Section E: Implementation Plan  

HCA-699

June 17, 2020

Implementation Plan

Settings and potential subjects

The EBP project would be best applied in hospitals and health care facilities with pediatric units, with the potential subjects being the nurses working in these units. Accessing these subjects would be made possible through visits to five health care facilities with pediatric units. Drafted approval forms would be distributed to the participating nurses, with the head of their department being a signatory ion all the forms.

Timeframe

This project would require six months for the introduction and full implementation. The first weeks of the first month would be spent in the determination of the medical facilities to implement the plan. The remaining weeks of the first month would be to conduct training while putting up the required systems to implement EBP. The second, third, and fourth would be for the implementation and running of the evidence-based practice. Key performance indicators shall be set to help gauge the success of the plan. Evaluation of the effectiveness of the plan would be in the fifth month. Required changes shall be made in the sixth month.

Required Resources

Required human resources would be the experts required to train the nurses on the requirements of the EBP. The implementation would also require financial resources to invest in the systems supporting the plan and pay the hired experts. These finances would also be used in the provision of incentives and the purchase of rewards to recognize outstanding performers.

Methods and Instruments

Measurements instruments of choice would be the questionnaires. These questionnaires shall measure the nurses’ satisfaction with the introduced plan. Also, the nurses would be able to freely give their opinions on the changes in the plan to increase its efficiency and effectiveness. The questionnaires would be shared among the respondents who would dully fill the forms and return them to a designated location without indicating their details. Anonymity helps in maintaining the confidentiality of the participants.

Delivery of the Intervention

The intervention in question is pediatric asthma education, with the best mode of the delivery being training. Experts on the intervention would be hired where the training would be provided through an open forum. This forum will accord all the nurses an equal platform to ask questions and give opinions.

Data Collection Plan

Data collection would be through the focus groups. The focus group would be an easy means of determining the groups’ opinions on the introduction of the intervention. Also, this is efficient as it helps save the money that would be used in running individual interviews. In ensuring the privacy of the collected data, all information about the intervention would be stored in electronic forms under high encryption. Characteristically, the sharing of information would be through encrypted files.

Strategies to deal with barriers

Possible challenges and barriers that the intervention may encounter are such as resistance and financial constraints. In dealing with the outlined issues, the managers of the plan could obtain financial institutions such as banks. To curb resistance, there would be adequate efforts to sensitize the participants on the importance of the intervention as a means of improving health outcomes.

Feasibility of the implementation

Huge costs would be incurred on the investments on the personnel to facilitate training. The complexity of the implementation of the intervention means that the plan would consider hiring several experts in the field of concern. Also, there would be huge investments in data security to avoid compromising the safety of the collected data and the respondents.

Discontinuing proposed Solutions

Discontinuation of a proposed solution would be after adequate evaluation of the same. The evaluation shall involve the input of the hired team of experts and the nurses to practice intervention. Relatively, the evaluation would be in line with the findings after comparing the solutions with the formulated key performance indicators.

Section D: Change Model

HCA-699

June 17, 2020

Change Model

Change is an inevitable life process. One of the significant challenges in change management is resistance to change. While resistance is a normal human reaction to new development, there is a need for the management in question to embrace processes that ensure the gradual adoption of new practices. Rodger’s Diffusion of Innovation theory is one of the models that could be applied in introducing the new change, which is evidence-based practice (EBP) in nursing. Dearing and Cox (2018) defined diffusion as the social process that takes place during the learning of innovation, with the example of an evidence-based approach for improving health care. Simin and Jankovic (2014) highlighted the Diffusions of Innovations as a crucial theory developed in the United States by rural sociologists. This theory describes the change processes with the example of the diffusions of innovations in society.

The Diffusion of Innovation (DOI) theory, as developed by E.M. Rodgers, is one of the major theories in social sciences. This theory sought to expound how a product gains popularity among a group of people and is slowly assimilated into a social system. According to Kaminski (2011), the DOI theory was historically explored by Gabriel Tarde, a French sociologist. The current version of the theory, as popularized by Everett Rogers, has additional categories. An analysis of this model will unearth the different individuals and their characteristics, which should be considered when introducing a new EBP. Kaminski (2011) outlined categories of adopters and their influence on the adoption and innovative process.

