*** please follow all guidelines, must be in APA format***1. In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan using the material attached. Include the following: Rogers’ diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, you may also choose to use change models, such as Duck’s change curve model or the trans-theoretical model of behavioral change. Other conceptual models presented 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 intervention in clinical practice.Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.Create a conceptual model of the project. 2. In 500-750 words (not including the title page and reference page), provide a description of the methods to be used to implement the proposed solution using the material attached. Include the following: Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created.Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
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Organizational Culture and Readiness Assessment: Section A
Organizational culture and readiness assessments are important tools that are used to plan
a change management strategy. The value of these assessments help to examine the scope of
change, the number of employees affected, the capacity for change, and investigates how
prepared employees are for change. The organizational cultural survey tool that was selected
and used on 3 West Progressive Care Unit at Torrance Memorial Hospital was titled,
“Organizational Culture and Readiness for System-Wide Integration of Evidence-based Practice
Survey,” and consisted of 19 questions about evidence-based practice.
Based on analysis, the highest surveyed categories scored 75%, in which employees
stated they felt a great majority of nurses have strong EBP knowledge and skills, and that
advanced practiced nurses such as practitioners, doctoral researchers, and nurse educators are
committed to EBP. Over 80 percent of the population of nurses at our facility holds an education
degree above the associate level. Studies have shown that nurses with higher levels of education
have more knowledge about the importance of EBP, as they have learned this rigorous process
throughout nursing school (Linton & Prasun, 2013). The lowest surveyed category scored was
the use of librarians as resources, as the facility utilizes other available resources for EBP such as
certified nurse specialists and doctoral researchers. Although 50% of employees stated that EBP
is “somewhat” practiced in our organization, the survey indicates 3 West is “ready to go” in
readiness for EBP, as most nurses have positive attitudes towards its implementation.
An important strategy needed for leading successful change is communication. People
need to understand the complexity of the change from both task and relationship implications of
the change, and leaders needs to address both specifically when communicating with the change
agents (Goodyear & Mehmedovic, 2016). For example, this may include the articulation of why
change is happening, when the change initiative will start/duration, specific job roles, support
from the facility, prospective outcomes, and so on. Educating and providing immense
explanation can help influence and motivate people in the change movement more effectively
and reduce any barriers to learning and resistance.
Problem statement: Section B
It is the wish of every patient that their length of stay at hospitals is maintained at
minimal. In addition, creating a negative economic impact to them and their families, extended
hospital stay has also been shown to have a significant psychological and emotional impact on
the patient and their loved ones (Pumar, Gray, Walsh, Yang, Rolls & Ward, 2014). This is an
occurrence when patients need time with their loved ones, and the extended stay creates negative
feelings and perceptions that may, in turn, affect their health and time of recuperation. At
present, there is a rising awareness on health and particularly that focused on early intervention,
which has significantly raised the demand for healthcare services as well as lowering the
physician-patient ratio (Mastaneh & Mouseli, 2013). While hospitals strive to lower the time of
stay in healthcare facilities in order to meet these demands and raise their employee satisfaction
and quality ratings, it goes without saying that some of their practices may be contributing to the
extended length of stay at hospitals. In line with this problem, this paper seeks to identify the
relationship between promoting early mobility vs. prolonged bed rest on hospital length of stay
for post-operative patients.
The results of this study will benefit multiple parties. Patients are the most affected by the
extended length of stay at healthcare facilities, which means that a solution to this problem could
be a reprieve to them. At the same time, this study will create a solution for physicians and
healthcare facilities to understand the link between the length of stay and the joint providerpatient efforts in promoting early mobility. At the same time, this could be an important research
to the general health care sector, and more so the different national and state agencies, as it will
help in formulating a way of raising the quality of care. At the same time, it could form a strong
foundation to other cohort studies as it will create a systematic link to various studies that have
been conducted on from a specific perspective.
Purpose of the Project
The purpose of this project is to study the various practices that occur during the hospital
stay for post-operative patients and the impact this poses on both the patients and the institutions,
with a greater focus towards the length of the time of stay.
To identify the whether healthcare providers put up efforts to promote early mobility for
To identify the role of healthcare providers on the bed rest practices of post-operative
To establish the link between promoting ability and bed rest and the length of hospital stay.
