conditions and psychosocial stressors. The main limitation of this research is the methods. It is not empirical to draw findings from real cases, implying that selection bias was inevitable. In another study, Cushing et al. (2019) conducted interviews in teens and adolescents with asthma to assess factors affecting inhaled corticosteroids (ICS) adherence and possible interventions. They found adolescents are a vulnerable population to suboptimal asthma self-management since their executive functioning capabilities are still developing. Accordingly, health education is crucial to ensure that adolescents are more aware of asthma attacks’ triggers and can avoid them as a precautionary measure. Despite the participants’ commitment, the study population (20 teens and 100 adolescents) is too low to generalize what happens in the entire population.

Nurmagambetov et al. (2017) relied on multiple data sources to examine the economic burden for costs involved in asthma treatment. Data sources such as Kaiser Family Foundation and U.S. Census Bureau were the primary reference point supporting the need for the urgency for strategies to strengthen efforts to prevent and control asthma attacks. The only limitation is the study depending on websites’ data to summarize outcomes. Dharmage et al. (2019) supported the need for policy interventions to enable adolescents and other affected populations to deal with problems that intensify asthmatic complications such as genetic susceptibility and environmental factors. Life coaching and asthma education can help people cope with asthma-related challenges. The main limitation of the research is being primarily a narrative review.

In conclusion, asthma is a serious illness that significantly affects children and adolescents. Accordingly, evidence-based solutions should be used to improve community response and coping mechanisms. The Sentara’s Asthma Disease Management plan can be an effective solution, but organizational support is necessary. The organizational culture survey shows readiness to support change. However, resistance to change can be a setback, and it is crucial to engage all departments to enhance understanding of the concept so that it can be supported to achieve the desired outcomes.

References

Cushing, C. C., Fedele, D. A., Patton, S. R., McQuaid, E. L., Smyth, J. M., Prabhakaran, S., … & Nezu, A. M. (2019). Responsive Asthma Care for Teens (ReACT): development protocol for an adaptive mobile health intervention for adolescents with asthma. BMJ Open, 9(8), e030029.

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of Asthma in Children and Adults. Frontiers in pediatrics, 7, 246. https://doi.org/10.3389/fped.2019.00246

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. https://doi.org/10.1017/S1463423618000488

Nurmagambetov, T., Khavjou, O., Murphy, L., & Orenstein, D. (2017). State-level medical and absenteeism cost of asthma in the United States. Journal of Asthma, 54(4), 357-370.

Stridsman, C., Dahlberg, E., Zandrén, K., & Hedman, L. (2017). Asthma in adolescence affects daily life and school attendance – Two cross-sectional population-based studies 10 years apart. Nursing Open, 4(3), 143–148. https://doi.org/10.1002/nop2.77

Sullivan, K., & Thakur, N. (2020). Structural and social determinants of health in asthma in developed economies: a scoping review of literature published between 2014 and 2019. Current Allergy and asthma reports, 20(2), 5. https://doi.org/10.1007/s11882-020-0899-6

Details:

Before making a case for an evidence-based project, it is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation.

1. Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,” located in the textbook appendix.
2. Develop an analysis of 250 words from the results, addressing your organization’s readiness level, possible project barriers and facilitators, as well as how to integrate clinical inquiry.
3. Make sure to include the rationale for the survey categories scores that were significantly high and low, incorporating details and/or examples. Also explain how to integrate clinical inquiry into the organization, providing strategies that strengthen the organizations weaker areas.
4. Submit a summary of your results. The actual survey results do not need to be included.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, revise “Section A: Organizational Culture and Readiness Assessment” for your final paper submission. This will be a continuous process throughout the course for each section.

Organizational Culture and Readiness Assessment-Section A

Organizational Culture Survey Tool

The selected organization culture survey tool for the assessment is “Organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice” (Brown, 2014). The survey tools will help in the investigation, evaluation and identification of the organization’s readiness to involve itself in the EPB. NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples

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Organization’s Readiness Level

Basing o the findings of the Organizational Culture and Readiness evaluation, the organization has the readiness to participate in evidence-based practice. The nurses have the commitment to drive the evidence-based practice. Additionally, the physicians also have the passion for supporting the nursing staff in the evidence-based practice.  The organization also has a research department linked with the regional and national research centers with nurses who are dedicated having several published journals about the research topic (Brown, 2014). Furthermore, the organization has libraries with the dedication on evidence-based practices and research with a well-established mentoring program. NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples.

