Directions for Use of the Action Planning Tool Discussion
The healthcare sector is one of the areas that has received significant changes over the years most of which are geared towards improving quality, fostering patient safety as well as the implementation of evidence based practices. Some of the projects that have been implemented in healthcare include the implementation of technology such as electronic health records, remote monitoring, artificial intelligence and robots (Hathaliya, Tanwar & Evans, 2020). These changes and trends have significantly aided in the provision of quality, safe and timely healthcare services among patients and the general population.
According to Dang et al., (2022), the Johns Hopkins Nursing Evidence-Based Practice model is a powerful problem-solving approach to clinical decision-making and is accompanied by user-friendly tools to guide individual or group use. The tool is especially useful among practicing nurses who use it for guidance in their day to day activities. The tool also helps to ensure that evidence based practices are incorporated into patient care to promote efficiency and appropriate patient outcomes.Directions for Use of the Action Planning Tool Discussion
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Current healthcare issue
The current healthcare issue of interest is patient falls. Patient falls refers to the unplanned descending to the floor of a patient that ends with or without an injury. Patient falls can lead to internal bleeding, external and internal fractures or even lacerations that worsens the health of an individual. According to LeLaurin & Shorr, (2019), patient falls are the most common adverse events that are reported in hospitals with an annual figure of 700,000 to 1 million cases reported in the United States. Further, it is estimated that at least one in four falls results in injury and about 10 percent sustain serious injuries. Cases of inpatient falls results in significant burden to the patient as well as the healthcare facilities as they increase chances of sustaining injuries as well as death. Further, falls can increase the length of stay among patients leading to congestion and litigation, both of which are adverse effects on the healthcare facilities. Also, falls reduce workflow among healthcare providers due to an increase in emergencies that require the attention of healthcare providers thereby increases the workload for the already overburdened healthcare providers. The Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for fall-related injuries thereby; healthcare facilities have increased their efforts in fall prevention among hospitalized patients.
There are a number of risk factors that predispose one to an increased risk of fall and they include weak muscles especially those in the legs that easily lose balance and leads to uncertain falls. Poor balance is another risk factor that can predispose one to falls and it is caused by issues with the gait such as a weak back born. Directions for Use of the Action Planning Tool Discussion
Relevancy of the problem in healthcare
Falls represent a major cause of preventable injury in healthcare and a commonly reported serious adverse event among patients. Hospitalized patients are at an increase risk of fall than outpatients and this can lead to serious injuries such as subdural hematomas, fracture or even death. Further, one aspect that makes fall prevention in healthcare a topic of concern is the fact that several strategies have been shown to help prevent falls in hospitals therefore, the need to evaluate and implement these strategies to improve patient outcomes. According to King et al., (2018), patient falls has a multifactor etiology that consists of three causes; the first one is environmental hazards; the second factor is physiological unanticipated factors such as fainting and the last one is physiological anticipated such as gait and fall history.
With the increase in awareness and research on patient falls, several evidence based interventions have been established that can help prevent patient falls in healthcare facilities. The first prevention intervention is familiarizing the patient with the hospital environment. Most patients fall because they are not familiar with some hazards that exist within the hospital environment. In addition, keeping the patient’s possessions within a safe reach is another preventive measure against falls. As a fact, some patients fall while looking for some of their essential items and this at times may lead to falls among frail and weak patients who cannot control themselves while in bed. Also, another evidence based fall prevention measure is the installation of sturdy handrails in hallways and bathrooms to offer support to patients while walking on when in the washrooms. Lastly another fall prevention measure is the installation and maintenance of the bedside alarms within the reach of patients to enable them signal when they are in need. Directions for Use of the Action Planning Tool Discussion
Staff education on patient falls
In nursing staff education is a critical ingredient in professional development as well as in enhancing competencies among healthcare providers. Staff education is the act of teaching healthcare providers or helping them to gain important skills, attitudes, knowledge and values that helps in making them more competent with current healthcare trends. Fall prevention training in particular helps healthcare staff to assess the risk factors as well as highlight appropriate measures to help minimize the occurrence of risks. In addition, staff education should as well encompass what steps and procedures to follow during a patient fall event. Fall prevention education helps empower individual healthcare providers, teams and the healthcare facility at large.