To develop a comprehensive paper that should highlight the challenges and create a solution
that could be adopted by healthcare providers.
In 2013, a study by Hodgson, Berney, Harrold, Saxena & Bellomo studied physiological
intervention for patients in the intensive care unit and the effect that this had on their muscles. In
their findings, it was concluded that, although early patient mobilization might be labor-intensive
and create additional costs to the hospitals, it had immeasurable benefits on the side of the
patient, and where the researchers suggested that this is a practice should be integrated into
routine processes. In another systematic review, Epstein (2014) found a close relationship
between the length of hospital stay and early mobility of patients, and where hospitals that
promoted early mobility for spinal patients helped in reducing hospital-acquired illnesses (HAIs)
such as venous thrombosis, respiratory decompensation, and urinary tract infections among
others. Consequently, this significantly lowered the time that patients spend in hospitals as a
result of HAIs and thus reduced the time that they spend in hospitals.
Prolonged bed rest has been closely associated with extended hospital time of stay. The
TEAM Study Investigators (2015) identified that only a few post-operative patients received
early mobility assistance and, although this did not significantly affect their time of stay, it led to
50% of them being discharged with ICU-acquired weaknesses. While hospitals strive to lower
the patients’ length of stay, most of them are not aware of their contribution to the problem. A
recent study, for example, revealed that some facilities fail to put up measures that will promote
early mobility and thus contribute to their problems (Clark, Lowman, Griffin, Matthews & Reiff,
2013). This calls for a need for healthcare providers to pay critical attention to their practices
and the impact that they have on the time that patients stay in hospitals.
Literature Support: Section C
It is important that a project’s problems and the proposed solution for the problems are
well supported by quality research. Failure to support the problems and proposed solutions will
definitely lead to a poor outcome, erroneous solutions, and misleading results. In line with the
current project, and that seeks to identify the relationship between promoting early mobility vs.
prolonged bed rest on hospital length of stay for post-operative patients, the following section
analyzes the selection methods for the papers and their justification.
The resources used in this paper were searched through the PubMed Central (PMC)
repository. Unlike most other repositories, PMC specializes in high-quality research articles in
the biomedical and life sciences segments. The resources were searched through the use of
keywords that were developed from the project’s objectives and thesis statement. In this case,
various studies were identified in the repository. However, various studies whose topics met the
keywords were analyzed at the abstract level so as to help in easy identification of relevance.
Only those that proved valuable to the objectives were selected and a thorough analysis was
conducted on the studies. The following keywords were applied: “Early mobility,” “Length of
stay,” “Relationship between early mobility and length of stay.”
In “Effectiveness of an Early Mobilization Protocol in a Trauma and Burns Intensive
Care Unit: A Retrospective Cohort Study,” Clarke, Lowman, Griffin, Matthews & Reiff (2013)
conducts a research study involving 2,176 patients, and seeks to identify the effects of early
mobilization on the length of stay (LOS), complication rates, and ventilator days. They find a
close relationship between the variables, which is a confirmation of their hypothetical
development that arises from their basis of their research. This is a primary study, and that had a
high confidence rate at 95%. However, a number of limitations arose such as use of historical
events as controls and challenges in estimating the situation at two periods due to changes in
Epstein (2014) conducts an exploratory analysis of existing studies that discuss the
impact of early mobilization following spinal surgery on LOS and comorbidities. The study
found that early mobilization had a significant effect in reducing LOS as well as the occurrence
of comorbidities. A strength of this study is that it was based on spinal surgeries, which is
common area for post-operative patients. At the same time, its statistical significance was high as
it involved multiple studies, whose results were consistent across 12 ICUs that formed the area of
study. However, a limitation arose in that the paper was just a review and no actual primary
research was conducted.
Hodgson, Berney, Harrold, Saxena & Bellomo (2013) explore the practice of early
mobilization in healthcare in the intensive care unit (ICU). They identify that this is a concept
that is not clearly understood, which could potentially affect the practice as well as the
recommendations from research. As far as the current project is concerned, this study is critical
as it will help in understanding early mobilization, how it is practiced, and its possible impacts.
At the same time, the study is based on multiple research studies. Although this is one of its
strengths, it further creates a limitation in that the researchers held no primary observation to
substantiate what they identified in existing literature.
