Development Of A Service Innovation

Evidence-Based Practice Proposal Final Paper Usha Kizhakkedan Grand Canyon Final Paper of Evidence Based Proposal NUR-699 Dr. Debbie Long June 1, 2016 Table of Contents Part 1: Organizational Culture and Readiness Assessment 4 • Introduction to Evidence-Based Practice 4 • Barriers to Evidence-Based Practice 4 • Facilitators of Evidence-Based Practice 5 • Integration of Clinical Enquiry 5 • The Survey 6 Part 2: Problem Description 7 • Description 7 • Identification of change agents in the Health care system 8 • PICOT question 8 • Purpose and Objectives 9 • Rationale 10 • Literature support 10 • Research Method 10 Part 3: Literature Support 11 • Research Questions 11 • Search Method 12 • Organization of Literature 12 • Framework 12 • Nursing Rounds- Patient and Family Satisfaction: 13 • Communication: 15 • Management of Pain, Use of Call Lights and Cases of Patient falls 15 • Data Collection 16 Part 4: Solution Description 16 • Objectives 17 • Change Methodology 17 • Implementation Plan 18 • Evaluation 19 Part 5: Change Model 19 • Change Model 20 • Implementing Change 21 • Rationale 22 Part 6: Implementation Plan 22 • Staff Education 23 • Client feedback 23 • Timeframe 23 • Hiring Process 24 • Implementation 24 • Data collection and Evaluation 24 • Progression 24 • Resource Management 24 • Budget Plan 25 • Outcomes and its impact 25 • Summary 26 Part 7: Evaluation of Process 26 • Objectives 26 • Methodology 27 • Procedure 27 • Collection and Analysis of data

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

“The control of pain is the key to all other care”(Raiman 1998). This is especially true within old age psychiatry as if a client is in pain it may be impossible to recognise a pure diagnosis of agitation or depression and intervene accordingly when there is the possibility that these symptoms may be reactive due to inadequate pain relief. The key to therapeutic success is how well are the symptoms being relieved. Untreated pain in the client with dementia can delay healing, disturb sleep and daily activity, reduce quality of life and prolong hospitalisation (Horgas 2003).

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

Dealing with aging dementia patients can be a challenge in and of itself. However, when healthcare providers need to include regulating pain as well, the challenge becomes even greater. Pain management with cognitively impaired patients is a constant problem within geriatric care in modern healthcare facilities (Zwakhalen et al 2006). The reduced self capacity to report pain in its true degrees then makes pain management a challenge for physicians and healthcare providers (Husebo et al. 2007). Thus, research aims to explore effective measures for observing and reporting pain management within aging dementia patients.

Throughout our nursing careers we have come into a situation where we needed to advocate for our patient or co-worker. It takes leadership skills, respect, and accountability to advocate in our workplace. Moreover, in order to create change one must first evaluate the issue then set goals to implement the plan. The purpose of this paper is to discuss my weaknesses and strengths to nursing, use of current leadership skills to advocate change in the workplace, and reflection on personal goal for leadership growth and development of implementation plan to reach goal.

Service improvement is arguably one of the most important challenges facing the National Health Service (NHS) today, as both patients and service users search for a ‘good quality’ service, and expect services to be both efficient and effectual. All staff within the health service need to be educated and competent in their roles, in order to be able to offer a service that is beneficial to the patients that make use of it.

There is a growing geriatric population of people with dementia (the subpopulation) throughout the world that are living in pain constantly. Because dementia as a condition with multifaceted symptomology manifested by advancing overall decline of cognitive ability, it causes severe and distinctive barriers to pain assessment and pain management in this subpopulation. The existence of multiple comorbidities, polypharmacy and the declining cognition in this subpopulation results in a much more complex pain symptomology. Zwakhalen, Hamers, Abu-Saad, and (replaced & with and) Berger, (2006), explain that common behaviors associated with pain may be absent or difficult to interpret in this subpopulation because some dementia symptoms may be an indication of pain, but such behavior, however, might also be incorrectly interpreted as a symptom of dementia. Therefore, pain in this subpopulation is exceptionally challenging to evaluate and manage as a result of this difficulty.

Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.” (Jarvis, 2016) In our society today, the older adults and older adults who suffer from dementia are poorly assessed in terms of pain assessment. Studies have shown that about 35-48% of older adults living at home suffer from chronic pain, another 45-85% of older adults living nursing homes lives with chronic. Older adults suffer from chronic pain as most suffer from conditions that can lead to chronic pain. The health care professional with the proper pain assessment skills can better manage and treat pain in the older adult. The assessment

The education strategy developed for this QIP is aimed at ensuring nurses are accurately assessing and documenting pain. The nurses are not being required to learn a brand new skill; rather this strategy is aimed at changing how nurses are completing this task in their practice. Planned change must be a “well thought out and deliberate effort to make something happen” (Marquis & Huston, 2012, p. 163). Therefore, the application of Kotter’s eight-step change model (1995) will help to implement this change.

Ongoing development and changes in healthcare delivery enable nurses to maintain standards of nursing and develop their competence and performance. Through this the patients well-being is maintained, respecting them through accessing up to date knowledge and skills that are essential in an ever changing environment.

The main focus of the theory is motivation, inspiration and empowerment to create changes. It is based on the idea of empowering others to facilitate overall goal. Bennis and Nanus (1985) describe this new leader as a leader who “commits people to action, who converts leaders into leaders, and who converts leaders into agents of change” (p.3).177. According to processes to engage and motivate staff article “Transformational leadership is important for high quality care delivery, and behaviors that nurse leaders inspire, role model and reinforce are instrumental in creating work practice that deliver optimum care”.

UBS Group is a worldwide financial advice and solutions provider. One of the main reasons why UBS Group is standing in the leading position in the global financial market is that it embraces the concept of service design and as a result improves its organization’s performance.

Being developed for centuries, Hotel Industry has been in its maturity period for a long time. Confronted with fierce competition and the current global economic crisis, it becomes a hot topic in Hotel Industry how to maintain and raise revenues. By shifting focus from „Goods-Dominant Logic‟ to „Service-Dominant Logic‟, Service Science presents a new perspective on value creation and service experience. In