Benchmark – Evidence-Based Practice Proposal Final Paper

Benchmark – Evidence-Based Practice Proposal Final Paper
Sample Answer for Benchmark – Evidence-Based Practice Proposal Final Paper Included After Question
Assessment Description

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 should:

Incorporate all necessary revisions and corrections suggested by your instructors.
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).
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:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model, or Framework
Implementation Plan
Evaluation Plan
Appendices

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

All final changes or revisions for the drafts that will be included in the appendices of your paper.
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.

A Sample Answer For the Assignment: Benchmark – Evidence-Based Practice Proposal Final Paper
Title: Benchmark – Evidence-Based Practice Proposal Final Paper
Abstract

Today, nursing professionals experience extraordinary stressors in their clinical practice. The bulk of these stressors have existed in the nursing practice for long such as death of patients, emotional suffering, coping with pain, supporting patients’ families, working for long hours, and caring for dying patients. However, in the present health care system, there are additional stressors in among nursing practitioners emanating from various factors such as acute shortage of nursing workforce, financial problems, intricacy in patients, and evolving technologies. Often nurses are needed to deal with challenging situations that need timely, accurate decisions that directly impact patient lives.

However, the stress negatively impacts top cognitive functions, particularly memory and attention, which worsens the already stressed nurses. In turn, the intricate, highly stressful, and technologically advanced health care system hinders the ability of nurses to be entirely present at the moment, especially when providing care to patents. The inability to present at the moment implies lack of attention or mindlessness, which is dangerous because it creates an environment where nurses can make decision without thoughtful, conscious involvement in the task at hand. Moreover, drift in attention is likely to lead to severe consequences such as failure to identify life-threatening signs and symptoms, medication errors, and other critical safety concerns in patients. Moreover, stress inherent in nurses can lead to lower job satisfaction, depression, disruption in personal relationships, and psychological stress, which can lead to a risk of patient harm. Therefore, this EBP project sought to advance stress among nurses by proposing the implementation of training on mindfulness mediation among nurse to improve overall attention, empathy, and presence of nurses with patients and their families. Prior to the commencement of the project, the readiness to adopt the project was determined using the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS). The outcome demonstrated that the organization was willing to accept the project. In addition, the Trans-Theoretical Model of behavior change was adopted to foster change adoption among nurses. The implementation plan was formulated and duration of six months set to conduct the follow up and establish the outcomes.

Section A: Organizational Culture and Readiness Assessment

Evidence-based practices (EBP) are increasingly adopted by the health care organizations to help in maximizing patient outcomes and ensure provision of patient-oriented, quality care. Essentially, a meaningful adoption of EBP can be realized when the health care organization is ready and able to recognize the limitations and facilitators that may influence the process of EBP implementation (Schaefer & Welton, 2018).Therefore, to foster the implementation of the current EBP project at the VA healthcare system, the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS) will be used as a tool to assess the organizational readiness for EBP (Egeland et al., 2016). The assessment revealed that VA healthcare system was ready for new EBP implementation.

Barriers and Facilitators
Benchmark – Evidence-Based Practice Proposal Final Paper

The major project barriers included lack of commitment to EBP adoption by the health care staff. Moreover, time limitation impeded the implementation of the project. This is due to overwhelming workload, which cannot allow the staff to review the emerging evidence. As a result, there was inadequate experience in EBP application. Conversely, the facilitators of the project included availability of existing providers who were ready to promote the EBP. Moreover, the project enjoyed management support.

High Scores and Low Scores

Concerning the high scores, the EBPAS assessment tool comprises of 19 categories and the VA healthcare system showed exemplary performance in 12 categories. Among the best scored categories included management support and the willingness by the health care providers to adopt EBP (Egeland et al., 2016). Contrarily, low scores were demonstrated in six categories, with major one being inadequacy of leading professionals in EBP implementation such as librarians to direct nurses and other providers on EBP implementation.

Integration of Clinical Inquiry

To optimize application of EBP, healthcare providers in VA health care system will be provided with training on EBP to encourage them and increase their confidence. The training will be crucial in identifying and working on areas that need improvement. Moreover, a study will be performed on the areas that need improvement to identify potential solutions to improve in them. Accordingly, the organization will formulate a policy to act as a blueprint to the project implementation and help in executing the proposed solutions.

