Medical-Surgical Nursing: EBP Change Process Assignment - Week 6

This assignment presents a student's application of the ACE Star Model of Knowledge Transformation to address the issue of Health-Associated Infections (HAIs) in a medical-surgical nursing context. The assignment follows the framework of the ACE Star Model, starting with identifying the practice issue and the rationale behind it, which involves a rise in HAIs due to non-adherence to policies or procedural errors. The student formulates a PICOT question to guide the intervention, focusing on infection control programs. The assignment includes the selection of a systematic review from the Cochrane Database and other scholarly sources to support the evidence-based solutions, such as staff education and antimicrobial catheters. It outlines an action plan with stakeholders' roles and responsibilities, the nursing role in the change process, and the cost analysis required. The implementation plan involves gaining permission, educating staff, and establishing a timeline. The assignment also details measurable outcomes, data collection methods, and the use of pilot implementations. Finally, it describes the evaluation process, reporting outcomes, and the potential next steps for using the change process information. This assignment is a comprehensive analysis of the EBP change process in healthcare.

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Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.
Name: _____________________
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing
practice issue.)
According to the case study, the main character in the case is a nurse named Daniel. Daniel is a RN who
has been working for 12 years and he is working under the Medical-surgical department. According to
Daniel there is a nurse practice issue that is causing Health-associated issue (HAI) which has significantly
risen around 35% in few years. There is an unsure suspicion behind the Health-associated issue which is
non-adherence to policies, or procedural errors.
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Health-associated issues are the type of infections which a patient receives while getting a treatment for
medical or surgical conditions. HAI’s can occur at anyplace in healthcare facility, clinics, hospitals, and
surgical units. Health-associated issue is caused by the bacteria, pathogens, fungus, viruses. HAIs are a
main reason of disease and mortality, and they can cause disturbing sensitive, economic, and medicinal
concerns. However, HAI’s are preventable by applying proper measures. According to Daniel there can
be procedural errors which can be a reason. While treating a patient the improper use of catheters, and
injections, unhygienic surgical room, overuse or improper use of antibiotics. Also HAI’s can rise if the
medical unit staffs don’t follow policies properly, neglecting ethical guidelines, breaking the rules and
regulations (Haque et al., 2018).
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
P – Health-associated Issue
I – Infection control programs
C – Nursing responsibilities towards controlling the blood borne pathogen exposure.
O – The targeted outcome will be a decrease in infection rate, decreasing the HAI percentage.
T – Timeframe would be around six months.
The practice problem that can arise through the PICOT will be – How infection control programs help in
decreasing the Health-associated Issue and how will the specified intervention be effective comparative to
prevention of blood borne pathogen in six months duration?
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List the systematic review chosen from the Cochrane Database of Systematic Reviews from the
Chamberlain library. Type the complete APA reference for the systematic review selected.
Planning health promotion programs: an intervention mapping approach (Eldredge et al., 2016).
List and briefly describe other sources used for data and information. List any other optional
scholarly source used as a supplement to the systematic review in APA format.
Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health
problems: systematic review and meta-analysis (Koslowski et al., 2016)
Briefly summarize the main findings (in your own words) from the systematic review and the
strength of the evidence.
There is a lack of available evidence in relation to the effectiveness of interventions for adults with mild
to moderate intellectual disability and mental health problems.
Outline one or two evidence-based solutions you will consider for the trial project.
1. Staff education and compliance.
2. Antimicrobial catheters
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that may be in place to support your
intervention planning (These may come from your organization or from the other sources listed in
your Summary section in Star Point 2).
1. Patients who are having Neutropenia, Diarrhea, Skin rashes, communicable disease, carriers of
epidemic strain of bacteria and other types of infected diseases, they need to be shifted to protective or
source isolation. The isolation rooms should consist of tight doors, glass windows for observations,
negative and positive pressure ventilations.
2. The medical staff members who will be providing treatment or proceed to surgical unit should keep
their hands clean as hands are most common source for the spread of harmful microorganisms.
3. Standard precautions consist of basic preventive measures which should be followed all times,
regardless of patient’s infection status.
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List your stakeholders (by title and not names; include yourself) and describe their roles and
responsibilities in the change process (no more than 5).
To coordinate the HAI prevention efforts there are stakeholders comprising of registered nurse, clinicians,
scientists, and public health leaders belonging to the Agency for Healthcare Research and Quality,
Centers for Disease Control and Prevention, Department of Health & Human Services. The role and
responsibilities of the stakeholders is to follow the systematically accepted principles and exercise for the
deterrence and regulation of infection. They are also accountable to evaluate those for whom the
stakeholder is accountable (National CGCU, 2012).
What specifically is your nursing role in the change process? Other nursing roles?
A role of nurse is to implement the effective measures to prevent the HAI. It is a duty of the nurse to
follow the nursing guidelines efficiently and apply the practices effectively.
