Evidence-Based Practice Proposal – Section D: Change Model.

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. Evidence-Based Practice Proposal – Section D: Change Model.Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.

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In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan: 1. Identify the selected model or theoretical framework and discuss its relevance to your project. 2. Discuss each of the stages in the change model/framework. 3. 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 – Section D: Change Model.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. Please, Please look at the papers uploaded to continue with Section D. This is a continuous proposal I live in el Paso, Texas I work in a Managed Care organization. I look at Hierarchical Condition Category coding (HCC codes) and proper documentation for accurately diagnosing and reimbursement. More specific, I work for WellMed Medical Management. I am a clinical nurse coding consultant. I have been working my papers around diabetes, elderly with Type 1 diabetes and continuous glucose monitor PICOT question In elderly patients with type 1 diabetes mellitus (T1DM), how does continuous glucose monitoring (CGM), when compared to the traditional self-monitoring of blood glucose (SMBG) levels decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions or admissions in the long-term.Evidence-Based Practice Proposal – Section D: Change Model.

Evidence-Based Practice Proposal – Section D: Change Model

The Selected Theoretical Framework: Roger’s Diffusion of Innovation Theory

The proposed EBP aims to introduce continuous glucose monitoring (CGM) strategyto decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions in the long-term among elderly patients with type 1 diabetes mellitus (T1DM). Roger’s Diffusion of Innovation Theory will be utilized to guide the implementation of the proposed change.Evidence-Based Practice Proposal – Section D: Change Model.

E.M. Rogers developed the Diffusion of Innovation (DOI) Theoryin 1962(Aizstrauta et al., 2015). It is ranked among the oldest theories in the social science field. This theory was based on communication regarding how a particularly new idea, behavior, or product diffuses or gains momentum after a certain period. Therefore, the idea spreads out over a particular social system or population. Consequently, part of a social systemadopts the new idea, behavior, or product. Individuals tend to abandon their old behavior and practices and implement what is proposed by the new idea. However, people must consider the idea as new before adopting it. Diffusion is only possible if the new idea is considered as innovative.Evidence-Based Practice Proposal – Section D: Change Model.

The DOI theory is relevant to the selected project. The idea of using continuous glucose monitoring (CGM) strategy to manage diabetes among elderly patients with type 1 diabetes mellitus (T1DM) will diffuse through the healthcare facility. Care providers will consider the new idea as innovative, thus embracing it. Consequently, they will stop using the old strategies of managing diabetes among this patient population but instead adopt the new approach. This move will, in turn, decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions in the long-term among elderly patients with type 1 diabetes mellitus (T1DM).Evidence-Based Practice Proposal – Section D: Change Model.

Stages of the Diffusion of Innovation (DOI) Theory and their Implementation to the Proposed Project

The model constitutes of five major stages. These stages play a significant role in determining the new model’s impact on nurse practitioners in the healthcare facility. The first stage is innovators, which entails the practitioners willing to take risks and implement a new idea that they consider as innovative in their practices(Dang & Dearholt, 2018). The level of convincing required in this stage is not much. These nurses only need to understand the logic behind the new concept. Early adopters are the second stage of this change model. It involves practitioners involved in convincing and influencing other healthcare staff, including the management and opinion-makers about the new idea. They are willing to support the new concept since they know its effectiveness in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) in the long-term.

The third stage of this model is the early majority, which involves subordinate nurses. This group of practitioners requires evidence for them to adopt the new idea in their practices. The new idea’s previous success stories determine their willingness to embrace it Grinspun & Bajnok, 2018). They are convinced by success stories and evidence of the concept being effective before they adopt it. Therefore, statistical data about the effectiveness of continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) would be required to influence them to adopt the new approach.Evidence-Based Practice Proposal – Section D: Change Model.

The fourth stage of this model is known as the late majority, which involves skeptical nurses. This group of practitioners is only willing to adopt the new idea once it has gained popularity in the nursing practice, and many other nurses having already implemented it(Dibra,2015). Therefore, success stories of the nurses who have used continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM)are required to convince these nurses to adopt the new approach in their practices. The final stage is known as laggards. This stage involves a group of conservative nurses who are reluctant to adopt the new idea (Dearing& Cox,2018). This group of practitioners is only willing to implement the new idea if no other option is available. In other words, they require pressure from workflow and procedures changes for them to embrace any new idea or behavior. Thus, influencing these nurses to adopt the continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) would require workflow pressure.