Section B: Proposal/Problem Statement and Literature Review
Refining PICOT into Problem Statement

This project delved into the training on mindfulness meditation in nursing. Currently, the health care environment is complex, technologically laden, and highly stressful, which interferes with the ability of nurses to fully discharge their duties. This intricate nature of nursing practice and the adverse working conditions leads to risk of stress and burnout among nurses. In particular, the stress in nurses is attributed to many factors such as poor shift rotation, heavy workload, failing to reward or acknowledge nurses, intricate interpersonal relationships, and continuous need of knowledge. Consequently, the complex, technologically laden, and highly stressful environment reduces the ability of nurses to fully operate as required, especially during patient interactions. As a result, nurses lose attention (mindlessness) in provision of patient care, which leads to an environment where a nurse can make clinical decision without a thoughtful, conscious determination of the situation at hand (Sankoet al., 2016). As such, this EBP project sought to advance cultivation of mindfulness mediation among nurse professionals. Mindfulness mediation is believed to have capability to enhance nurses’ empathy, overall attention, and presence with patients and families. Since this paper sought to synthesize the research on mindfulness mediation into problem statement and literature review and create a refined PICOT statement. The refined PICOT statement would be:

In nurses (P), does training on Mindfulness meditation (I), compared to no intervention (C), reduce stress levels (O) within six months (T)?

Several studies have been conducted to support the position of the identified PICOT statement. For instance, Janssen et al. (2018) conducted an exploratory study that sought to get detailed perceptive of the impact of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the employees’ mental health. The study incorporated systematic review of databases such as CINAHL, PubMed, and PsycINFO to identify articles about the influence of MBSR and MBCT on various facets of mental health. The findings demonstrated that MBSR results in minimized stress, anxiety, occupational stress, depression, and psychological distress. The findings also revealed positive changes in employees who implemented mindfulness, personal achievement, quality sleep, relaxation, and self-care. However, the limitation of the study is the use of different methodological quality study levels.

Kriakous et al. (2020) sought to inform the current evidence-based practice and enhance knowledge on the value of MBSR on enhancing the psychological functioning of health care professionals. The study used systematic review to investigate controlled clinical trials, randomized controlled trials, pre-post designs, and qualitative studies with follow-up that lasted for 12 months. The major finding in this study is that MBSR significantly reduces the experiences of depression, stress, and anxiety among the health care professionals and also increases their levels of self-compassion and mindfulness. However, the study also revealed that MBSR cannot effectively minimize burnout or enhance resilience. There were various limitations in this study such as the use of small sample size, poor systematic literature review, non-quality articles, and self-selected samples.

The other was study conducted by Lin et al. (2019) to establish the impact of a customized MBSR program on the level of stress, affect, and the resilience among nurses working in general hospitals in mainland China. The study utilized randomized controlled trial by randomly assigning 110 nurses into intervention and control groups. The results indicated that intervention group showed lower levels of stress, and improved positive affect, high levels of resilience. The limitations of the study include utilization of small sample size, which can result in challenges in validity of the study. The convenient sampling method used in identifying hospitals can also limit the representation of sample population.

Penque (2019) also conducted a study to evaluate the influence of MBSR on factors associated with nursing practice such as work satisfaction, burnout, empathy, self-care, serenity, incidental overtime, and mindfulness. The study involved the use of mixed methods including quasi-experimental, longitudinal, pre-test and post-test, and correlational methods. The study involved 61 RNs working at a 619-bed tertiary health care setting based in the upper mid-western US. The key outcome in this study is that MBSR lowers burnout and improves specific psychological factors such as serenity, self-compassion, and mindfulness among nurses. The limitation of the study included lack of comparison group and limitation of sample population in one geographical area, which limits generalizability.

Van der Riet et al. (2018) sought to critically evaluate the literature on the value of mindfulness mediation programs on nurses and nursing students. Various databases were used to review literature including SCOPUS, EMCORE, CINAHAL, ERIC, EMBASE, and PsycINFO. The findings revealed that mindfulness mediation have positive impact on nurses and nursing students by improving anxiety, welfare, empathy, depression, burnout, and stress. However, the limitation included review of studies that used small sample size, thus, compromised generalizability and representativeness of the results.

Section C: Solution Description
The Proposed Solution

The proposed solution for this project was training on mindfulness meditation in nursing. The technologically advanced, intricate, and stressful nature of health care has greatly compromised the ability of nurses to diligently discharge their duties due to risks of burnout and stress. Stress and burnout in nurses are contributed by various factors such as overwhelming work burden, complex interpersonal relationships, poor shift rotation, evolving nature of nursing practice that need continuous education to stay abreast with current practices, and failure to reward or acknowledge the efforts by nurses. In turn, the ability of nurses to diligently provide care during patient interactions is significantly compromised as a result of these stress-related factors (Kriakous et al., 2020). As a result, nurses tend to portray mindlessness by losing attention to patient care provision leading to various risks such as medical errors and failure to make informed and conscious nursing decision. Therefore, this project advanced the adoption of mindfulness mediation among nursing workforce to assist in enhancing the general attention, presence, and empathy of nurses with patients and the patients’ families.