The Barriers

The barrier to the evidence-based practice includes both the organizational and human factors. The first barrier is less time in reading the literature because of heavy workload. The second barrier of the practice is little staff experience as most of the staff had less experience to participate in the evidence-based practice (Brown, 2014).  There is also lack of resources to facilitate the procedure of the evidence-based practice.

The Facilitators

The facilitators of the evidence-based practice as identified will help in the adoption of new cultures that improve the treatment of stress urinary incontinence in women (Jankowski et al., 2014). Facilitators include increased information access as well as the application of role modeling. NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples.

Conclusion

Conclusively, for the achievement of better treatment of the treatment of stress urinary incontinence, the adoption of an EBP culture is significant; the organization has the readiness for EBP.

References

Brown, C.G. (2014). The Iowa model of evidence-based practice to promote quality care: An illustrated example in oncology nursing. Clinical Journal of Oncology Nursing, 18(2): 157-9.

Jankowski, R., Werner, S., Snyder, S., Chancellor, M., Kultgen, P., & Pruchnic, R. (2014). Cell    therapy for treatment of stress urinary incontinence in women: potential dose effect of             autologous muscle-derived cells for urinary sphincter repair (AMDC-  USR). Cytotherapy, 16(4), . NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples

When evaluating the culture of an organization, it is important to conduct a thorough evaluation and appraisal of the willingness for implementation by considering the evidence executed for that of evidence based practice (EBP). To successfully implement EBP and prevent failure there need to be essential fundamentals in place that will include a required set of time, having the necessary supplies and resources needed. When EBP is implemented the organizations’ culture needs to be identified and the motivation behind the implementation or change all while considering possible obstacles not matter when they might arise during any stage of the implementation process for an EBP (Houser, J., & Oman, K.S., 2011)

For Midland Memorial Hospital the result from the survey shows that they are ready for the change to the nurse intern program. The organization is ready for a change to help keep new nurse retention up. Most of the new nurses stay for the time needed to get experience then move on to other jobs in a more urban area. One barrier seen from this plan is, the increase of disgruntled experienced nurses who no longer due to the high turn around rate. Another barrier is having new trainers in place because they need to learn the new system themselves. However, they can also facilitate because they don’t know the old ways and are not stuck in how things were done. In the organization the culture is right for implementing a new nurse intern program. When implementing a new system staff and managers will be constantly engaged with the process. NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples.

References

Houser, J., & Oman, K.S., (2011). Evidence-Base Practice: An Implementation guide for Healthcare Organization. Retrieved from http://sgh.org.sa/Portals/0/Articles/Evidence-based%20Practice%20-%20An%20Implementation%20Guide%20for%20healthcare%20Organizations.pdf NUR 699 EBP Section A: Organizational Culture and Readiness Assessment Essay Examples.

Details:

Write a paper of 500-750 words (not including the title page and reference page) on your proposed problem description for your EBP project. The paper should address the following:

1. Describe the background of the problem. Tell the story of the issue and why it deserves attention.
2. Identify the stakeholders/change agents. Who, or what organizations, are concerned, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc.
3. Use the feedback from the Topic 2 main forum post and refine your PICOT question. Make sure that the question fits with your graduate degree specialization.
4. State the purpose and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus. Measurements need to be taken before and after the evidence-based practice is introduced to identify the expected changes.
5. 5) Provide supportive rationale that the problem or issue is an important one for nursing to resolve using relevant professional literature sources.
6. Develop an initial reference list to assure that there is adequate literature to support your evidence-based practice project. Follow the “Steps to an Efficient Search to Answer a Clinical Question” box in chapter 3 of the textbook. Use “NUR-699 Search Method Example” to assist you.
7. 7) The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ) and others may be used when you are gathering statistics to provide the rationale for the problem.
8. Once you get into the literature, you may find there is very little research to support your topic and you will have to start all over again. Remember, in order for this to be an evidence-based project, you must have enough evidence to introduce this as a practice change. If you find that you do not have enough supporting evidence to change a practice, then further research would need to be conducted.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section B: Problem Description” for your final submission. This will be a continuous process throughout the course for each section.

