Organizational Culture and Readiness Assessment.

Evidence-Based Practice Proposal – Section A: Organizational Culture and Readiness Assessment and Section B: Proposal/Problem Statement and Literature Review

In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.Organizational Culture and Readiness Assessment.

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Section A: Organizational Culture and Readiness Assessment

It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization\’s readiness.

Develop an analysis of 250 words from the results of the survey, addressing your organization\’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization\’s weaker areas.
Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
Submit a summary of your results. The actual survey results do not need to be included.Organizational Culture and Readiness Assessment.
Section B: Proposal/Problem Statement and Literature Review

In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:

Refine your PICOT into a proposal or problem statement.
Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.
General Guidelines:Organizational Culture and Readiness Assessment.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the 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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.Organizational Culture and Readiness Assessment.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

Evidence-Based Practice Proposal: Section A and B

Section A: Organizational Culture and Readiness Assessment

According to the survey results, the healthcare organization is highly prepared to implement the proposedproject. The proposed EBP project involves the implementation of home-based blood pressure telemonitoring among hypertensive African Americans. The EBP aims at improving blood pressure control within six months of the initiation of the medication.However, the success of the project might be compromised by various barriers. The primary barrier is patients’ reluctance to implement the home-based blood pressure telemonitoring program due to a lack of understanding of how it works.Most providers fail to inform patients and their families about multiple benefits associated with home-based monitoring. Consequently, patients and their families prefer traditional clinic visits to home-based monitoring.Organizational Culture and Readiness Assessment.

On the contrary, the project’s success is enhanced by its facilitators. Various communication modes, including telephone calls and SMS, will facilitate communication between patients and their care providers. According to Lee and Park (2016), telephone contact provides a medium for reaching the patients irrespective of their geographic location. Therefore, providers will monitor the patient’s condition without visit the clinic. The clinical inquiry will be integrated into the organization by asking whether the proposed EBP will improve patient care. The organization’s weaker areas, specifically the providers’ failure to create awareness about the benefits of home-based monitoring, will be addressed by hiring external quality improvement specialists. These professionals will work together with the providers to educate the patients about home-based monitoring. The survey results indicate that home-based monitoring will improve blood pressure control among hypertensive African Americans within six months of medication initiation.Organizational Culture and Readiness Assessment.

Section B: Proposal/Problem Statement and Literature Review

Proposal

The PICOT question is, “In hypertensive African Americans, how does Home-based blood pressure telemonitoring compare to traditional clinic visits for blood pressure monitoring in improving blood pressure control within six months of initiation of the medication?” This question can be refined into a proposal topic, “The effectiveness of home-based blood pressure telemonitoring compared to traditional clinic visits for blood pressure monitoring in improving blood pressure control among hypertensive African Americans within six months of the initiation of the medication.Organizational Culture and Readiness Assessment.

A Summary of the Conducted Research

            A study was conducted to assess the effectiveness of home-based blood pressure telemonitoring compared to traditional clinic visits for blood pressure monitoring in improving blood pressure control among hypertensive African Americans within six months of the medication initiation. Data was gathered by reviewing five articles addressing the subject matter. The articles were obtained from the Grand Canyon University (GCU) Library.

First, the researcher reviewed the study conducted by Margolis et al. (2018). The study primarily focused on comparing the impact of home-based BP telemonitoring to clinical management in lowering blood pressure among individuals with poorly controlled hypertension.The study findings revealed that home blood pressure telemonitoring resulted in significantly better control of hypertension, reduced risk of cardiovascular conditions, and reduced cost of care than pharmacist management within the first 18 months.

The second article utilized during data collection was authored by Spruill et al. (2015). It aimed to determine whether the integration of home-based blood pressure telemonitoring with nurse case management helps address the barriers to blood pressure monitoring, thus improving BP control. Study findings indicated that integrating home-based blood pressure telemonitoring in primary care settings resulted in increased comparative effectiveness, cost-effectiveness, improved BP and stroke control, and reduced risk of complications and comorbidities among Blacks and Hispanics with uncontrolled hypertension. This study had a significant limitation since only Black and Hispanic patients participated. Therefore, it is difficult to generalize the study findings to fit other ethnic groups.Organizational Culture and Readiness Assessment.

Furthermore, an article authored by Peters et al. (2017) was used during data collection. This study aims to determine whether a home base blood pressure telemonitoring approach was more acceptable by patients at a high risk of hypertension than the traditional nurse management approach. The study findings revealed that the adoption of home-based BP telemonitoring reduced healthcare costs improved adherence to regular BP monitoring, and improved BP control.