This proposed solution is consistent with earlier studies done on the topic. New Jersey State Nurses Association (2021) found that mindful mediation is a big way of engaging in peaceful balance and self-care among nurses and it is associated with improved problem-solving and planned action since it strengthens brain region responsible for attention. Mindful mediation also enhances coping skills, reduces burnout, reduces stress, improves self-understanding, enhances compassionate care, improves relationships with colleagues, and increases relaxation. Zeller et al. (2021) affirms that comparison of mindfulness and control groups after mindful training indicates difference in clinical performance with mindfulness indicating high performance and improved listening skills. Kriakous et al. (2020) also found that Mindfulness-Based Stress Reduction (MBSR) greatly minimized the incidences of stress, depression, and anxiety among clinicians and improved their self-compassion and mindfulness levels. Lin et al.  (2019) also affirmed that MBSR lowered stress, enhances positive affect, and increased levels of resilience.

Essentially, the proposed solution of mindfulness meditation in nursing is practical in the VA Healthcare System since it strives to introduce solutions that strive to improve attention, empathy, resilience, and stress among nurses while providing care. Although the project may require substantial financial resources to be implemented, it can still be considered cost effective to health care system because of benefits associated with such as reduction in medical errors and the associated effects and as cost of damages for medical malpractices and improving care delivery and patient outcomes. Moreover, the organization tends to set supplementary budgets to cater for emerging issues such as the implementation of quality improvement initiatives such as the current project. Therefore, the organization has the capacity to implement the project.

Organizational Culture

It is critical for the proposed solution to be in line with the organizational culture (Ariza Aguilera, 2018). One of the outstanding organizational cultures of VA Healthcare System is supporting of change initiatives and innovations. As such, the organization is likely to support this change initiative. Moreover, the proposed imitative seeks to facilitate EBP in implementation of mindfulness mediation, thus, consistent with organizational culture of using EBP interventions.

Expected Outcomes

The anticipated outcomes of the proposed intervention include assisting nurses to enhance their capability to manage clinical stress and improve their health, overall attention, empathy, work satisfaction, and enhance presence with patients and patients’ families. Other anticipated outcomes include improved serenity, mental health, and reduction in incidental overtime and burnout.

Method to Achieve Outcomes

Training on mindfulness mediation will be conducted among all nurses in the organization. Nurse educators will be asked to act as the agents to promote the proposed intervention among nurses. Nurse educators will also be required to conduct follow-ups to establish whether or not the nurses adhere to intervention. Potential barriers include different literacy levels among nurses, resistance to change, and abandoning of the project by the nurses. However, these barriers can be mitigated through active involvement of nurses in the project, fostering free communication, and creating awareness. The fundamental assumption in this project is to achieve positive outcomes.

Outcome Impact

The proposed solution will impact the relationship between nurses in the organization by ensuring collaboration with relevant stakeholders such as the management to effect the proposed solution. The intervention will also impact the patient health outcomes since the intervention to enhance mindfulness levels will improve emotional states of nurses and put them in a position to provide best nursing care.

Section D: Change Model
Change Model

The Trans-Theoretical Model of behavioral change is the selected change model that will be used in this project. This model gives an in-depth analysis on how people can make decisions to inform their behavior change. The model presupposes that behavior change does not happen instantly but happens consistently by incremental enhancement of behaviors (Haghi et al., 2018). The Trans-Theoretical Model of behavioral change is deemed appropriate to this project because it appreciates the fact that behavioral change is never an instant event but requires sequential process (Sharma, 2017: Hayden, 2019). In the current project involving training on mindfulness meditation in nursing, there is need of sequential interventions to enable the target population who are nurses to attain the desired goal. Nurses should be made aware of the essence of change, the behaviors that they need to adopt, the manner of sustaining the desired changes. As such, the focus on Trans-Theoretical Model of behavioral change, which is critical in stimulating behavior change in individuals, is poised to be a valuable framework for this project since it is linked to gradual yet effective modeling of behavior changes in people by guiding every step in the process of behavior change.

Stages of Change in the Model

According to Hashemzadeh et al., (2019), Trans-Theoretical Model of behavior change comprises six different stages of behavior changes including precontemplation, contemplation, Preparation, action, maintenance, and termination.

