Dissemination of an Evidence-Based Practice Project Proposal Essay

PICOT statement

Adult hypertensive patients whose language is Akan, an African language. (P) Could providing written treatment education materials in their primary language Akan (I), be more effective than using an interpreter, (C) Leading to improved controlled blood pressure (O) and avoiding possible complications associated with the disease progression and preventing mistrust between healthcare providers and patients (T) over a period of 4 months.

• Organization – Montefiore Medical Center – sufficient resources and readiness for changes
• Issues – reduced level of trust, poor adherence to the treatment, and lower quality of care
• Core instrument – the written treatments in the Akan language

Organizational Culture

• Organizational culture – plays a major role in determining the effectiveness of change
• Evidence – “change-oriented leadership has a positive and significant direct effect on planned change and a positive and significant but indirect effect on planned change and emergent change” (Al-Ali et al., 2017, p. 723).
• Organization’s leadership – proactive and transformational
• Culture – flexible
• Mission and values – continuous quality improvement
• Core of the strategy – patient satisfaction

Organizational Readiness Tool

• The clinical site – supportive of changes
• Organizational change – willingness does not equate to readiness
• The readiness assessment tool – Organizational Readiness for Implementing Change (ORIC)
• Evidence – ORIC “measures if organizational members are confident in their collective commitment towards and ability (efficacy) to implement organizational change” (Storkholm et al., 2018, p. 1).
• The organization’s strength – moderate level of commitment with high efficacy for change

Organizational Readiness Assessment

• A medical center and ORIC with leadership – high-level readiness
• Evidence – a leader using ORIC can “gain a deeper understanding of the organizations’ current perceived culture and … pivotal in identifying the culture gap in moving toward a preferred culture over an 18-month period” (Davis & Cates, 2018, p. 71).”
• Key stakeholders – leadership, patients, and staff
• Transformational leader – supports and encourages proactive action and improvement

Problem Statement

• The problem statement – rust and miscommunication are created as a result of the language barrier between Akan-speaking patients and health professionals
• The problematic outcome – poor quality of care and patient dissatisfaction with health services
• The written treatment format – designed to reduce or eliminate the Akan language barrier to improve the quality of care and safety
• Effective treatment and care delivery process – health professional’s ability to communicate critical and essential information

Literature Review

• The literature – insight into potential barriers and underlying measures to be implemented
• Interprofessional cooperation – challenges can be overcome with the use of an interprofessional collaborative approach focused on organizing their input in a structured format (Al Shamsi et al., 2020).
• Interprofessional strategy – effective in improving adherence to the recommended practices and functional status among patients (Reeves et al., 2017).
• Critical part – minimize unnecessary interactions – eliminate potential points of conflict

Change Model: Framework

• The framework – Lewin’s change model
• Three phases – unfreezing, changing, and freezing (Abd el –shafy et al., 2019).
• Unfreezing – ensuring the readiness of the organization and the involvement of all stakeholders
• Changing – focus on incorporating and integrating the written statements as a core aspect of the practice
• Freezing – solidify the changes by turning them into the center’s protocols of care and organizational policies

Implementation Plan

• Implementation – through a nursing foundation
• A nursing foundation for quality of care – highly effective facilitator for improving the readiness and willingness factors
• Evidence – “nursing foundation for quality of care and supportive leadership was positively associated with readiness, change commitment and change efficacy. However, staffing and resource adequacy was positively associated only with change efficacy” (Sharma et al., 2018, p. 2798).
• Implementation plan – supportive leadership, patient-centered culture, and a nursing foundation for quality of care

Implementation Design

• The implementation design – calculated, precise, and quantitative
• The measures – blood pressure values and trust level scores
• Evidence – “the guidance provided by current mixed-methods research is inconsistent and incomplete, and this compounds the lack of available direction” (Bressan et al., 2017, p. 2878).
• Integration – the evaluation and progress monitoring will be more accurate with numerical data

Evaluation Plan

• Evaluation plan – physical improvements as well as direct feedback from the target patient group
• The evaluative metric 1 – measurement of blood pressure with a sphygmomanometer
• The evaluative metric 2 – simple questionnaire – level of trust of patients towards their healthcare providers
• Evaluative approach – comparative assessment – one-way analysis of variance

Conclusion

• PICOT – the adult Akan-speaking hypertensive patients will be provided with written treatment education materials in their primary language leading to improved controlled blood pressure and avoiding possible complications associated with the disease progression
• The goal – prevent and eliminate mistrust between healthcare providers and patients over a period of 4 months
• The change model – Lewin’s change model
• Core element – the written treatments in the Akan language
• The evaluation – precise and quantitative in order to direct and accurately observe the improvements
• The key metrics – patient feedback and blood pressure changes

References

Abd el -shafy, I., Zapke, J., Sargeant, D., Prince, J. M., & Chnistopi(erson. N. A. M. (2019). Decreased pediatric trauma length of stay
and improved disposition with implementation of Lewin’s change model. Journal of Trauma Nursing, 26(2), 84-88. Web.

Al Shamsi, H. Almutari, A.G., Al Mashrafi, S., & Al Kalbani, T. (2020) Implications of language barriers for healthcare: A systemic
review, Oman Medical Journal, 35(2), 1-9. Web.

ALAli, A. A., Singh, S. K., Al-Nahyan, M., & Sohal, A. S. (2017). Change management through leadership: The mediating role of organizational culture. International Journal of Organizational Analysis, 25(4), 723-739. Web.

Bressan, V., Bagnasco, A., Aleo, G., Timmins, F., Barisone, M., Bianchi, M., Pellegrini, R., & Sasso, L. (2017). Mixed-methods
research in nursing – A critical review. Journal of Clinical Nursing, 26(19-20), 2878-2890. Web.

Davis, R., & Cates, S. (2018). The implementation of the organizational culture assessment instrument in creating a successful organizational cultural change. International Journal of Business & Public Administration, 15(1), 71-94. Web.

Moore, W. L. (2021). Does faculty experience count? A quantitative analysis of evidence-based testing practices in baccalaureate nursing education. Nursing Education Perspectives, 42(1), 17-21. Web.

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 6, 1-50. Web.

Sharma, N., Herrnschmidt, J., Claes, V., Bachnick, S., De Geest, S., & Simon, M. (2018). Organizational readiness for implementing change in acute care hospitals: An analysis of a cross-sectional, multicentre study. Journal of Advanced Nursing, 74(12), 2798-2808. Web.

Storkholm, M. H., Mazzocato, P., Tessma, M. K., & Savage, C. (2018). Assessing the reliability and validity of the Danish version of organizational readiness for implementing change (ORIC). Implementation Science, 13(1), 1-7. Web.