The Application Of Kotter 's Eight Step Change Model

The interviewee claimed that, the quality improvement and star rating is a driving force in the care delivered. The nurses are much more motivated when they know they are recognized and valued for their effort. Teamwork and collaboration between all interdisciplinary teams and management improves the way the care is delivered. Through training and innovation with new technology,

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

quality of patient care, and can be implemented in practice, to provide solutions to nursing

Quality improvement is referred to as “the use of data to monitor the outcomes for care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care” (Sherwood & Barnsteiner, 2012). Data is used as the reflection of quality care that is provided by nurses and presents whether or not improvement is needed. In order for nurses to be mindful of the care that they give, they must be taught a systematic process of defining problems, identifying possible causes of those problems, and methods for trying out new solutions to prevent those problems (Sherwood & Barnsteiner, 2012). Currently, quality improvement measures are being utilized throughout hospitals to reduce the risk of patient falls and fall injuries.

Before any quality improvement plan (QIP) can be developed, the overall aim of the project must be determined to ensure the QIP stays on track. This includes deciding what is going to be measured, what the current baseline is, what the target will be and a timeline for accomplishing the goal (Health Quality Ontario, n.d.). Thus, the aim for this QIP is to reduce the rate of worsened pain in the VC from the current value of 20.2% of residents with worsened pain by 1% by the next quarter by educating nurses on the correct way to assess and document pain in the electronic system.

The Quality and Safety Education for Nurses (QSEN) Institute developed six core competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Quality and Safety Education for Nurses Institute, 2017). At my facility, it is clearly evident that they have adopted these six core competencies to improve patient quality and safety. My facility created the Office of Patient Experience which supports care that is safe, of high quality and high value. Patient satisfaction is a top priority which is why our guiding principle is known as “Patients First”. Through teamwork and collaboration, we deliver care that is patient-centered by working together in multidisciplinary rounds on the inpatient units. Also, the nursing education department supports quality, safety and consistent nursing care through a database of policies and procedures developed using evidence-based research. Lastly, the nursing informatics department is working towards making our EPIC system more patient-centered. They are doing this by decreasing the redundancy in charting for the nursing staff and finding ways to improve processes which automate tasks. This in turn will reduce the time that the nursing staff spends with their computer and increase the time that the nursing staff can spend with their patients.

A quality improvement strategy is defined as “any intervention aimed at reducing the quality gap for a group of patients of those encountered in routine practice” (Shojania, McDonald, Wachter & Owens, 2004, p, 13). Therefore, the strategy for this QIP needs to be targeted at ensuring pain is accurately assessed, managed and documented in the VC. Additionally, because all nurses need to be assessing and managing pain according to organizational and professional standards, nursing education is the strategy that will be most effective in addressing this issue.

Some patient’s were either on other pain medications or psychotropic medications and the nurse was unclear as to treat with medical therapy or non-medical therapy. This lack of knowledge can play in delay of treatment. Suggestions to overcome this were recommended for a pain management program. The change led to more patient routine pain scales being conducted but strategies were limited to show effectiveness since mostly non-pharmacologic measures were used. As a future advanced nurse practitioner, I believe that this article is useful to me and my career because it will remind me to use formulated pain scales and cues for pain based on the cognitive ability of the dementia of the patient. Despite the pain measures that the patient is already on, the patient should be treated appropriately for the pain that they are having. For instance, if their pain measures a 7 on the scale and they are receiving pain management scheduled and they are not due for a scheduled narcotic for another six hours then that patient should receive a PRN medication rather than a non-pharmacological

This reflective account is going to discuss quality systems in nursing practice in relation to service development and improvement. Quality systems in healthcare are the systems that are put in place by the management to monitor, assess and improve the quality of care provided (Wagner, 2001). Examples of such kind of activities are the implementation of guidelines, continuing education, internal audits, patient feedback questionnaires, nursing dashboards and the use of care plans to assess patients' needs. In this reflective account, I am going to use Driscoll's (2007) reflective model reflect on incidences that I have observed in practice. To protect the identity of the patients and the department I worked on I am going to adhere to Nursing

However, a better understanding of the factors that affect such knowledge and attitudes and of the discrepancy between attitudes and practice can provide useful information to be included in education programs for nurses and to inform policy on the provision of pain management. On the other hands (Rushton, Eggett, and Sutherland, 2003) stated that nurses do not use evidence-based practice in pain management consistently. Until recently there was no standard of care by which to judge the adequacy of pain management. Study findings support the premise that many nurses have inadequate knowledge about pain theory, assessment, and management strategies, especially pharmacological and non-pharmacological strategies. Importantly, study findings suggested that nurses do not objectively assess pain or individualize care plans for patients with pain complaints. In particular, nurses expect patients to tolerate pain, do not differentiate well between acute and chronic pain, consistently overestimate the incidence of narcotic addiction and malingering (i.e., false pain complaint), and tend to rate patients ' pain and related needs lower than patients themselves. Pain assessment is the first step in effective pain management and is an independent nursing function. It has been estimated that a significant number of problems with pain management relate to inadequate assessment (Clark et al., 1996). The research evidence suggests that nurses ' attitudes and beliefs constitute significant

This study was little different from the previous studies as it was carried out by the student nurses. The students performed a research in collaboration with the faculty and unit to describe the root cause and provide recommendation on improving clinical documentation practices within the health care setting. This included describing the pain reassessment process or plan of care compliance. Six pilot units were selected within the healthcare system with a team or 4-5 students for each unit with a lead faculty for each team. Each faculty was responsible for the work of 3 student teams. 2 teams focused on the pain reassessment and one team on the plan of care documentation. Each student used about 8 hours of clinical hours for this project. The RCA teams met weekly to summarize the current status and develop data tools and recommendations on this project. The project process was completed in 3 phases: background overview, data collection and synthesis and project evaluation including recommendations. The total time to complete the project was approximately 7

The new healthcare system is based on the quality service rendered that will eventually decrease the costs (James, 2012, p. 1). This system will give a reward or a bonus to the health care providers whenever they meet or exceed quality standard that are being set (James, 2012, p. 1). In contrary, the system can also penalize those providers that are unsuccessful in providing the indicated goals or cost savings (James, 2012, p. 1-2). With the healthcare systems demand on quality care, institutions participate in various quality improvement activities (Draper, Felland, Liebhaber, & Melichar, 2008, p. 1). Because nurses are the frontline in patient care, they can affect the outcome of the treatment given. And therefore, their involvement in quality improvement are essential (Draper et al., 2008, p. 1).

By focusing on overall patient care and satisfaction many areas patients are surveyed on can be improved. Once a performance standard is selected staff must develop a plan for improvement. The first step would be to research as many sources as possible to find the best evidence based practices that would work for the specific facility. This can be divided into two the two categories of direct nursing care and indirect nursing care. Direct nursing care would include implementing hourly rounding, adequate nursing staff and SBAR communication. Indirect nursing care includes availability of technology such as wireless communication, real time locating, wireless monitoring, and electronic medical records. The second step would contain education of the staff on what is to be implemented and why. The why is important for nurses to overcome any barriers that might be encountered. While nursing practice has grown based on evidence Vanhook (2009) explains the greatest barriers to evidence based practice, such as difficulty interpreting findings, limited time, and misunderstanding of research itself, and how to overcome these barriers. With phase one and two completed facilities can move forward with implementation and evaluation.

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 QI goals are four fold for this task. The first goal is to conduct an internal study of the hospitals on the same lines as the study conducted by Dupertuis. Nurses will be expected to serve patients