At the facility level, education helps to increase staff awareness on their responsibilities in identifying, reporting and preventing potential hazards that are within the facility that are fall risk factors. Further education can help train on appropriate use of safety and fall prevention facilities and equipment such as handrails and bedside alarms for patients. Further education helps the facility in identifying and providing the necessary assistance to patients with high risks. Lastly, education programs help the facility enhance surveillance for hazards such as poor lighting and spills.
At the level of healthcare team, staff education should help the healthcare providers acknowledge the importance of fall prevention as well as how to identify risk factors and conditions that can lead to falls. Further, they can learn to take the most appropriate action after as fall incidence.
At an individual level, staff education helps providers learn how to use the risk awareness tools as well as assessing patients prior to admission to establish the fall risk index. In addition, individual healthcare providers can learn to help patients in using available devices as well as seek for help when the effort of one caregiver is not enough. Directions for Use of the Action Planning Tool Discussion
Appendix I Action Planning Tool
| 1. Activities to ensure successful translation: | |||
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The following activities are essential in ensuring successful translation; ❑ Secure a project leader. ❑ Identify change champions. ❑ Consider whether translation activities require different or additional members. ❑ Schedule time to complete milestones. ❑ Identify critical milestones and related tasks. ❑ Identify observable pre- or post-measures. |
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| 2. Identify barriers to the success of the change, and then identify strengths that can be leveraged to overcome barriers. | |||
| Barriers | Resources or Strengths | Plan to Overcome Barriers by Leveraging Strengths as Appropriate | |
| Existing workload dissuades nurses from accommodating new projects. | The site leader and project mentor are ready to back the project implementation. Directions for Use of the Action Planning Tool Discussion
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Provide evidence-based research findings on the benefits of nursing staff education on fall prevention. | |
| Organizational leadership perceives the new project as a financial burden to the organization. | The organization has a collaborative culture that supports the implementation of staff education. | Provide evidence-based research findings on the benefits of nursing staff education on fall prevention. | |
| Financial challenges that can affect appropriate implementation. | Project sponsors can offer the required financial support. | Efficient use of available resources. | |
| Negative experience with a past change project that kills morale among nurses to adopt new projects. | The project outcome has already been established which is improvement in knowledge after attending education. It is expected that nurse’s attendance to the in-service classes on fall education will increase their understanding of risks, causes, prevention and management of falls at the emergency department.
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Discussing on the future prospects of new projects and outlining the causes of failure in previous projects with all stakeholders will help create confidence among nurses that new projects will succeed. | |
| The negative notion of a “super nurse” is a major barrier to the implementation of staff education on falls as junior nurses fear giving their opinions on the implementation mechanism. | Junior nurses are aware of the impacts of anxiety and fear of a “super nurse” hence, this helps them in making appropriate preparations. | According to Dang et al., (2022), the Hopkins Nursing Evidence-Based Practice model is a powerful problem-solving approach to clinical decision-making and is appropriate for individual or group use therefore; there won’t be any major influence of the super nurse on the outcome of the project. | |
| There is lack of motivation among nurses to participate in the education programs. | Participation in staff education helps in promoting professional development therefore; it is an opportunity for nurses to participate in the educational programs to improve on their professional skills and knowledge. Directions for Use of the Action Planning Tool Discussion | Nurses who participate in educational development programs should be awarded or even given promotions as a way of motivating them to actively engage in such activities. Giving promotions is an appropriate mechanism of motivating the nurses to participate in educational programs organized by institutions. | |
| Lack of knowledge on the use of technological platforms such as zoom for e-learning among elderly nurses. | The use of e-learning offers an opportunity for all nurses to participate in the staff education as opposed to the face to face learning because e-learning can be done at a time when at least all nurses are free and at their comfort including those in their homes. | The institutions should provide electronic gadgets such as smartphones to nurses who are using analogue mobile devices and train them on their uses to help them be at bar with the young generation nurses in terms of the use of technology because such devices offer platforms such as zoom that can help in the process of e-learning. | |
| There is a nursing shortage due to nurse turnover and an increase in the number of retiring baby boomers, therefore, multiple competing demands minimizes the time for nurses to participate in educational programs. | Staff education acts as a platform to bring together all nurses and address some of the challenges facing them. Therefore, besides being a forum for offering organizational education programs, it offers a forum to address some of the issues affecting nurses. | Organizations should address some of the pertinent issues affecting nurses in such forums including salary increments as a means of motivating their participation. | |
| 3. Consider whether or how this change will affect the following: | |||
| ❑Electronic health record- the electronic health records will be affected in that staff education will improve the quality of care thereby the quality index and ratings will improve.
