Evidence based practice: Implementation and Evaluation Plan

Implementation and Evaluation Plan
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1.0 Implementation Plan
1.1 Introduction
Like many other parts of the world, Saudi Arabia is challenged with a nursing shortage. By the year 2010, there was a chronic nursing shortage of 30 percent, which was worsened by increased migration of nurses (Almalki, Fitzgerald & Clark, 2011). In light of the above predicament, policies and measures were developed so as to augment the nursing profession. The policy change was inline with the policy of “Saudization”, which refers to the effort to increase the number of Saudi employees working in all sectors, including nursing (Fielden, 2012). As a result, most hospitals require new nurses to complete a 3 month Departmental Orientation Program, upon which they are expected to be competent in the provision of patient care (Almalki, Fitzgerald & Clark, 2011).
The focus of the policy makers has been on increasing quantity at the expense of quality. A 3 month period may be deemed short in gathering the necessary skills and knowledge to work as a nurse (Fielden, 2012). Henceforth, most of the nurses leave the profession within the first year of working due the lack of self-confidence, job-satisfaction or the essential skills and knowledge (Edwards et al., 2011; Strauss, 2009). This further compounds the nursing shortage and leads to loss of investments in the new nurses, in addition to further recruitment costs for the employing bodies. The short orientation time can also lead to a compromise in patient care provided by the stressed and inexperienced nurse.
Faced with this predicament, it is essential to increase the orientation program to a period sufficient enough to permit the acquisition of the necessary skills, knowledge and attitude (Edwards et al., 2011). The intent of this paper is to come up with a plan for implementing a one-year orientation program from the 3 months program using an appropriate change model. The paper further analyses the facilitators and barriers to this change, in addition to developing an evaluation plan, to discern the effectiveness of the evidence-based practice (EBP) change.
1.2 Planning for Practice Change
Most researchers have correlated adequate graduate program time with beneficial effects on the nurses, patients and employers. Edwards et al. (2011) systematic review was chosen as best recent evidence in implementing the changes in the graduate nurse program. After successive advocacy of the (EBP) change to policy makers/decision makers, a change of practice will be carried out to replace the 3-month training program with a one-year graduate program for the Saudi graduate nurses. The program will incorporate learning experiences, nursing knowledge and the training of skills in a manner that prepares the nurse for the working environment. This is expected to boost the self-confidence of the nurses, job satisfaction and patient care (Strauss, 2009).
In order for effective implementation of change, multidisciplinary collaboration is essential (McCabe & Kalpin, 2005; Mohide & King, 2003). This collaboration will be between the health ministry, nursing colleges and universities, the government and hospitals offering graduate nurse program. This collaboration is essential for the successive implementation of evidence based practice on both the public and private sector (Levin & Feldman, 2006). After dissemination of evaluation findings to the decision makers and policy makers, the aforementioned bodies will be able to pin-point stakeholders and processes that will be entailed in effecting change.
1.3 Model for implementation
The Stetler model of change was chosen for utilization in the implementation and evaluation of evidence-based change. The reason for choosing this model is that it assists health practitioners to utilize evidence in daily practice so as to inform implementation of change (Stetler, 2001; Stetler, 2003). The model is imperative as it links research use with evidence-informed practice. The integration of both concepts augments the overall application of research. According to the model, research use (with regards to the available evidence in aiding decision making), provides the premier step for research-related actions (Stetler, 2001). These actions later on develop to evidence-informed practice.
Stetler model of change
The Stetler Model was developed in 1976 in a bid to synchronize the critique of research evidence and application in practice (Stetler, 2001). The model has undergone scrutiny, leading to revisions that have forged a strong model that fosters effective evidence-based practice (Stetler, 2003). The refined model of 2001 will be adopted for use in implementation of change in the graduate nurse program. The model consists of five phase that are designed to facilitate critical thinking with regards to the practical application of research findings. Further, the phases result in the utilization of evidence within the context of daily practice.
Phase I: Preparation
The first phase entails identification of the purpose of consulting evidence (Stetler, 2001). The phase begins with defining a priority need. This is then followed by reviewing the context of research utilization and the systematic initiation of a search of relevant research evidence. Preparation entails identification of an area with a gap, or one that needs improvement. The present paper has identified the need to change graduate nurse program from 3 months to 1 year as evidenced by Edwards et al. (2011) systematic review, which was found to be best evidence in literature search. The purpose of this change is to foster skills and knowledge and enhance the levels of job satisfaction, confidence and professional nursing behaviour.
Phase II: Validation
The second phase involves assessing each source of evidence for the level of credibility and applicability. In the current paper, validation was ascertained through a rigorous appraisal the sources in the Edwards et al., (2011) systematic review. Each source was systematically critiqued and selected. The relevant details of each source were then summarized in an applicable statement of finding in order to ascertain the implications for practice in Phase 3 below. The summary of findings in the selected sources reflected the meaning of study findings of the problem at hand, in accordance with the tenet of Stetler model validation phase (Stetler, 2001).
Phase III. Decision making/ Comparative evaluation
This phase involves the logical organization of summarized findings from all validated sources depending on their similarity and differences (Stetler, 2003). It is then imperative to determine the feasibility of applying the summarized findings in practice. This is based on an applicability criterion where one substantiates evidence with regards to the overall strength of findings. According to Stetler (2001), the user can decide to use, consider use, delay use or reject the use of evidence gathered. After comparative evaluation of the literature sources, the decision to use them in the implementation process was made.
Phase IV: Application/Translation
In this phase, the practitioner converts the findings, plans their application and puts them to use (Stetler, 2001). The health practitioner develops an implementation plan that defines operational details of how to utilize the acceptable findings, and then goes ahead to implement the changes within the framework of evidence-based change plan. This phase will deal with the methods of obtaining approval, logistics that will be involved in implementation and the resources that will be required to accomplish the task. Facilitators and barriers to change will be identified and dealt with during this phase. Overall, the phase should identify the “who, where, when and how” of implementation (Cookson, 2005).
Phase V: Evaluation
In the evaluation phase, one should clarify the expected outcomes in relation to the purpose of seeking evidence (Stetler, 2001). This entails evaluation of the plan in regards to the degree in which it has been implemented, and whether the objectives for using the evidence have been met. This will be the final phase of the present paper. The plan will cover the evaluation of implementation and outcome objectives and the procedures involved in the management and monitoring of the evaluation process.
1.4 Barriers and Facilitators to Change
According to Asadoorian et al., (2010), the change process is naturally faced with various barriers, which hinder attempts in service improvement. The lack of autonomy, control/authority over nursing practice is an inherent barrier to the planned change (Rycroft-Malone et al., 2004). According to Pagoto et al., (2007), the evidence based change may encounter resistance from health authorities. The methods for addressing this barrier will entail the acquisition of approval from the relevant authorities and administrators by clearly delineating the benefits of the proposed changes.
Cost is also a limiting factor that may inhibit the change process (Rycroft-Malone et al., 2004). Funding is essential in order to fac...