List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members
chosen (stakeholders) important to your project?
In the HIA prevention program, there will be several stakeholders like clinical nurse, pharmacist, senior
nurse managers, and many other members. The clinical nurse will be responsible to see whether other
registered nurses are working accordingly by following the guidelines or not. Their role will be to manage
the patient problems and administer medications. The role of the pharmacist will be to ascertain that the
medicines which are being delivered are at top notch conditions. None of the medicines are damaged or
no medicines are being delivered prior to the expiry period and they also have duty to keep in check that
correct medicines are being delivered to the assigned patient.
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
Cost analysis of the healthcare mediation under contrast in an experiment is required for all three types of
analysis which are cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. This cost
assessment can be done in the perspective of the trial, provided that responsibility is taken of the fact that
the costs related with mediation in the trial may be diverse from those which would relate if the mediation
was involved in a public health program.
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a trial. Is there a specific group,
committee, or nurse leaders involved?
A detailed plan is reviewed and approved by a group of people which includes doctors, health care
professionals, and non-medical members of the public. They look for certain things after which approve
the trial – The objective and importance of the trial, design of the trial, the patients research team would
like to include, how they would examine the outcomes, whether the research team knows about the
possible issues or not. Only after evaluating all these they give permission to initiate the trial
(cancerresearchuk.org, 2019) (Kueny et al., 2015).
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Describe the plan for educating the staff about the change process trial and how they will be
impacted or asked to participate.
The nursing staff members should be educated about the Plan-do-check-act procedure which will help
them in understanding the trial process effectively. In the Plan-do-check-act procedure the nursing staff
have to recognize and opportunity and plan a change if needed, test the change process and do a small
scale study, reviewing the test to analyze the results and re-evaluate their learning outcomes, and finally
they should implement strategies based on their learning outcomes (Wang et al., 2019).
Outline the implementation timeline for the change process (start time/end time, what steps are to
occur along the timeline).
The change process trial will continue for six months in which the teams members will be have a learning
session about the trial procedures. Infection rates will be monitored as part of the data collection. The RN
and the unit manager will go through a cost analysis of the trial resources which will be used, including
the costs incurred when patients develop central line infections, as a way to demonstrate how infection
prevention will actually result in cost savings.
List the measurable outcomes based on the PICOT. How will these be measured?
The measurable outcomes will be the reduction in the HAI rate, and reduction in the infection incidence
rate in the hospitals. An explanation if the problem identified, the scope of the problem, and an evidence
summary will be detailed.
What forms, if any, might be used for recording purposes during the pilot change process.
Describe.
Pilot implementations are a widely used approach for identifying design flaws and implementation issues
before full-scale deployment of new health information system.
What resources are available to staff (include yourself) during the change pilot?
In the change pilot process nurse leadership qualities, nurse and staff timings are critical, and external
funding is also helpful.
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they
meet?
Throughout the trial there will be participations in between the stakeholders which will help in the
provision of important data to inform the research intervention. Stakeholders will be actively involved in
designing the research intervention and impact significantly on study outcomes.
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Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
Comparative measurable data results will be saved over the six month duration with the hope that the
various interventions and learning sessions will result in a reduction in central line infections on the unit.
The results can be imposed on a bar chart throughout the timeline to demonstrate the results.
What would be the next steps for the use of the change process information?
If the results are positive, that if there is any decrease in the HAI rate, then the decision which should be
taken by the hospital leader will be to consider using a permanent warning system throughout the facility
and then later on allocating the required resources to accomplish the positive result.
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REFERENCES
Collins, A. (2019). Preventing Health Care–Associated Infections. Retrieved 17 August 2019,
from https://www.ncbi.nlm.nih.gov/books/NBK2683/
Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S.
(2016). Planning health promotion programs: an intervention mapping approach. John Wiley &
Sons.
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–
an overview. Infection and drug resistance, 11, 2321.
How clinical trials are approved. (2019). Retrieved 17 August 2019, from
https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/how-clinical-trials-are-
planned-and-organised/how-clinical-trials-are-approved
Koslowski, N., Klein, K., Arnold, K., Koesters, M., Schuetzwohl, M., Salize, H. J., & Puschner,
B. (2016). Effectiveness of interventions for adults with mild to moderate intellectual disabilities
and mental health problems: systematic review and meta-analysis. The British Journal of
Psychiatry, 209(6), 469-474.
Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation
of evidence-based practice through contextual support and nursing leadership. Journal of
healthcare leadership, 7, 29.
National, C. G. C. U. (2012). Infection: Prevention and Control of Healthcare-Associated
Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2.
Wang, Q., Ma, J., Yan, M., Yan, Y., Wang, Y., & Bian, D. (2019). The Effect of PDCA Cycle
Management Method on the Promotion of Nursing Quality Management in the Operating
Room. American Journal of Nursing, 8(3), 104-109.
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