Therefore, each stage of the Diffusion of Innovation (DOI) theory can be implemented in the proposed project. However, the results vary significantly depending on the implemented stage. More positive results would be obtained if stage one was implemented since the nurse would be willing to adopt the new idea without much convincing. The possibility of getting positive results declines once other stages of this change model are implemented. Consequently, very minimal positive results can be obtained once stage five is implemented. In this stage, nurses are unwilling to adopt the new idea unless they are pressurized to do so either by the management or by the workflow.

Evidence-Based Practice Proposal

Section A: Organizational Culture and Readiness Assessment

The “organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice”is the organizational culture survey tool that was utilized during the assessment. This tool has been shown to be effective in assessing and determining the organizational readiness to adopt evidence-based practice (EBP) (Yoo et al., 2019).

The survey findings show that the organization is ready to participate and adopt evidence-based practice. Nurses at the Managed Care organization are knowledgeable about EPB and are adequately equipped with EBP skills. The management and leadership in the organization are supportive of EBP and provide the necessary resources and finances to support EBP projects. The survey also identified that there are nurse scientists in the organization who generate evidence and actively search and locate research evidence. There are nurse practitioners who mentor nurses about EBP and support the implementation of EBP projects. There is the availability of computers, electronic devices, and the internet, where the staff can effectively search for evidence to support EBP.Evidence-Based Practice Proposal – Section D: Change Model.

However, the survey identified barriers to EBP, where some staff members were not ready to embrace changes and innovations due to time limitations and busy schedules. The staff members were generally resistant to changes. The resistance is attributable to heavy workload, and thus the staff may lack time to participate in EBP projects. This barrier can be addressed by using change champions to educate the staff members about the importance of EBP changes. Secondly, the organizational leadership should consider recruiting more staff members to reduce the workload among the staff. (Harper et al., 2017).Evidence-Based Practice Proposal – Section D: Change Model.

Evidence-Based Practice Proposal

Section C: Solution Description

Type 1 Diabetes (T1D) is a chronic disease that limitsthe pancreas from producing enough insulin (Kahanovitz, Sluss& Russell, 2017). Insulin is an essential hormone in the body. It is required to allow sugar or glucose to enter body cells to produce energy.Although T1D is commonly diagnosed in childhood, its incidence has been rising in the elderly population. The condition predisposes them to hypoglycemia, which is associated with seizures, loss of consciousness, and altered mental status. An effective way to manage T1D in the elderly is the application of continuous glucose monitoring (CGM). According to Health Quality Ontario (2018),CGM is more effective than self-monitoring of blood glucose in T1D management. In light of this, the paper describes CGM as the proposed solution, explains how CGM is consistent with the organization’s culture,and expounds the expected outcomes. The paper also provides insights on methods used to achieve the outcomes and describes the impact of the outcomes.

Proposed Solution

Several factors, including certain viruses, age, environmental factors, and genetics, contribute to T1D. The condition may lead to neuropathy, heart attack, stroke, atherosclerosis, nephropathy, high blood pressure, blindness, skin and mouth infections, and damage to the foot. To manage type 1 diabetes and prevent the mentioned complications, the Managed Care organization should use a continuous glucose monitoring strategy on elderly patients.Evidence-Based Practice Proposal – Section D: Change Model.

Continuous glucose monitoring tracks blood glucose levels or blood sugar all day(Heinemann &Stuhr, 2018). An individual can see their glucose levels anytime when using a continuous glucose monitoring device. In healthcare organizations, CGM devices can be used to review how a patient’s glucose changes over a specified period; for instance, over a few days orhours to note the trends. As healthcare providers have glancedat a patient’s glucose levels in real-time, they can make more informed decisions, such as administering drugs, conducting physical therapy, or balancing the patient’s food(Sørgård, Iversen &Mårtensson, 2019). Elderly patients with T1D are unable to reach or maintain the recommended A1C targets. However, evidence shows that real-time CGM devices potentially help users enhance diabetes control as it reduces hypoglycemic and hyperglycemic exposures(Wood, O’Neal, Furler&Ekinci, 2018). The proposed solution is realistic in the Managed Care organization since staff members are willing to participate and adopt evidence-based practices. Additionally, the organization is knowledgeable and equipped with EBP skills.Evidence-Based Practice Proposal – Section D: Change Model.