Review the “General Appraisal Overview for All Studies,” available in Appendix B in the textbook. You should save this tool and use it throughout the development of the PICOT question, problem description, and literature review.

Begin the development of your PICOT question, using the following resources:

1. “Appendix A: Template for Asking Clinical Questions,” available in the textbook appendix
2. Text readings

Formulate your PICOT question and post it to the main forum. Respond to at least four other statements, providing feedback. Review the statements to see if the clinical issue is clearly defined and that all aspects are identified. Also refer to the “PICOT: Components of an Answerable, Searchable Question” table, located in chapter 2 of the text. If one PICOT statement has at least three feedback posts, move to another statement.

You will be using the feedback to make revisions to your PICOT question before using it in your “Section B: Problem Description” assignment.What is the difference between research- and evidence-based practice projects?

Details:

To begin, work through the reference list that was created in the “Section B: Problem Description” assignment in Topic 2. Appraise each resource using the “Rapid Critical Appraisal Checklists,” available in the textbook appendix. The specific checklist you use will be determined by the type of evidence within the resource.

Develop a research table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the “Evaluation Table Template,” available in the textbook appendix. Use the “Evaluation Table Template” as an adaptable template.

Write a narrative of 750-1,000 words (not including the title page and references) that presents the research support for the projects problem and proposed solution. Make sure to do the following:

1. Include a description of the search method (e.g., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria).
2. Summarize all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations.
3. Incorporate a description of the validity of the internal and external research.

It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant, and from peer-reviewed professional journal articles.

Although you will not be submitting the checklist information or the evaluation table you design in Topic 3 with the narrative, the checklist information and evaluation table should be placed in the appendices for the final paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section C: Literature Support” for your final submission. This will be a continuous process throughout the course for each section.

Evidence-Based Practice Proposal – Section D: Solution Description

Details:

Write a paper of 500-750 words (not including the title page and reference page) paper for your proposed evidence-based practice project solution. Address the following criteria:

1. Proposed Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, too costly, or there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your PICOT before continuing.
2. Organization Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
3. Expected Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the PICOT.
4. Method to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations which may need to be addressed.
5. Outcome Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, and/or professional expertise.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section D: Solution Description” for your final submission. This will be a continuous process throughout the course for each section.

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Details:

In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan. Include the following:

1. Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students
   

   

   may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models presented such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based intervention in clinical practice.

2. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
3. In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 5 with the narrative, the conceptual model should be placed in the appendices for the final paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section E: Change Model” for your final submission. This will be a continuous process throughout the course for each section.

Evidence-Based Practice Proposal – Section F: Implementation Plan

Details:

In 500-750 words (not including the title page and reference page), provide a description of the methods to be used to implement the proposed solution. Include the following:

1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval form(s) in Topic 5 with the narrative, the consent or approval form(s) should be placed in the appendices for the final paper.
2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, the timeline should be placed in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, the resource list should be placed in the appendices for the final paper.
4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, the instruments should be placed in the appendices for the final paper.
5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, the data collection tools should be placed in the appendices for the final paper.
7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, the budget plan should be placed in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Evidence-Based Practice Proposal: Section G: Evaluation of Process

Details:

In 500-750 words (not including the title page and reference page), develop an evaluation plan to be included in your final evidence-based practice project. Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

1. Describe the rationale for the methods used in collecting the outcome data.
2. Describe the ways in which the outcome measures evaluate the extent to which the project objectives are achieved.
3. Describe how the outcomes will be measured and evaluated based on the evidence. Address validity, reliability, and applicability.
4. Describe strategies to take if outcomes do not provide positive results.
5. Describe implications for practice and future research.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedbac

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