Evidence-Based Practice Proposal Essay.

The proposed EBP project is based on the PICOT question, “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?” The implementation of this project will be guided by Roger’s Diffusion of Innovation(DOI) Theory. E.M. Rogers developed this change model in 1962(Aizstrauta, 2015). It is ranked among the oldest social science theories. The model explains how a new idea acquires momentum and spreads out among a specific population over time. The model is subdivided into stages.Evidence-Based Practice Proposal Essay.

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The Stages in Roger’s Diffusion of Innovation Theory

            This change model has five stages. In the first stage, innovators involve a group of people interested in trying innovative ideas first(Dibra,2015).These individuals like taking risks and venture into something they don’t know much about to develop new ideas. New ideas appeal to the innovators, with very little being done on them. The second stage is the early adopters. This group of people represents opinion leaders who like taking leadership roles during the change implementation process(Zhang et al., 2015). Early adopters are aware of the benefits that the change would accrue to the organization. Consequently, they are willing to implement a new idea. They only require manuals and procedures to guide them during the implementation of new ideas. Persuasive information is not required to convince this group to adopt the new idea.Evidence-Based Practice Proposal Essay.

The early majority forms the third stage of this change model. This group does not constitute leaders, although they are willing to adopt the new idea before other people(Stephenson et al., 2015). However, evidence of the early success of the new idea will be required to convince this group to adopt it. Therefore, evidence of the innovation’s effectiveness and success stories are shared to influence the early majority. The late majority forms the fourth stage of this model. This group consists of individuals who are skeptical of change. Their willingness to implement the new idea will dependon the results after the majority tried the innovation. Thus, success stories of others are the greatest inspiration for the late majority. The last stage of this model involves laggards. This group of people constitutes conservative. This group is comfortable with the traditional methods, and itsvery skeptical of change. Therefore, it is the hardest group to influence to adopt the new idea. Laggards are convinced through statistics indicating the success and effectiveness of the new idea. Evidence-Based Practice Proposal Essay.

The Application of the Stages in the Change Implementation Process

The five-stage of Roger’s Diffusion of Innovation Theory will be applied during the implementation process. In the first stage, innovators will involve a group of healthcare practitioners interested in trying innovative ideas first. The new idea will appeal to these clinicians with very little being done on it. Therefore, medical officers will be willing to implement the idea even if they know very little about it.Evidence-Based Practice Proposal Essay.

In the second stage, the early adopters involve opinion leaders in the healthcare organization. These healthcare staff will take leadership roles during the change implementation process. These healthcare leaders are aware of the benefits that the change would accrue to the entire organization. Therefore, persuasive information is not required to convince this group to adopt the new idea(Fry et al., 2018). Instead, these leaders are ready to adopt the idea. They only require manuals and procedures to guide them during the implementation of new ideas.Evidence-Based Practice Proposal Essay.

Furthermore, the stage of the early majority will be applied during the implementation process. This group does not constitute healthcare leaders but rather involves practitioners willing to adopt the new idea before other staff. However, these healthcare practitioners require evidence of the new idea’s early success to be convinced to adopt it. Therefore, these practitioners will be influenced by the innovation’s effectiveness and success stories. Their willingness to implement the project will depend on if it was successful in the healthcare organizations where it was initially adopted.Evidence-Based Practice Proposal Essay.

In the next stage, the late majority will be applied during the implementation process. The late majority will constitute of healthcare practitioners who are skeptical of change. Thewillingness of these clinicians to implement the new idea will mainly depend on the results after most healthcare staff tried the innovation. Thus, themajority of practitioners’ success stories fromthe greatest inspiration for the medical officers in the late majority category.Evidence-Based Practice Proposal Essay.

In thelast stage of the change model, laggards will be applicable during the implementation process. This group of people consists of conservative healthcare practitioners. These healthcare officers are comfortable with the traditional techniques implemented in the organization. They are very skeptical of any change. Thus, these medical practitioners will not be willing to implement a new idea in their clinical practices. These practitioners from the hardest group of officers to influence to adopt the new idea. Success stories and the effectiveness of the proposed idea will be used to influence these healthcare providers.Evidence-Based Practice Proposal Essay.

Therefore, applying the five stages of this change model will enhance the implementation of the proposed EBP project.

Roger\’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck\’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler\’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.Evidence-Based Practice Proposal Essay.

In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:

Identify the selected model or theoretical framework and discuss its relevance to your project.
Discuss each of the stages in the change model/framework.
Describe how you would apply each stage in your proposed implementation.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.Evidence-Based Practice Proposal Essay.

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 7th Edition Style Guide, located in the Student Success Center. An abstract is not required.

PICOT Question

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?Evidence-Based Practice Proposal Essay.

Population (P) – hypertensive African Americans.

Intervention (I) – Home-based blood pressure telemonitoring.

Comparison (C) – traditional clinic visits for blood pressure monitoring.

Outcome (O) – improving blood pressure control.

Time (T) – six months of initiation of the medication.

Description of the Population

African Americans refers to Americans of African descent. They are now the fastest-growing minority ethnic group in the US and the second largest after Latinos. They represent approximately 13 % of the national population (Kritz & Gurak, 2018). Compared to other races in the US, this group has the most inadequate health in regards to the high rate of infection, high disease burden, poor access to healthcare, high disease-related mortality, and poor health outcomes. The leading health issues in this community are heart disease, hypertension, cancer, and diabetes. Hypertension is the most significant health issue in the population. It refers to progressive exertion of high blood pressure on arterial walls, resulting in damage to arteries and body organs (Jackson, Zhang, Wiltz, Loustalot, Ritchey, Goodman & Yang, 2018).Evidence-Based Practice Proposal Essay.

