For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

ASSIGNMENT INSTRUCTIONS

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper for this assignment should:

1. Incorporate all necessary revisions and corrections suggested by your instructors.
2. Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
3. Contain supporting research for the evidence-based practice project proposal.

Main Body of the Paper

The main body of your paper should include the following sections:

1. Problem Statement
2. Organizational Culture and Readiness
3. Literature Review
4. Change Model, or Framework
5. Implementation Plan
6. Evaluation Plan

Appendices

The appendices at the end of your paper should include the following:

1. All final changes or revisions for the drafts that will be included in the appendices of your paper.
2. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.

General Requirements

You are required to cite 10-12 peer-reviewed 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.

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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.1: Translate research and knowledge gained from practice, while adhering to ethical research standards, to improve patient outcomes and clinical practice.

5.1: Design ethically sound, evidence-based solutions to complex health care issues related to individuals, populations, and systems of care.

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SAMPLE STUDENT ANSWER

Evidence-Based Practice Project Proposal Final Paper

The goals used by the current health care system are structured towards achieving the quadruple aims, which include providing quality care, making the health care services affordable, enhancing provider experience, and advancing population health (Valaitis et al., 2020). The United States government at different levels has been putting in place efforts to reduce the cost of care, which is noted to be amongst the highest among its OECD counterparts (Tikkanen & Abrams, 2020). Increased prevalence of chronic diseases is one of the contributing factors associated with high health care costs.

Some of the known chronic diseases with a high prevalence in the US include cancer, diabetes, cardiovascular diseases, to list a few. Interestingly, I almost all of the chronic diseases the major links is obesity. Over time, statistics as will be discussed show that obesity has been on the rise and so has the number of patients reporting with chronic diseases (Centers for Disease Control and Prevention, 2019). Obesity is a significant risk factor associated with type-2 diabetes, cardiovascular diseases, and certain types of cancer. Therefore, it is a condition that can be directly be viewed as a barrier to achieving some of the quadruple aims indented by the health care system.

As per the Centers for Disease Control and Prevention (CDC) statistics, approximately more than 40% of adults living in the US are obese with over 10% of them having severe obesity (CDC, 2019). In the same light, the CDC further notes that African American adults have a higher prevalence of obesity compared to other racial/ethnic groups with a risk factor of nearly 50%. What this data indicate is that the African American population are at a higher risk of getting chronic diseases like type-2 diabetes compared to other population groups, which is actually the case as noted in the CDC (2021) factsheet.

As such, the African American community was considered the population of interests in this project by virtue of higher prevalence, high rates of morbidity and mortalities related directly and indirectly to obesity. In a study conducted by Chooi et al. (2019), the researchers concluded that the impacts of obesity may be far more prevalent and serious than previously anticipated, thereby necessitating for more urgent attention and stringent actions to alleviate the pandemic. Based on the underlying factors, this project aims to identify some of the evidence-based approaches that could help deal with obesity as a community health challenge, To achieve this objective, the following PICOT question was established;  

PICOT: In adult African American patients with obesity (P), does a physical exercise program held for 30 minutes, thrice a week (I) compared to no exercise (status quo) (C) help to reduce BMI (O) within three months (T)?

Organizational Culture and Readiness for Change

            Change is a systematic and complex process that if poorly handled can lead to organizational conflicts or conflicts with other stakeholders. That is why as change agents, we ought to assess the organization’s culture and readiness for change before implementing the change initiative. That being the case, there are various tools and steps that we can consider to facilitate the assessment of an organization’s culture and readiness to change. This section of the proposed project plan will give an elaborate description and assessment of an organization’s readiness to imitate and sustain a community-based quality improvement project targeting African Americans with obesity.

Organization Culture

            The organization currently embraces a clan culture based on a value system with team work and interprofessional collaborating being some of the key values. The organization also embraces a culture of quality formed by patient-centered approach to care, stewardship and customer-focus. One of the elements that define organizational culture is leadership. (ALFadhalah & Elamir, 2021). The organization currently embraces a transformational style of leadership, which is a style associated with continuous organizational change, employee empowerment, and high levels of team collaboration and autonomy Doody & Doody, 2012).

