Evidence-Based Intervention: Change Model Application in Practice

This report discusses the application of change models and evidence-based interventions in clinical practice, focusing on Rogers' diffusion of innovation theory and various models like Stetler, ARCC, and Iowa. It emphasizes evidence-based practices (EBP) and their integration into clinical settings to improve patient care and reduce healthcare costs. The report also explores the Duck's Change Curve model for resisting infectious diseases like Carbapenem-resistant Enterobacteriaceae (CRE), detailing the five stages of denial, preparation, implementation, and outcome assessment for effective intervention and behavioral change in high-risk environments. The ultimate goal is to enhance clinical expertise, improve patient outcomes, and promote social change through statistical evidence-based clinical practice.

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Running head: CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN
CLINICAL PRACTICE
CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
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1CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
Table of Contents
Introduction......................................................................................................................................2
Evidence-Based Intervention in Clinical Practice...........................................................................2
Duck’s Change Curve Model:.....................................................................................................3
References........................................................................................................................................6

2CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
Introduction
The notion of diffusion in the process of innovation is theorized by E.M.Rogers where
the usage of communication is made as a medium that helps in providing explanation regarding
the process of, how any idea gains momentum as well as spreads over the societal system
(Baldwin et al., 2016). The people within the system prefers to adopt the new concepts and hence
changes occurs in the approach of doing things (White & Spruce, 2015). The paper delves into
the different steps those are incorporated by the change model of Rogers' diffusion of innovation
theory in order to provide an effective framework based on which it is able to bring change upon
the clinical practice.
Evidence-Based Intervention in Clinical Practice
Any evidence based practices cynically focuses upon the appropriate and rapid
application of current research as well as best practices upon the field of clinical practices. The
evidence based practices (EBP) bring together these aspects and cultivates a culture of care and
nursing practices based upon the evidence accumulated through the implementation of practice
question, evidence and translation (Butcher, 2016). On this respect the Stetler model regarding
research utilization helps to assess the findings from the research and related evidence that have
relevance with the applied practices of clinical science. The three forms of the research with the
instrument of concrete, direct and applicability of knowledge. The ARCC model is the advancing
of the research and clinical practice through the close collaboration where integration is
encouraged along with cognitive behavioral theories. It builds a cadre of the EBP mentors in
order to advance the evidence based practice in the system. On the other hand, Iowa model of
evidence based practices deals with controlling the healthcare costs as well as improving the
quality of the patient care. Thus the evidence based research practices are inclusive of the five

3CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
steps which are ask, acquire, apply, appraise and assess respectively. This integrates the best
possible evidences from the research with the objective of enhancing the clinical expertise and
values rendered to the patients in terms of services. This if be applied through the evidence based
practices by the practitioners then it will lead to improved patient outcome.
Duck’s Change Curve Model:
The infectious diseases of Carbapenem-resistant Enterobacteriaceae (CRE) can be
effectively resisted by the implementation of change models of behavioral change. The trans-
theoretical model or Duck's change curve model provides a constructive framework of evidence
based approach were the treatment of CRE can get resisted with the incorporation of step by step
control program of the Duck's change curve model (White & Spruce, 2015). It is imperative to
understand that CRE is airborne rather the problem with the disease is that the germs have strong
capability to provide resistance against antibiotics. Even it is been seen that the germs render so
much resistance that the antibiotics breaks before they can even work upon the patients as
medicine. The Duck's change curve model have five stages for effective intervention in order to
control the CRE and facilitating behavioral change in the high-risk environments. The stages can
be incorporated as follows:
Stage 1
The initial stage of the change carve is the denial stage or the stage of shock and
stagnation. In this stage the CRE intervention is incorporated within the target population
through it not have been accepted by the population due to their ignorance about the intervention
as well as fear of the unknown. The lack of proper information or asymmetric information
regarding the intervention is the major reason for which this stage is the stagnation stage
(Butcher, 2016). The population remains unaware about the effectiveness of this intervention. It

4CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
is also considered to be the take off stage since the population comes across the intervention and
interact with its flaws and fortes based on their perception. The end of the stage happens when
significant actions are taken for enlightening the populace regarding the barriers that they face in
fully accepting the CRE intervention and comes out of their hesitation followed by accepting the
intervention completely (Jameson & Walsh, 2017).
Stage 2
The second stage of the Duck's change curve model is the preparation stage where
intervention of evidence takes place for assessing and controlling the CRE. It is critical to
provide education regarding the usage and acceptance of CRE intervention. However, the
emotional climate of the populace is taken under consideration as it is marked by the aspect of
hopefulness and anxiety. The population in this stage asks about what they can do and hence
buy-in from the individuals are critical at this stage. The limitation of stage one can be overcome
in this stage by taking the preparation stage as a platform for opportunity. As for example the
existing opportunity lies in improvising the facilitation of awareness generation to the target
population and convincing them regarding the effectiveness of CRE intervention followed by
making them existed about it.
Stage 3
The third stage of the Duck's change curve model is the implementation stage where the
readiness of the populace in accepting the CRE intervention is being assessed. The community
members as well as the patients within the affected population commence to accept the CRE
intervention and hence the individuals must look at what is there for them within the evidence
based intervention process that will encourage them towards the change (Davison, Ndumbe-
Eyoh & Clement, 2015).

5CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
Stage 4 & 5
The pen-ultimate and the ultimate stage of the change model is a deterministic approach
regarding the yields of the intervention where significant results are found to be outcome of the
process after implementation. The population will provide their willing obedience towards
accepting the evidence based clinical practice of CRE intervention in order to mitigate their
problems (Melnyk, 2017). The creation of small success is the opportunity acquired through the
Duck's change curve model and bringing together the step by step implementation of the entire
process it is been found that how change models can pioneer towards a greater development and
social change coupled with statistical evidence based clinical practice, in the long run.

6CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
References
Baldwin, C. M., Schultz, A. A., Barrere, C., Dossey, B. M., & Keegan, L. (2016). Evidence-
based practice. Holistic nursing: A handbook for practice, 637-659.
https://www.researchgate.net/profile/Carol_Baldwin/publication/281640599_Evidence-
Based_Practice/links/5b7b4d15299bf1d5a718d671/Evidence-Based-Practice.pdf
Butcher, H. K. (2016). Development and Use of Gerontological Evidence-Based Practice
Guidelines. Journal of gerontological nursing, 42(7), 25-32.
https://www.healio.com/nursing/journals/jgn/2016-7-42-7/%7Be1b08229-d2c3-4381-
978c-739f87010890%7D/development-and-use-of-gerontological-evidence-based-
practice-guidelines
Davison, C. M., Ndumbe-Eyoh, S., & Clement, C. (2015). Critical examination of knowledge to
action models and implications for promoting health equity. International journal for
equity in health, 14(1), 49.
https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-015-0178-7
Jameson, J., & Walsh, M. E. (2017). Tools for evidence-based vascular nursing practice:
Achieving information literacy for lifelong learning. Journal of Vascular Nursing, 35(4),
201-210. https://www.sciencedirect.com/science/article/pii/S1062030317301115
Melnyk, B. M. (2017). Models to Guide the Implementation and Sustainability of Evidence‐
Based Practice: A Call to Action for Further Use and Research. Worldviews on Evidence‐
Based Nursing, 14(4), 255-256.
https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/wvn.12246

7CHANGE MODEL & EVIDENCE-BASED INTERVENTION IN CLINICAL PRACTICE
White, S., & Spruce, L. (2015). Perioperative Nursing Leaders Implement Clinical Practice
Guidelines Using the Iowa Model of Evidence‐Based Practice. AORN journal, 102(1),
50-59. https://onlinelibrary.wiley.com/doi/pdf/10.1016/j.aorn.2015.04.001