A study by Clark et al. (2020) was also utilized during data collection. The study aimed to determine whether the use of Home blood pressure (BP) telemonitoring as a substitute for a traditional clinical visit helps improve blood pressure control among low-income rural populations. The study findings indicated that Home blood pressure (BP) telemonitoring eradicated BP telemonitoring’s physical barrier in patients residing in rural areas, away from healthcare facilities. It also reduces the cost of regular travel and appointments at healthcare facilities, resulting in a significant blood pressure reduction. Nonetheless, the study had two significant limitations. First, the sample size (57) relatively small for this study. Thus, the collected data was biased. Additionally, all the participants were African American. Therefore, the results could not be generalized to fit other ethnic groups.Organizational Culture and Readiness Assessment.

Finally, data was collected by reviewing an article authored by Bengtsson et al. (2016).This study was conducted to evaluate the effect of the daily home-based BP telemonitoring in reducing blood pressure (BP) among primary care patients with hypertension. It entailed self-monitoring and reporting of BP and hypertension symptoms and delivering feedback regarding treatment adjustments, reminders, and encouragements.The study findings indicated that daily BP telemonitoring significantly reduced BP and improved self BP management. The study sample population was 50 primary care patients, which limited the findings. This sample size was relatively small making it hard to generalize the findings.Organizational Culture and Readiness Assessment.

The advancing medical technological and increased scientific studies have led to the discovery of new hypertension prevention and management interventions. Although progress has led to a significant improvement in the prevention and management of hypertension in the US, African Americans continue to lag. Despite being a minority ethnic group in the US, African Americans constitute the highest number of poorly managed hypertension. Studies show that 50% of national hypertension cases are adequately controlled, but only 10% of this group belongs to the African American race. Consequently, compared to other races in the US, this group has the highest rate of infection, disease burden, poor access to healthcare, disease-related mortality, and poor health outcomes regarding hypertension. Hypertension has also been established to develop earlier in life and more severe in clinical presentations among this population than the rest of the US population. The high prevalence of hypertension among the population is attributed to a combination of multiple factors. The high prevalence of both obesity and diabetes in the population, and unique renal system caused by the presence of gene makers that make members of this population more sensitive to salt and unresponsive to hypertensive medication contributes to the issue (Deere & Ferdinand, 2020).Organizational Culture and Readiness Assessment.

Racial discrimination, cultural and financial barriers to access to healthcare services and education have hindered adequate blood pressure monitoring, and medical literacy essential for healthy lifestyle choices. Poverty is another significant issue. It results from racial discrimination in the job market and low academic qualifications. This hinders the ability to afford health insurance and a healthy diet. Discriminating government laws such as the affordable care act have led to unequal access to health infrastructure, by discriminating against non-American citizens in health insurance coverage. These factors have hindered physical access to healthcare facilities for regular BP monitoring and health education. Therefore, there is a need to introduce an intervention that helps collectively address these risks and barriers. A home base BP telemonitoring device seems to have the potential to improve the issue (Deere & Ferdinand, 2020).Organizational Culture and Readiness Assessment.

The Method used to choose the Articles

During the article search, the definition of home-based Blood pressure telemonitoring adopted was a technology-facilitated process that entails home-based measuring and remote transmission of BP readings to a healthcare provider for feedback regarding lifestyle and prescription adjustment. Five articles were used in the literature review. They were obtained from the Grand Canyon University (GCU) Library. The search terms used to get the articles were hypertensive African Americans, blood pressure telemonitoring, and traditional clinic visits for blood pressure monitoring. The initial search resulted in 120 articles. Numbers was significantly high, thus not convenient for analysis. Boolean operators were applied to narrow down the articles. Search terms were paired into African Americans and blood pressure telemonitoring, hypertensive African Americans and traditional clinic visits for blood pressure monitoring, blood pressure telemonitoring and traditional clinic visits for blood pressure monitoring. The second search resulted in 42 articles. Inclusion criteria were used to narrow down the article selection further. The inclusion criteria were primary studies on the current study topic, published within the past five years, BP was self-measured and transmitted by the participants, and the participants were hypertension patients. Procedure resulted in only five articles, which were reviewed.Organizational Culture and Readiness Assessment.

Discussion of the Main Components of Each Article

Article 1

The study aimed at comparing the impact of home-based BP telemonitoring. Clinical management in lowering blood pressure among individuals with poorly controlled hypertension. A follow-up cluster randomized clinical trial was performed. The sample population was 16 care providers and 450 patients with managed hypertension, followed for five years—one group subjected to home-based BP telemonitoring, and the other to pharmacist management through clinical visits. The study findings indicated that home blood pressure telemonitoring resulted in significantly better control of hypertension, reduced risk of cardiovascular conditions, and reduced cost of care compared to pharmacist management within the first 18 months. The findings also indicated that these positive outcomes reduced in the long run. The article supports the current PICOT because it provides a reliable comparison of the nursing interventions under study (Margolis et al., 2018).Organizational Culture and Readiness Assessment.