As is currently, the level of team work and collaboration is among the entire staff. According to Willgerodt et al. (2020), embracing interprofessional collaboration is a critical aspect needed to effectively implement change within an organization. Similarly, the organization has participated previously in other community health improvement projects, with some still ongoing which makes the current staff to be quite receptive about change initiatives. The achieved and anticipated outcomes of those initiatives being one of the intrinsic motivators to the entire team. However, further analysis on stakeholders and their likelihood to support the change initiative is critical to determine the current organizational readiness for change.

Organization Readiness Tool

            The tool that was used to assess organizational readiness for change is the Partnership Assessment Tool for Health (PATH). PATH is a tool that helps to analyze the nature and quality of partnership between the organization and other stakeholders. The tool considers partnership as a critical aspect that defines an organization’s readiness for change. PATH describes the quality and nature of partnerships using four major aspects that include; internal and external relationships, funding and finance, data outcomes, and workflow and service delivery (CHCS, n.d). Results from the organizational analysis across the four measures indicated positive outlook describing the organizations readiness for change, with three of the aspects being positive.

With finance and funding being the only aspect that requires improvement. From the results, it was noted that the current organization culture embraces a system of collaboration and teamwork that helps it to achieve common goals. Therefore, the collaborative culture needs to be sustained to ensure that the organization retains high scoring in terms of readiness to change in implementing community evidence-based change initiatives. The culture will help in ensuring that there is effective partnerships and support from both internal and external stakeholders who are crucial in supporting the change initiatives.

The results collected from the PATH tools also indicated a number of strengths held by the organization. Some of the strengths include strong internal and external relationships based on common goals, strong workflow and service delivery, and finally communication of data outcomes. Inadequate sources of finance and a weaker finance structure was identified as a major weakness in implementing and sustaining change outcomes

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Strategies to Facilitate Organizational Readiness

After the analysis of the organization in terms of culture and readiness for change, the next step is to come up with effective strategies that aim to enhance organization readiness in implementing and sustaining an impactful change initiative. From the readiness assessment using PATH, there was one element that was noteworthy as a barrier to change; stakeholder support. To improve on this aspect, it will be essential to do a thorough stakeholder analysis and engage them early enough to promote buy in to the change initiative.

Engaging both internal and external stakeholders is crucial in preventing resistance to change and consolidating the required resources, including finance needed for the change initiative (Butt et al., 2016). Another approach is to employ an evidence-based change model to allow smooth transition to the change. This will allow the different stakeholders to adjust t the new approaches that aim to improve community health outcomes.

Stakeholders and Team Members

            The project team will consist of professionals from different disciplines. For example, the project will involve community health nurses wh will facilitate implementation of different aspects of the intervention, including patient education, data collection and communication with patients and other stakeholders. Nurse informaticists will also be part of the team where they will help in data anayissi and partly relay of communication to different stakeholders.  Other members of the team will be a trained dietician, and a fitness expert to advice on dietary and training guidelines respectively to achieve maximum health benefits on the targeted population. The two will also participate occasionally in community education on living a heathy lifestyle

 Information and Communication Technologies Needed

            One of the elements that is critical when assessing organizational readiness for change is availability of resources. In community-based health care projects, and this particular project to be specific, communication and technology resources will be required to achieve successful implementation. One of the evidence-based technologies that will be required is remote monitoring systems that will facilitate collection of data from the participants regarding the level of exercise engaged per session. The application of remote patient monitoring systems has changed how nurses interact with patients and deliver care, especially among patients with chronic conditions.

Such technologies have significantly helped in communication efforts in remote places, improved speed and efficiency of health care delivery (Malasinghe et al., 2019). The remote monitoring technology will facilitate patient monitoring to confirm adherence to the prescribed intervention, instead of doing so manually. This approach will cut on cost and time needed by the interdisciplinary personnel.

Other communication devices that will be used in the project include mobile handsets, to relay the collected information and any other correspondences that is relevant for the project back to the facility for analysis. Nurse informaticists stationed at the facility, will collect the information and use the available data analytical tools within at their disposal to produce results that can help in decision-making.

Evaluation Plan

In any change initiative, having an elaborate evaluation plan plays a critical role in confirming whether the project managed to achieve the intended outcomes or not. With a good  evaluation plan, the project team will be in a position to continuously assess the project to confirm whether it is on track, allowing it to run efficiently throughout the different project stages, and if need be, areas that may require adjustments to achieve the outlined project objectives.