❑Workflow- there will be in increase in workflow because staff education will minimize patient falls that brings unnecessary emergencies that limits or halts normal activities. ❑Policies and/or procedures- procedures will equally be affected as nurses will embrace evidence based interventions aimed at preventing patient falls. |
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| 4. Confirm support and/or availability of funds to cover expenses. (Check all that apply). | |||
| ü Personnel costs
ü Supplies/equipment ü Technology
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ü ❑Education or further training
ü ❑Content or external experts ü ❑Dissemination costs (conference costs, travel)
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| 5.Identifycriticalmilestonesandrelatedtasks: | ||||
| Effective leadership
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Preparing the Organization for Change | Organizational Culture that supports change. | Reviewing Progress and Analyze Results | |
| Organizational leadership is essential in ensuring that the project to be implemented has been understood by all stakeholders and that the necessary recourses have been harmonized as well as the stakeholders are committed towards enforcing the change (Laureani & Antony, 2018). | There is need to prepare the organization prior to implementing change to overcome resistance that may affect change implementation. | The organization should develop a culture that seeks feedback and employee engagement. | Reviewing progress and results helps to ensure transparency and accountability. | |
| The organization should constitute appropriate leaders who are goal oriented and who intend to meet organizational objectives. | There is need to develop a communication strategy to ensure that all stakeholders are aware of their responsibilities and duties in accomplishing the project. | The organization must establish a regular cadence of communication. Directions for Use of the Action Planning Tool Discussion | Also, reviewing progress and results allow for debate between stakeholders. | |
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Purpose of form
This form is used to guide you as you create an action plan.
Activities to ensure successful translation
These are all activities that must be completed as you plan the change. Consider pre- and post- observable measures that can be used to determine whether the change was successful. In addition, identifying critical milestones allows the team to see whether they are on track to accomplish the goals.
Identify strengths/resources and barriers to the success of the change
This analysis allows teams to identify barriers to implementation and potentially mitigate them using inherent strengths and resources. You may find specific challenges that will likely impact the ability to deliver on the action plan. Though these obstacles can get in the way, knowing about them up front is helpful so that you can engage support and create a plan to address them.
Consider whether or how the change will impact workflows and processes
Be mindful of the impact of the change downstream. For example, will changes need to be made to the electronic medical record to accommodate the change, or will this change impact the workflow of any other staff who have not been considered?
Confirm support and/or availability of funds to cover expenses
Use this as a guide to prompt thoughtfulness about financial obligations that may be a part of the rollout. Directions for Use of the Action Planning Tool Discussion
Identify critical milestones and related tasks
Consider all the categories of work (milestones) necessary to implement this change. What tasks must be accomplished first for each milestone in order to move forward? When must they be completed to stay on track? For example, if a milestone is to implement a protocol, list all tasks to accomplish it. Directions for Use of the Action Planning Tool Discussion