1. Innovators. Kamanski (2011) defined individuals in this category as technology enthusiasts. Among all the categories, these individuals require the least time to adapt to a new change. The author added that these individuals easily understand and apply complex concepts to deal with a high degree of uncertainty. During the EBP introduction, these people make up the least number.

2. Early adopters. Kamanski (2011) highlighted that early adopters are also visionaries. Individuals under this category attract admiration from their peers, with their adventurous nature drawing them to projects with high risks or rewards. An implementation with early adopters stands a higher chance of success, especially due to the challenging aspect of EBP.

3. Early Majority. Also known as the pragmatists, Kamanski (2011) noted that this category has people that frequently interact with their peers while also serving as opinion leaders later on in the process. These people make up 34% hence the need to ensure their cooperation during the introduction of change. Their opposition could significantly influence the stand of others, lowering the chance of succeeding.

4. Late majority. These people are also known as conservatives and have the same composition as the pragmatists. According to Kamanski (2011), the late majority derive their motivation from the need to keep up with the competition or existing trends. These people are easily influenced by the laggards, which mean that they could be easily influenced by declining the awaiting change. The late majority make up 34%.

5. Laggards. They are also known as skeptics and make up 19%. Kamanski (2011) stated that the laggards prefer to maintain the status quo. As such, these individuals may prove difficult during EBP implementation.

The first step before the introduction of the change would be identifying the presence of the highlighted categories among the participants. This realization would help to determine what people to include in completing particular elements of the plan.

References

Dearing, J. & Cox, J. (2018). Diffusion of Innovations Theory, Principles, And Practice. Health Affairs, 37(2), 183-190. https://doi.org/10.1377/hlthaff.2017.1104

Kaminski, J. (2011). Diffusion of Innovation Theory. Canadian Journal of Nursing Informatics, 6(2). https://cjni.net/journal/?p=1444

Simin, M. & Jankovic, D. (2014). Applicability of Diffusion Of Innovation Theory In Organic Agriculture. Belgrade, 61(2), 517-529

Solution Description

HCA-699

June 9th,

Solution Description

Overview

Pediatric asthma is a disease characterized by the obstruction and inflammation of the airwaves. According to Lizzo and Cortes (2019), maternal smoking increases the risk of wheezing during childhood, while increasing the possibility of the development of asthma. Asthma is a chronic disease with high mortality and morbidity rates. The author highlighted exposure to tobacco smoke, among other air pollutants, such as mold, as increasing the risk of asthma among children.

Proposed Solution

Pediatric asthma education enlightens people on taking precautions while identifying the risk factors to eliminate the possibility of pediatric asthma. People often suffer due to their ignorance. Some asthma cases among children could be avoided if parents knew the measures to take and the exposures to avoid. Coffman et al. (2008), associated pediatric asthma education with a relative reduction in the number of hospitalizations and emergency department visits. According to the authors, two or more asthma education interventions denote the interventions with more sessions as increasing the interactions between educators with the children and caregivers as being more effective. Children, parents, and caregivers attend sessions on pediatric asthma education, becoming more aware of the importance of symptoms monitoring and the measures to take. Pediatric asthma education is not too expensive, and parents should consider joining welfare groups that would increase the possibility of accessing these services.

Organization Culture

One aspect of the community culture that heightens the intervention’s success is the high levels of interaction. Due to this interaction, people can engage in social activities as a means of enjoying themselves or as part of improving the community’s livelihood. The community also has resources such as social halls where people meet when they need to attend crucial meetings. The culture of interaction and available resources facilitates the implementation of the solution. People can easily communicate on scheduled sessions of pediatric asthma education. Also, the social halls provide a venue for attending the educations sessions.

Expected Outcomes

It is expected that following the provision of pediatric asthma education, there would be a relative reduction in hospitalization rates and visits to the emergency department. Characteristically, there would also be improved school attendance among school-going children.