Precontemplation Stage

Here, the target population has no intention or motivation to assume the new behavior any time soon. In the present project, nurses do not have the understanding of the essence on engaging in training on mindfulness meditation. Therefore, they do acknowledge the benefits of involving in behavior change (Tseng et al., 2017).

The Contemplation Stage

Here, the target population begins to contemplate instigating changing their behavior in the near future. The individuals already have understanding of the dangers in their present behaviors. However, they are still unprepared for behavioral change. In the present case, nurses are already aware of the benefits of mindfulness meditation but are still unwilling to adopt mindfulness mediation (Tseng et al., 2017).

Preparation Stage

Here, the nurses have resolved to change their behavior and initiates initiatives to adopt the new behavior change. That is, the nurses are set to go on training on mindfulness mediation to attain the desired change (Tseng et al., 2017).

Action Stage

At the action stage, the target nurses who recently accepted to adopt the new behavior put more effort to nurture the behavior. In this case, the target nurses make suitable adjustments in behavior to ensure they apply the change and perfect the acquired behavior, which is mindfulness mediation (Tseng et al., 2017).

Maintenance Stage

The maintenance stage is characterized by effort by the nurses who recently assumed new behavior change to maintain the acquired behaviors and taking caution not to fall back to the old behaviors (Tseng et al., 2017).

Termination Stage

This is the final stage in the Trans-Theoretical Model of behavior change where the nurses who have completely adopted mindfulness mediation do not wish to go back to the old behaviors. At this stage, relapse is not expected and the target nurses are willing to get more information about the essence of the newly assumed behavior(Tseng et al., 2017).

Application of Each Stage on Proposed Implementation
Precontemplation Stage

Here, the target nurses have no plan to go on training on mindfulness mediation. They have no idea about the benefits of mindfulness mediation.

Contemplation Stage

Here, the target nurses start to acknowledge the essence of training on mindfulness mediation. They begin to consider attending training on mindfulness mediation in the near future. But, they are still unwilling to change their behaviors.

Preparation Stage

At this stage, the target nurses are set to get training on mindfulness mediation and learn about the benefits associated with it. They initiate different actions to attain the desired goals.

Action

Here, the nurses continue with training program to get more information about mindfulness mediation to help in improving nurses’ empathy, overall attention, and presence with patients and families.

Maintenance

At this stage, are putting more effort to continue with training on mindfulness mediation as needed and take caution not to fall back to the old behaviors.

Termination

This is the final stage where the target nurses have mastered the new behavior of mindfulness mediation. Here, relapse is not expected and so, the project is terminated.

Section E: Implementation Plan
Setting and Access to Potential Subjects

The setting is characterized by a technologically advanced, intricate, and stressful nature of health care that greatly compromises nurses’ ability to discharge their duties diligently. In such a state, nurses are usually overwhelmed, burdened, and stressed. Such conditions among other issues such as poor shift rotation, complex interpersonal relationships, and lack of motivation increase the nurses’ vulnerability to burnout and stress (Dall’Ora et al., 2020). Accordingly, the nurses are the primary subjects for the EBP project whose primary role is increasing their focus and readiness to provide patient by mindfulness meditation training.

Accessing the VA healthcare system’s nurses is not complicated as long the reasons for accessing them are clear and the necessary administrative protocols are followed.  With the management being pro-change, a change agent should present the EBP project proposal and explain how it will enhance outcomes. Next, the change agent should work closely with the management to search for the resources necessary to implement the change fully. In this case, nurses’ training and progressive evaluation should be done collaboratively with the management. The management provides several appointees depending on the type and scope of the project to serve as members of the project team. They also monitor how the change process occurs to ensure that all procedures are correct and subjects are not harmed.

Time Needed to Complete the Project

The entire process should take a maximum of six months. The first month should be about preparation for change. Nuño-Solinís (2018) postulated that change readiness depicts a scenario where health care organizations can initiate and respond to change with minimal risk and in a way that creates advantage and sustains excellent performance.  Here, the change agent alongside the management should share the vision for change with the nurses. Preparation for change is necessary to ensure that the health care staff understands the type of change coming and its reasons (Miake-Lye et al., 2020). Doing so is vital to minimize resistance to change and achieve the desired goals within the projected timelines.