The disease affects approximately 40% of the African American population (Deere & Ferdinand, 2020). Advanced technology has improved the nursing science field and led to the discovery of new hypertension treatment therapies. Despite the development of new classes of hypertensive drugs and non- pharmacological interventions, they have had an insignificant impact on African Americans. It is attributed to the high cost of the new hypertension medication and the inefficiency of the medicines on African Americans. They have a unique genetic composition that renders them resistant to hypertension drugs. This is also because most hypertension clinical trials majorly focus on the most white population while neglecting the minority populations. Therefore, although the new pharmacological and non-pharmacological discoveries have resulted in more than 50 improvements in blood pressure control, African Americans constitute less than 10% of this ratio.Evidence-Based Practice Proposal Essay.

Genetic factors have also contributed to the prevalence of hypertension and its poor management in this community.  Studies have determined that African Americans have a unique genetic makeup that makes them susceptible to hypertension. It entails a different mechanism of blood pressure control from the other populations, characterized by increases sensitivity to sodium salts and higher renal retention of sodium salts. Some theories have attributed this gene mutation to the slave trade era, where slaves had limited access to adequate salt; thus, their bodies developed a modification to protect them from salt deficiency diseases (Friedman & Luyckx, 2019). As a result, although the risk of high blood pressure increases with age among other populations, African-Americans develop high blood pressure earlier in life. Economic, social, and cultural health determinants in this population have also contributed to the problem of poor hypertension management.Evidence-Based Practice Proposal Essay.

Members of the African American population are among the most impoverished individuals in the US. Significant members of this community live below the poverty line. It is attributed to racial discrimination in the job market and unemployment. Consequently, they are unable to afford a proper diet and healthcare cost for regular blood pressure assessment. Due to racial discrimination in the education sector, only 25 % of the population members have attained higher education, while the rest are either uneducated or possess just a high school diploma. As a result, health literacy is limited to the community (Assari, 2019). This has significantly impaired the adoption of healthy behaviors that reduce the risk of hypertension and impaired adherence to the hypertension treatment plan, thus causing an increase in cases of uncontrolled hypertension. Besides, due to limited educational attainment, the representation of African Americans in the healthcare workforce is significantly low (Akinlua, Meakin & Freemantle, 2017). This hinders African Americans from seeking regular hypertension assessment due to fear of receiving culturally incompetent care from health works from other ethnicities. Evidence-Based Practice Proposal Essay.

Attitudinal barriers are also accountable for poor hypertension management among African Americans. These include cultural stereotypes that discourage access to healthcare checkups and screening when one is not sick. Traditionally, this preventive practice is viewed as a bad omen by some members of this community (Kelley, Haas, Felber, Travis & Davis, 2019). It hinders blood pressure monitoring and early diagnosis. As a result, hypertensive cases are discovered in advanced stages during which they are challenging to manage. The prevalence of obesity and overweight in the population has played a role in the issue of hypertension. It is attributed to unhealthy dietary choices such as the preference for soul food, traditional cuisine in this population that is often preferred for cultural functions. The meal is characterized by high calories, fats, and salts, which impairs the effectiveness of hypertensive therapy. It is one of the cultural preservation methods in this community.Evidence-Based Practice Proposal Essay.

The increased consumption of this meal is blamed on limited health literacy and limited access to health care facilities for health education. Another significant health determinant is cultural discrimination in access to healthcare services and health insurance. The government provides Medicare and Medicaid insurance programs that have increased access to healthcare services primarily among the elderly and poor Americans. These groups are the most affected by hypertension. However, only American citizens are eligible for these programs. This has left the problem of uninsured among African Americans immigrants in the US unsolved, thus impairing adequate prevention and management of hypertension.Evidence-Based Practice Proposal Essay.

Potential Solution

The above analysis indicates that reduced access to healthcare facilities for blood pressure monitoring is the most significant barrier to adequate control of hypertension in the selected community. To address the identified barrier, the study proposes the implementation of home-based telemonitoring of blood pressure. The intervention entails providing members of the African American population with a blood pressure monitor, which they will use for the home taking of blood pressure (Duan, Xie, Dong, Wu, Lin, Sun & Xu, 2017). They then communicate the BP readings with their specific care providers remotely via e-Health-related technology. Through the initiative, the need for a regular physical visit to a healthcare facility for BP monitoring is eliminated, and patients only visit healthcare facilities when the need arises.Evidence-Based Practice Proposal Essay.

The initiative is economical because the home BP monitoring device is affordable, and the cost of transport to healthcare facilities for BP monitoring is eradicated. Besides, through the intervention, hospital congestion is reduced, critical cases of hypertension in need of physical hospital visit receive adequate and quality attention.  The remote BP monitoring eradicated the cultural, attitudinal, and discriminatory barriers to access to BP monitoring services. The approach has the potential to bridge the distance created by housing problems and frequent migration among African Americans. Thus, it is beneficial to homeless individuals without permanent residences. The intervention also promotes access to social support for patients without family members through daily communication with the health providers (Duan et al., 2017).Evidence-Based Practice Proposal Essay.

Health Policies and Goals

Some intervention purposes include reducing healthcare costs and racial disparities in healthcare access and outcomes. These goals are persistent with the objectives of the Patient Protection and Affordable Care Act (ACA) enacted in 2010. The initiative will promote patient-family-care providers collaboration in the treatment process and enable the provision of care outside the health facility, thus increasing patient experience and satisfaction. These goals are aligned with the objectives of the Patient-Centered Medical Home (PCMH) healthcare model, enforced by the Centre of Medicare Services through reimbursing healthcare providers according to patient satisfaction scores (Elder, Penm,  Pallerla, Meulen, Short,  Diers & Boone, 2016).Evidence-Based Practice Proposal Essay.