Method to Achieve Outcomes

The first step in achieving the outcomes is setting objectives. These are the goals that the program seeks to achieve among its targeted population. The second step would be the involvement of the necessary stakeholders. These parties are parents, health officers, teachers, caregivers, and children. The possibility of resistance is one of the barriers that need to be addressed. People may rule out the interventions as a waste of time and a disruption of their busy schedule. Tackling this barrier would involve a proper sensitization to the population on the importance of the training session and the dangers of failing to attend the same. The second barrier would be the lack of adequate commitments from the involved health care officials. In order to deal with this challenge, there should be steps targeting to motivate the officials through incentives, rewards, and recognition. 

Outcome Impact

           The outcomes would ensure an improvement in patient-centered quality care. Health care providers would be well informed on a patient’s underlying condition and provide care in cognizance of the same. As such, any medication or care provided would be with caution to ensure that it does not worsen their condition. The patient’s involvement in the care provision means that they are well-informed and can highlight any allergies that they have.

References

Coffman, J., Cabana, M., Halpin, H. & Yelin, E. (2008). Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875139/

Lizzo, J. & Cortes, S. (2019). Pediatric Asthma. https://www.ncbi.nlm.nih.gov/books/NBK551631/

Pediatric Asthma Education

May 26th 2020

HCA-699

Pediatric Asthma Education

Pediatric asthma is one of the chronic diseases that affect infants and children and characterized by the obstruction of the airwaves. Pediatric asthma is difficult to diagnose, and parents and guardians may realize that their children are having the disease when it is in an advanced stage. Herzog and Cunningham-Rundles (2011) highlighted additional symptoms of the disease as being the inflammation of the airwaves and bronchial hyper-responsiveness. The presentation of the asthma phenotypes among the children is dependent on age, gender, and even genetic compositions. Herzog and Cunningham-Rundles (2011) outlined that pediatric asthma affects approximately 8.5% of children in the United States, and it is the leading cause of school absenteeism and hospitalization among school-going children.

Herzog and Cunningham-Rundles (2011) discussed asthma as being more prevalent among boys during their first years of life while being predominant among females during adolescence. Ferrante and La Grutta (2018) highlighted asthma as imposing a burden on the health system due to its being common and due to its chronic nature. Patterns of asthma differ between children and adults. According to Dharmage, Perret, and Custovic (2019), asthma often begins during childhood, with its recurrence occurring at any stage of one's adulthood. However, some individuals develop asthma during their adulthood.

Parents, schools, and the health care system are bound to be affected by the proposal's outcomes. Parents undergo financial and emotional hardships when their children have to be admitted to the hospital due to asthma cases. On the other hand, schools are unable to achieve their objectives when dealing with cases of absenteeism when school-going children have to be admitted to hospitals. The consistent burden of pediatric asthma on the health system means that there is the incurring of high medical costs while also compromising the quality of life. A determination of the precautionary measures in the prevention of the disease would help lower the huge financial costs that the health care system would have to incur in handling the diseases.

PICOT Question: Does the provision of pediatric asthma education among grade school children lower the rates of hospitalization compared to self-management and self-monitoring with guidelines.

The proposal's purpose is to determine the impact of pediatric education on the rates of hospitalization among grade school children. The objectives are to evaluate the effectiveness of pediatric education compared to self-monitoring and self-management. The hospitalization rates shall be determined before the pediatric education program. Following the program's introduction, the hospitalization rates shall be measured to determine possible changes in the rates. The occurrence of asthma in adulthood means that the condition was present during childhood only that it could not be detected. As such, the adoption of the necessary measures ensures that there is the elimination of the possibility of recurrence while lowering the number of fatalities from the condition.

Ferrante and La Grutta (2018) observed the high-income countries as recording high cases of severe asthma among children. However, the severity of asthma symptoms among children stood out in low-income countries. It, therefore, means that the high-income countries could adopt measures that could curb the disease while barring it from burdening the health care system and the economy at large. Characteristically, the low-income countries should consider measures that would eliminate the possibility of the disease escalating to uncontrollable levels.

References

Dharmage, S., Perret, J. & Custovic, A. (2019). Epidemiology of Asthma in Children and Adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591438/

Ferrante, G. & La Grutta, S. (2018). The Burden of Pediatric Asthma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023992/

Herzog, R. & Cunningham-Rundles, S. (2011). Pediatric Asthma: Natural History, Assessment and Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172616/