The second month involves searching for resources necessary to implement the EBP project. Human, material, and required financial resources should all be available by the end of the second month. The training should occur in the third month. As the training takes place, all questions about the training and its implications should be answered at this stage. The main activity in the fourth month should be a detailed assessment of how nurses react to change and whether some improvements are necessary. If differently stated, it is the piloting stage before adopting the new practice in the fifth month. The last month should be for compiling a report and disseminating information for use in other practice settings. Dissemination spreads knowledge about EBP interventions on a wide scale (Derman & Jaeger, 2018). Its primary aim is to ensure that other health care organizations and providers have a reference when faced with a similar problem.

Resources Needed in the Implementation

The project requires nurse educators as change promoters, trainers on mindfulness mediation, and management as a partner. Professional assessment of the progress also requires human facilitation (external) to avoid bias. Financial resources are also required to purchase training materials, payment for the training venue, and payment for facilitators. Communication, refreshments, and training miscellaneous expenses also require some budgetary allocation. Some materials such as projectors can also be hired instead of purchasing. Generally, human and financial resources are the most needed to make the project a success.

Methods and Instruments

EBP projects require close monitoring to track and assess the outcomes of the proposed interventions. A monitoring plan represents a living document that should be updated regularly as the project’s implementation progresses. Questionnaires will be used to measure how nurses perceive the process and whether they are ready to apply the new knowledge to enable them to work more productively. Activity logs are also necessary, and data will be collected through attendance sheets. The other vital instrument is track indicators which will compare the project’s progress against the set timeline weekly. Track indicators will rate the project against expectations to determine whether any adjustments are required at some point.

The Process of Delivering the Solution

The required solution will be delivered via mindfulness meditation training of nurses. In this training, nurses will be shown how to focus on being intensely aware of what they are experiencing (sensing and feeling) at the moment without interpreting or judging the situation. Kriakous et al. (2020) supported the approach as among the most effective to enable nurses to provide diligent care amid stressful situations such as overwhelming work burden and poor shift rotation. Some of the strategies to be taught include guided imagery and breathing methods that relax the nurse’s body and mind and improve concentration (Gilmartin et al., 2017). The primary aim is to ensure that nurses are more informed about stress reduction in highly demanding situations.

Many benefits are associated with mindfulness meditation training of nurses. Firstly, mindfulness meditation helps nurses engage in peaceful balance and self-care by strengthening the brain region responsible for attention (New Jersey State Nurses Association, 2021). It also improves coping skills, relationships, self-understanding, and relaxation. According to Zeller et al. (2021), mindfulness meditation is associated with high clinical performance and excellent listening skills among nurses.  Accordingly, the training is critical for creating an empowered workforce that can cope with stress, understands issues, avoids reacting, and has high resilience levels (Lin et al., 2019). The impacts are profound and justified.

The Data Collection Plan

EBP projects’ implementation should be data-centered. There should be data to evaluate whether the project’s outcomes achieve the desired outcomes. Data should be collected at every phase as described in the timeline. It should be both manual and automated as situations obligate and to enhance safety. The project manager will work alongside data analyst to manage and maintain the data. Electronic data will be stored in password protected devices and only availed when authorized by the project manager. Data analysis will be primary comparing what has been achieved against the set timelines. It will also involve an in-depth analysis of nurses’ overall behavior change against the set objectives. The difference in what is achieved compared to the expectation will inform whether the process is a success or not.

Dealing with Barriers, Facilitators, and Challenges

EBP projects are not immune to barriers and implementation challenges. Lack of resources, resistance to change, and the organizational culture are common barriers to change (Tappen et al., 2017). In the current project, potential barriers and challenges include different literacy levels among nurses, resistance to change, and abandoning of the project by the nurses. Facilitation will be managed by looking for expert trainers at a cost. These barriers can be mitigated through active involvement of nurses in the project, fostering free communication, and creating awareness. The fundamental assumption in this project is to achieve positive outcomes.

Feasibility of the Implementation Plan

Generally, the implementation requires substantial financial services, but its overall impact makes it cost-effective. Personnel, consumable supplies, equipment to facilitate training would cost up to $7,700. Computer-related costs to support data access, data management, and communication would cost up to $1,500. Other costs such as travel, presentation, remuneration, and miscellaneous expenses would go up to $4,500. Each resource is needed to make the training effective and achieve the desired effects.

Maintaining, Extending, Revising, and Discontinuing the Training

The training will improve patient health outcomes by ensuring that nurses are physically and mentally ready to provide health care services. After implementation, progressive evaluation is necessary every three months. If nurses’ capacity to work improves, the training program should be maintained and extended to other workforces, such as new nurses joining the organization. Progressive evaluation should also guide revisio