Organizational Culture

The organization’s culture acknowledges the adoption of evidence-based practices that help improve the quality of life. Staff members are willing and have the knowledge required to implement the proposed solution. In the case of healthcare workers displaying resistance, the Managed Care organization has a change champions program that educates about the significance of EBP changes. Additionally, the CGM project is consistent with the organization’s resources in that leadership and management provide necessary finances and resources such as electronic devices, computers, and the internet in support of the EBP.Evidence-Based Practice Proposal – Section D: Change Model.

Expected Outcomes

Based on research, the use of continuous glucose monitoring in the organization will address the problem of older adults with type 1 diabetes. CGM will lower hypoglycemia,a crucial aspect of T1D management. Thus, minimizing complications associated with hypoglycemia. Also, since the elderly do not recognize signs and symptoms of low or high blood glucose levels, CGM will assist providers in determining the appropriate time for medication or balanced diets, hence increasing patient satisfaction.Evidence-Based Practice Proposal – Section D: Change Model.

Methods to Achieve Outcomes

Outcomes will be achieved by interprofessional collaboration in the treatment and management of elderly patients with T1D. The interprofessional collaboration will reduce workload or burn-outs when checking real-time data from CGM devices. CGM data will inform healthcare providers about the patient’s glucose trends and levels and the rate of change. Alarms will constitute the second method, through which healthcare providers will be alerted to administer subcutaneous insulin infusion or insulin injection therapies.Evidence-Based Practice Proposal – Section D: Change Model.

Outcome Impact

The outcomes of implementing continuous glucose monitoring will impact quality care improvement. Healthcare providers will provide care that abides by the six domains of quality that comprise timeliness, safety, efficiency, effectiveness, patient-centeredness, and equitability.Through CGM alerts, providers will provide medication on time and generate informed decisionson the effective and patient-centered approach in managing patients’ conditions.Evidence-Based Practice Proposal – Section D: Change Model.

Typing Template for APA Papers: A Sample of Proper Formatting for the APA 6^th Edition

This is an electronic template for papers written in APA style (American Psychological Association, 2010).The purpose of the template is to help the student set the margins and spacing.Margins are set at 1 inch for top, bottom, left, and right.The type is left-justified only—that means the left margin is straight, but the right margin is ragged.Each paragraph is indented five spaces.It is best to use the tab key to indent.The line spacing is double throughout the paper, even on the reference page. One space is used after punctuation at the end of sentences.The font style used in this template is Times New Roman and the font size is 12.

First Heading

The heading above would be used if you want to have your paper divided into sections based on content.This is the first level of heading, and it is centered and bolded with each word of four letters or more capitalized.The heading should be a short descriptor of the section.Note that not all papers will have headings or subheadings in them.Evidence-Based Practice Proposal – Section D: Change Model.

First Subheading

The subheading above would be used if there are several sections within the topic labeled in a heading.The subheading is flush left and bolded, with each word of four letters or more capitalized.Evidence-Based Practice Proposal – Section D: Change Model.

Second Subheading

APA dictates that you should avoid having only one subsection heading and subsection within a section.In other words, use at least two subheadings under a main heading, or do not use any at all.

When you are ready to write, and after having read these instructions completely, you can delete these directions and start typing.The formatting should stay the same.However, one item that you will have to change is the page header, which is placed at the top of each page along with the page number.The words included in the page header should be reflective of the title of your paper, so that if the pages are intermixed with other papers they will be identifiable.When using Word 2003, double click on the words in the page header.This should enable you to edit the words.You should not have to edit the page numbers.Evidence-Based Practice Proposal – Section D: Change Model.

In addition to spacing, APA style includes a special way of citing resource articles.See the APA manual for specifics regarding in-text citations.The APA manual also discusses the desired tone of writing, grammar, punctuation, formatting for numbers, and a variety of other important topics.Although the APA style rules are used in this template, the purpose of the template is only to demonstrate spacing and the general parts of the paper.The student will need to refer to the APA manual for other format directions. GCU has prepared an APA Style Guide available in the StudentWritingCenter for additional help in correctly formatting according to APA style.Evidence-Based Practice Proposal – Section D: Change Model.

The reference list should appear at the end of a paper (see the next page).It provides the information necessary for a reader to locate and retrieve any source you cite in the body of the paper.Each source you cite in the paper must appear in your reference list; likewise, each entry in the reference list must be cited in your text.A sample reference page is included below; this page includes examples of how to format different reference types (e.g., books, journal articles, information from a website).The examples on the following page include examples taken directly from the APA manual.Evidence-Based Practice Proposal – Section D: Change Model.