Evidence Based Change Model

Nursing sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care. ("Nursing world," 2013) Having knowledge of these indicators

Nursing- sensitive indicators are defined as those outcomes that improve in the presence of greater quantity(higher staffing ratios) or quality(educational levels and competence of nursing staff) of nursing care (www.nursingworld.org). These nursing-sensitive measures help healthcare organizations to analyze the quality and quantity of nursing care services. (www.americansentinel.edu )Nursing sensitive-indicators (NSIs) are characterized by measures that are in the realm of nurses to improve and control. According to the website www.nursingworld.org , in 1998, the National Database of Nursing Quality Indicators was established by the ANA so that

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Whether it is evidence-based practice or change of behavior, the culture of the group, facility, or organization will need to be penetrated. For the group to be infiltrated, role models and leaders will need to be part of the plan. And this is where the nurse leaders with advanced degrees pierce through the organization at all levels,

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

The American Association of Colleges for Nurses [AACN], (2006) in 'The Essentials of Doctoral Education for Advanced Nursing Practice ' Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking, affirms "advanced nursing practice (APN) includes an organizational and systems leadership component that emphasizes practice, ongoing improvement of health outcomes, and ensuring patient safety. APNs should be prepared with sophisticated expertise in assessing organizations, identifying systems’ issues, and facilitating organization-wide changes in practice delivery". (p.10) Hameric, Hanson, and Tracy ( 2014) indicates that APN must assess the clinical microsystems in which they perform nursing practices, have knowledge of the medical organizations that impact their specialties, assist with establishing patient centered care reforms to enhance quality of nursing care, improve patient safety, and provide nursing indicators that evaluates nursing performance. (p.266) APNs perform leadership capabilities in four chief areas including clinical practice settings, in the nursing career, within organizations, and in healthcare politics at regional and national levels. (Hameric et al, 2014, p. 266)

Leadership traits associated with nurse executives are honesty, credibility, supportiveness, visibility, and flexibility. Nurse executives analyze nursing functions and empower nurses through participatory decision making, shared governance, and employee involvement. Nurse executives share the vision and goals of the hospital and promote application of a nursing theory into the nursing care delivery system. They anticipate the future of health care and nursing and serve as monitor, role model, and preceptor to lower level management (Upeniecks, 2003). Nurse executives in the Magnet program are required to have advance practice degrees with certification in their specialty (ANCC). Understanding evidence-based management and enabling the use of evidence-based knowledge provides the nurse executive with the tools to improve patient outcomes. The transformational leader will remove barriers to improvement and encourage outcome based thinking. While nurse leaders are charged with questioning the status quo, nurse managers in the transformational approach to leadership are charged with maintaining the status quo.

American Association of College of Nursing (2012).White Paper on The Role of the Clinical Nurse Leader Retrived from: http://www.aacn.nche.edu/publications/white-papers/cnl

Nurse leaders are faced with issues or problems on a daily basis that are often expected and sometimes unexpected. It “comes with the territory” so to speak. If there were no issues to solve or hurdles to overcome the necessity of designating a leader would not seem quite as important. Nurse leaders can tackle issues that occur in their work environment using nursing theory to guide them. Nursing theory provides a framework that nurse leaders can use to implement interventions or changes to positively impact the staff they lead. This framework of the theory will set the standards for achieving the desired outcomes and is based on knowledge that is gleaned from practice and/or research.

The most recent data collected by the Centers for Disease Control and Prevention (CDC) shows that 1 in 68 children are diagnosed with Autism Spectrum Disorder (ASD) (CDC, 2014). Children diagnosed with ASD often have difficulty with functional performance in several key areas including; social participation, communication, school based activities, motor performance and play. These impairments in functional performance are not exclusive to the child alone as the caregiver often assumes a great deal of burden in managing the symptoms of a child with ASD. Furthermore, these difficulties along with the rising diagnosis rate has pushed ASD to the forefront of clinical research and has raised issues regarding which Ayres

The Health Care System 's purpose is to meet the physical and mental health needs of the communities in which they serve, these systems operate using people working within heal care facilities as well as other health delivery resources. One group of individual that help with facility operations are nursing administrators. Nursing Administrators contribute in managing along with directing the nursing care delivery system. Their leadership style, characteristics, communication strategies, including the way that they negotiate as well as manage conflicts can determine the quality of the healthcare services treat the facility provide as well as help to develop a set of guidelines to standardize the type and quality of the nursing services. (Cipriano, 2011) Together the Nurse Mangers work toward the same goals along with guiding nurses in their practice and contribute to the facilities successes. (Frankel, 2011) The nursing leaders are advocates who directly affect the quality of the nursing care along with also having a positive impact on healthcare through leadership.

According to Porter-O’Grady, 2016 et al p 324, our healthcare systems today are at the center of what is considered major change. Much of the change today is directly related to the foundational principles, concepts and associated with complexity in systems and relationships, and an understanding by nurse leader and follower; of what it takes to make meaningful change. Nurse Leaders, registered nurses, advance practice nurses, and other followers, at every level of our organizations must be increasingly aware of meaningful and sustainable changes that improves our healthcare systems (Porter-O’Grady, 2016 et al p 324).

Healthcare changes occurring today along with shrinking budgets and reimbursement rates for hospitals has forced institution CEOs to do more with less. Changes and restructuring of various health facilities require nursing leaders with flexibility and adaptability. Nurse leaders must also consider budgetary constraints, cost effectiveness, patient safety, and quality care while maintaining focus on improved patient outcome. The responsibility of ensuring patients receive safe and high quality care belongs to every employee in the hospital, including support staff such as IV therapy. In this hospital, this led to the development of a nurse director position to oversee the

The main focus of the theory is motivation, inspiration and empowerment to create changes. It is based on the idea of empowering others to facilitate overall goal. Bennis and Nanus (1985) describe this new leader as a leader who “commits people to action, who converts leaders into leaders, and who converts leaders into agents of change” (p.3).177. According to processes to engage and motivate staff article “Transformational leadership is important for high quality care delivery, and behaviors that nurse leaders inspire, role model and reinforce are instrumental in creating work practice that deliver optimum care”.

Without competent leadership change can have negative impact on both the employees and the patients. According to Wright (2010), lack of leadership in change management could lead to adverse outcomes such as resentment, rebellious attitudes, and could end up damaging the same people it intended to make better (p.20). Therefore, experts warned that it is very important to have competent leadership at the helm of change management (p.20). As the focus of providing leadership shifts to nurse administrators who are often in the frontline of change management, nurse administrator should use essential tools such as the American Organization of Nurse Executives (AONE) five domain of competence as a framework in change management.