Article 2

The study aimed to determine whether the integration of home-based blood pressure telemonitoring with nurse case management helps address the barriers to blood pressure monitoring, thus improving BP control. The study used a randomized controlled trial design.   The sample population entailed randomly selected 450 Black and Hispanic patients aged 18 years and above with stroke and uncontrolled hypertension, separated into two groups where one group subjected to one intervention and the other to two interventions for 12-months. Study findings indicated that integrating home-based blood pressure telemonitoring in primary care settings resulted in increased comparative effectiveness, cost-effectiveness, and improved BP and stroke control, as well as reduced risk of complications and comorbidities among Blacks and Hispanics with uncontrolled hypertension. The study is significant to the current PICOT because it provides data that helps determine the most effective intervention for BP control and management among African Americans (Spruill et al., 2015).Organizational Culture and Readiness Assessment.

Article 3

This study aims to determine whether a home base blood pressure telemonitoring approach was more acceptable by patients at a high risk of hypertension than the traditional nurse management approach.  The study utilized a quality improvement design where patients’ records were studied retrospectively and prospectively—one hundred seventy-four hypertensive patients aged 18 years and above recruited for the study.  The inclusion criteria were hypertensive patients whose BP previously monitored through the traditional clinical visits approach. They subjected to home-based BP telemonitoring and the pre and post-intervention variables compared. The study determined that implementing a home-based BP telemonitoring reduced the cost of healthcare improved adherence to regular BP monitoring, and improved BP control (Peters et al., 2017). The article is relevant to the current PICOT because it helps determine the most applicable BP management approach among African Americans.Organizational Culture and Readiness Assessment.

Article 4

The study’s aim was to determine whether the use of Home blood pressure (BP) telemonitoring as a substitute for a traditional clinical visit helps improve blood pressure control among low-income rural populations. The study utilized a prospective pilot study design.   57 hypertensive study population comprising 54% African Americans were recruited for the study, subjected to daily home-based BP telemonitoring, and followed for six months. Participants trained on how to use the tools before the study. According to an evidence-based protocol, antihypertensive medications were adjusted by a clinical pharmacist at each review.Organizational Culture and Readiness Assessment. The findings indicated that the intervention eradicated the physical barrier to BP telemonitoring in patients residing in rural areas, away from healthcare facilities. It also reduces the cost of regular travel and appointments at healthcare facilities, resulting in a significant reduction in blood pressure (Clark et al., 2020). The article is substantial to the current PICOT because it confirms that home BP telemonitoring is more effective in BP management than nurse management among African Americans.Organizational Culture and Readiness Assessment.

Article 5

The purpose of the study was to evaluate the effect of the daily home-based BP telemonitoring in reducing blood pressure (BP) among primary care patients with hypertension. It entailed self-monitoring and reporting of BP and hypertension symptoms and delivering feedback regarding treatment adjustments, reminders, and encouragements. The study utilized an exploration, longitudinal study design, where the study participants followed for eight weeks. The study sample population was 50 primary care patients with hypertension, aged above 30 years, and able to read and write. They treated with either daily home-based BP monitoring or nursing care through the clinical visit. The study findings indicated that daily BP telemonitoring significantly reduced BP and improved self BP management (Bengtsson et al., 2016). The study is significant to the current PICOT because it shows the most effective strategy among the two compared to the PICOT.Organizational Culture and Readiness Assessment.

Comparison of the Articles

Each of the five reviewed articles had a unique research question, but they all focused on determining the effectiveness of home-based BP telemonitoring intervention on improving blood pressure control. The research questions of the first, third, fourth and fifth articles compared the effectiveness of BP telemonitoring with the traditional nurse management approach. The second article had a unique research question that compared the effectiveness of combining home-based BP telemonitoring and traditional nurse management with a single application of the former.  All the studies used a significantly high sample population other than the fourth and fifth articles, which utilized a sample of 57 and 50, respectively.  The sample population of first, second, and third articles was 466, 450, and 174, respectively, which increased the validity of the studies. The study participants were adults, hypertensive patients. All the studies utilized unique study designs. These were randomized clinical trials, randomized controlled trials, quality improvement, prospective pilot study, and longitudinal study designs for the first, second, third, fourth, and fifth articles, respectively.Organizational Culture and Readiness Assessment.