Mastaneh & Mouseli’s Journal of Health Policy and Management sought to identify the
awareness of inpatients in developing countries, by using Iran as an example. They identify a
low level of awareness that could potentially affect other factors such as LOS due to failure to
understand their privileges while in care. The strength of this study is that it involves a survey on
patients, which means that the results directly represent the patient views. At the same time, it
provides a clear understanding of awareness state, an indication of whether or not patients
understand the benefits of early mobilization and how they can be supported by healthcare
providers. One limitation is that only 200 participants were used, which could be too low to
make a well-informed conclusion.
Pumar’s study evaluates the occurrence of comorbidities for chronic obstructive
pulmonary disease (COPD) patients. The researchers find a close relationship between EM and
the occurrence of comorbidities and LOS as well as increased mortality. One limitation of this
study is that it has a poorly defined sample. However, it is an important piece as it expands the
study beyond other studies that often concentrate on spine and injury-related post-operative
patients, which could help in diversifying the understanding of EM and LOS in the general
A bi-national, cohort study titled, “Early mobilization and recovery in mechanically
ventilated patients in the ICU, ” is a 6-month study that investigated early mobilization practices,
LOS, discharge of patients, and the recovery of patients. They find high 90-day mortality rates,
high instances of weaknesses during discharge, and the occurrence of extended LOS due to low
early mobilization, and where as high as 84% of the cases did not adopt EM. One strength of this
study is that it was a cohort study that was based in 12 ICUs. However, there was a limitation in
that one of the ICUs failed to record/avail the relevant data for the study. Regardless, the
remainder of the samples was still large enough to warrant a good conclusion.
Solution Description: Section D
Early mobilization has proven benefits such as the reduction in the recovery time of the
patient (Epstein, 2014). In order to enhance early mobility within 72 hours of admission, the
proposed solution would be staff training and clinical audit. Primarily, the monitoring of
complications for post-operative patients ensures that there is early detection to avoid irreversible
and terrific consequences. The post-operative complications for patients are a major determinant
of the time taken for patient recovery.
Staff training, repetitive education, and clinical audit would help in the implementation of
clinical initiatives as well as protocols that support early mobilization. Training is an essential
element in ensuring that nurses increase their awareness and alertness in monitoring postoperative complications in patients. Clinical audit is an intervention which involves quality
improvement processes for patient care and patient outcomes. With clinical audit, there is the
review of current practices, implementation of positive changes and ascertaining of
improvements. Staff training and clinical audit are evidence-based and intervention oriented.
Staff training and clinical audits are consistent with the community culture and resources.
The proposed solution is an instance of case management in an organization. It entails the
process where the management assesses, implements, and evaluates services for the purpose of
meeting patient’s needs with the use of the available resources so as to enhance cost-effective
outcomes. Nurses need to be trained to assess, plan, implement and monitor post-operative
patients’ complications. Besides, in a health care system, nurses comprehend the organizational
culture and this facilitates the coordination of care and the collaboration with other professionals
in handling post-operative patients (Castelino et al., 2016).
The expected project outcomes include:
Reduction in complication rates
Reduction in morbidity rates
Reduction of the average length of stay for patients in hospitals
Improvement of healthcare outcomes for post-operative patients
Increased staff training
Method to Achieve Outcomes and Barriers
Staff training along with clinical audits will begin with the introduction of educational
strategies in handling post-operative patients. Therefore, nurses will be introduced to educational
training meetings to learn on the ways to reduce complications on post-operative patients and
enhance health outcomes. Barriers that will need to be assessed include; inadequate resources in
training the nurses and insufficient manpower to carry out health care processes in a safe and
smooth manner. Health care organizations can eliminate this barrier by seeking funds to increase
the levels of training for nurses. Also, the problem of manpower can be solved by changing and
expanding the role of nurses and supportive staff.
Outcome Impact: Quality Improvement and Patient-Centered Care
The quality of care for post-operative patients will be enhanced through early
identification of complications. Early mobilization is a substantial nursing intervention that aids
in the reduction in post-operative complications. Research indicate that early mobilization of
post-operative patients enhanced by staff training and clinical audit helps in reducing
impediments and thus enhancing the quality of care of the patients (Yeung, 2016).
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