This section of the evidence-based project proposal will provide a detailed structure of the evaluation plan, including the expected project outcomes, the data collection tools that will be utilized, how the data will be analyzed, including the tools and tests that will be used in the data analysis, and counter measures in case of deviations from the project outcomes.

Expected Outcomes

The proposed evidence-based project proposal is purposed on improving the health outcomes of community-dwelling, obese adult African Americans. The intervention will be a 30-minute walk conducted thrice a week. As such, the expected outcomes for the project include the following; reduction of BMI by 5% within the first three months. According to a study by Ballard et al. (2021), walking exercise was noted to be an effective weight reduction intervention for obese patients. One of the exacerbating factors that contributes to high prevalence of  obesity is sedentary lifestyle (CDC, 2019), which the exercise aims to discourage, and at the same time contributing to loss of body fat resulting in BMI reduction.

            Other than reduction in BMI, the intervention is subsequently expected to result in enhanced cardiovascular health. One of the risk factors linked to persons with obesity is the increased risk of getting cardiovascular diseases. Engaging in physical activity plays a critical role in improving systolic blood pressure among patients with obesity Towner et al. (2019).

            The third outcome that the project expects to achieve is improving the mental health outcomes among affected persons. Research indicates that a majority of patients with obesity experience social and psychological stress, which affects their daily functioning and social engagements (Blasco et al., 2020). In a study conducted by Lincoln (2019), a positive correlation was noted between mental health and engaging in physical activity among obese patients. Therefore, based on the available evidence on the intervention, the three outcomes will be used to evaluate the EBP project.

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Data Collection Tool

            The evidence-based project will use a quantitative research design, which is a research design that collects data which can be expressed in numerical form. One of the data collection instrument that is appropriate to use in this project is tests, specifically measuring changes in BMI at intervals in the course of the intervention. Several studies have proved BMI tests to be valid and reliable to measure the level of adiposity in routine clinical and public health assessments (Olfert et al., 2018).

The advantage of the BMI tests is that they are easy to administer, and can be done at the comfort of the patient’s setting, so long as they have a weighing scale and measuring tape and does not require any special skills to calculate. The simplicity of the data collection tool is considered one of the success factors in the implementation of this evidence-based project initiative.

Statistical Tests for the Project

            There are several statistical tests that can be used in quantitative research. For this project, descriptive and inferential statistics will be used to analyzed the collected data. Calculation of means to note the average change among participants will form the descriptive component of the analysis, while T-tests will form the inferential component of the analytical tests. T-tests will help to show the significance in terms of change achieved by comparing the means before and after the intervention.

Data Collection Plan

            To ensure compliance of the intervention, the participants recruited in the project will be asked to always wear a “walk-meter.” Most walk-meters are free and can be downloaded in smart phones or smartwatches. After confirming compliance, the participants will then be recording and transmitting their BMI scores using their mobile-handsets to the facility for analysis. However, to confirm the credibility of the data, the nursing team will occasionally measure the BMI scores of the participants. Patient education on how to properly calculate the BMI score will be done to ensure accuracy in data collection.

Strategies if Outcomes Will Not Be Met

            Having contingent strategies is crucial to mitigate a situation where outcomes are not met. The first step in the contingency is to evaluate the cause of deviation, for example, whether it was as a result of poor implementation, or lack of compliance, among others. Depending on the cause of the deviation, the project will either be readjusted, improved, or terminated.

Plans to Sustain or Terminate the Project

The main goal of the project is to live a long-term positive impact on the participants in terms of health outcomes, a change in lifestyle and their well-being. As such, sustaining the project would be the ideal situation that could lead to complete transformation from a sedentary unhealthy lifestyle to one that is more active. To achieve this goal, upon achievement of the set project outcomes, the intervention will be adjusted in consultation with the fitness expert. Further, health promotion activities with the community will be conducted to increase the number of participants to achieve continuity of the project and increase the level of impact to the community.

However, such an achievement can only be possible with the help and support from the stakeholders, especially in allocating more resources to the project. The project may also require revisions to be made as a way of ensuring sustainability, especially if deviation from the project outcomes is expected. In case the project results are not achieve within the stipulated timelines and budget, and any changes seem untenable, then the project will be terminated

However, before termination, a detailed report detailing the reasons for termination will be prepared and communicated to stakeholders for proper closure.