Despite having different research questions, sample sizes, and research designs, four study findings unanimously established that home-based blood pressure telemonitoring is more effective than traditional clinical management in blood pressure control. However, the second article had controversial findings. The findings indicated that a combination of both approaches attains better outcomes than a single application of traditional clinical management.Organizational Culture and Readiness Assessment. One common limitation in the second, third, fourth, and fifth articles is the failure to analyze the long term impact of home-based blood pressure telemonitoring to determine the sustainability of the intervention.  The fourth and fifth articles used a significantly low sample population. Third article neglected the impact of health and technical literacy on readings because there was no user training.it also neglected the effect of lifestyle changes on the improvement. The fifth article had sample bias due to the absence of racial diversity.  Although the studies had a varying scopeof research, their outcomes supported the study PICOT.Organizational Culture and Readiness Assessment.

Areas of Further Study

More research is needed to determine the long-term implications of home-based telemonitoring and the content, intensity, and duration of reinforcement necessary to maintainlong-term benefits of home-based BP telemonitoring intervention.Organizational Culture and Readiness Assessment.

Effective Approaches in Leadership and Management

The healthcare sector experiences a myriad of challenges affecting quality and delivery of nursing services. Nursing staff turnover is one of the challenges nursing leaders and managers have to contend with. Striking a balance between retaining the existing nurses and employing new clinical nurses has been an issue in many health care institutions. Empirically, there is an increase in labor turnover of nurses resulting to staffing shortages. Staffing levels in healthcare institutions are determined by the labour market and budgetary constraints. Administrative practices determine the nurses’remuneration, working conditions, nature of supervision, and career progression.Organizational Culture and Readiness Assessment.These practices also determine the rate of nurse turnover. For instance, the productivity of a nurse may be reduced due to oppressive leadership, lack of essential working tools and long working hours. Poor remuneration that is not congruent with a nurse’s skills and workload may lead to dissatisfaction and curtail resourcefulness at work. If a nurse stays in the same job group for long, or organizational policies do not promote training, development and career growth, de-motivation may set in and eventually high staff turnover. This paper seeks to discuss the issue of nurse turnover, role of managers, maintaining professional standards and patients’ safety in the light of staff shortage.Organizational Culture and Readiness Assessment.

Gillet et.al (2018)asserts that nursing staffing is a critical health policy issue in healthcare institutions that has an impact on safety and patient outcomes. The quality of nursing care involves assessment of patients to administer interventions resulting in optimization of patient outcome; safe care to identify deterioration in patients; and accurate administration of medication. Quality of nursing care provided by nurses depends on organizational culture, staffing levels, support services and personal characteristics such as skills, job knowledge, attitude, and experience. In addition, human factors such as lethargy, poor memory and distractibilityalso determine the quality of nursing care offered. The same nurse may offer services that differ in quality to patients with related medical needs due to variations in working conditions, number of staff, and leadership provided. According to Antwi and Bowblis (2018)nurse turnover has a negative effect on the quality and continuity of care offered to patients since nurses are often the primary caregivers in hospitals and are more in contact with patients compared to other medical professionals.Organizational Culture and Readiness Assessment.

Nurse turnover disrupts services offered in hospital and staffing processes. The quality of care reduces with high staff turnover because the existing workforce is unable to effectively meet the needs of the patients. Even when new staff are employed, it takes time to induct and orient them to the expected healthcare standards. In addition, the quality of care may be less that optimal due to miscommunication between new nurses and other professionals as they try to fit into organizational culture. Moreover, nurse turnover leads to loss of tactical knowledge acquired by nurses over the years and caused an imbalances composition between new and existing staff. These staffing problems result in difficulty in planning work schedules, increase in working hours and workload, as well as reduced attention to patient needs (Gillet et al., 2018). Once the workload increases, fatigue and low morale sets in among the existing nurses which lead to compromised quality of nursing care. In addition, the remaining nurses may be reluctant to take up the increased work loador teach the new nurses which impacts on service delivery to patients.Organizational Culture and Readiness Assessment.

Nurse turnover also has a negative impact on the patients.  Antwi and Bowblis (2018)opined that frequent nurse replacements makes patients perceive the new nurses as less competent which in turn results to dissatisfaction and increase in complains on the quality of nursing care.The negative impact in quality of nursing care may result to an increase in mortality due to compromised quality of nursing care. Nurse turnover lowers the effectiveness of nursing care because newly employed nurse are not familiar with standard operating procedures while the existing staff may disregard the health protocols due to increased workload. Several empirical studies have shown that the relationship between nursing turnover and quality of health care is statistically significant. According to Gilet et al (2018), high nurse turnover increases operational costs in healthcare institutions, lowers the quality of care rendered and negatively affect health outcomes.Organizational Culture and Readiness Assessment.

In the light of high nurse turnover and staff shortage, the nursing leaders and managers have a duty of ensuring professional standards of practice and conduct are demonstrated and maintained. The third standard according to the Standards of Professional Nursing Practice, nurse has a responsibility of ascertaining the expected health outcomes and individualized plan for each patient (American Nurses Association, 2015). This implies that each registered nurse should have a care plan for each patient and work towards its implementation with other team members. To ensure the expected patient outcomes are achieved, a registered nurse can take the role of leading the other team members and provide guidance to them. The registered nurse can take the administrative role of managing a unit as well as clinical leader while delegating other duties to the other team members who may include enrolled nurses, nursing assistants, and cleaners.Organizational Culture and Readiness Assessment.

When there is staffing shortages, the nurse leader may experience challenges in maintaining professional standards. This can be solved by practically delegating the workload to the available team members such that some team members are not overwhelmed by duties while others have little to do. The nurse leader can assign tasks that do not require direct supervision to other registered nurses. While assigning the tasks, the nurse leader should ensure that all care plans are prepared and individualized patient outcomes are accomplished as a way of maintaining professional nursing standards. Lesser tasks can be assigned to enrolled nurses while putting into consideration the level of supervision required and individual skills. Nursing assistants can be assigned duties that involve life skills to ensure patients are well fed and clean. Therefore, delegation of duties will ensure that professional conduct and professional standards are maintained amidst high staff shortages.Organizational Culture and Readiness Assessment.

In healthcare settings, the nursing managers and nursing leaders have a critical role in addressing the challenges caused by nursing shortage due to high labor turnover. Patients’ safety is one of the highest priorities of healthcare institutions and nursing managers and leaders have differing roles in maintain it.  Nurse managers ensure that their unit operating optimally by setting objectives, planning for patient care, quality enhancement and staff growth and training. They come up with ways of managing the nurse shortage while maintaining good quality of care and safety of patients (Sfantou et al., 2017). The nurse manager should come up with ways of rewarding the remaining staff for carrying out additional duties due to staff shortages.On the other hand a nurse leader ensures policies are set, quality measures are upheld and adherence to regulatory compliance. In addition, a nurse leader guides the team to fulfil organizational goals, spearheads transformation ensures fiscal responsibilities are met and the organizational culture and standards are upheld by all staff.Organizational Culture and Readiness Assessment.

Different nurse managers and nurse leaders will adopt differing approaches to address nurse turnover while promoting patient safety and quality of services rendered. Some managers will adopt dictatorial leadership style to get work done. This means staff will be forcefully allocated extra duties without consulting with them. Staff will take up the assigned roles and try to bear with pressure of work due to fear of reprisal. This approach is counterproductive in the long run since when the remaining staffcannot bear more pressure, they will leave leading to severe shortage(Lavoie‐Tremblay, Fernet, Lavigne, & Austin, 2016). Other managers will adopt participatory style which is more consultative, engages all staff in decision making and promotes teamwork. The manager will take up tasks alongside other staff hence reducing the workload. Other nurse leaders will adopt a transformative leadership style in which they communicate effectively to their staff members, empower, appreciate and encourage them to become innovative (Sfantou et al., 2017). The leader will become a role model, work alongside staff, and provide a conducive work environment despite work pressure. This ensures staff deliver best results and feel appreciated hence patients outcome are achieved.  The nurse managers apply the theories of leadership and principles of management to remain accountable for all the work while delegating other duties to team members.Organizational Culture and Readiness Assessment.

Nurse managers and leaders provide guidance and leadership during the nurse shortage crisis. Other additional measures that a nurse leader can take to ensure maintenance of professionalism, ethics and patient safety include having a team with the right skills needed for tasks execution. Staff should be motivated and allowed to take time off duty to prevent work related burn out which negatively impacts on quality of care and health outcomes for patients and nurses. A nurse leader should ensure staff are remunerated for the additional duties they undertake in the light if staff shortage to motivate them. Among the three leadership styles discussed, transformative leadership would be the best in addressing challenges that emanate from nurse turnover.  The leadership style promotes a good working environment, good working relations, creativity, innovativeness and a motivated workforce (Lavoie‐Tremblay et al., 2016). It is necessary for nurse managers and leaders to have a succession plan in place in order to replicate the transformative leadership style even when there are changes in management. High staff turnover in the health care sector has far reaching effects on patient safety and quality of nursing care which can be managed through application of transformative leadership style.Organizational Culture and Readiness Assessment.