Topic 6 Discussion Question 2

Nursing students research to gather evidence to support a particular theory. The gathered evidence can be statistically significant evidence or clinically significant evidence. This discussion will focus on the difference between the two pieces of evidence. Additionally, it will state how each of these findings can be used to advance an evidence-based practice project.

Statistically significant evidence indicates that the results of a particular study are reliable. Researchers frequently use the “P” value to measure statistical significance (Ranganathan et al., 2015). This value is the probability that the results of a particular study are based on chance. Statistically significant findings can be used to advance an evidence-based practice project. This type of evidence indicates if the findings of a particular study are credible enough to support an EBP.

On the other hand, clinically significant evidence portrays the impact of the findings on clinical practice. Evidence is considered to be clinically significant if the professionals in the field view a statistically significant finding to be substantial enough to be important in clinical practice (Schober et al., 2018).  Therefore, such evidence can be utilized to direct the provision of patient care. However, the clinical significance of findings is based on statistical significance. Therefore, a researcher must establish statistical significance before determining the clinical significance of the findings. Clinically significant findings can be used to advance an evidence-based practice project. This type of evidence indicates if findings are substantial enough to be guide practitioners in clinical practice. Therefore, using clinically significant findings improves the quality of care and the level of overall patient satisfaction.Topic 6 Discussion Question 2

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Statistically significant evidence and clinically significant evidence can be used to advance an evidence-based practice project.

References

Ranganathan, P., Pramesh, C. S., & Buyse, M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspectives in Clinical Research, 6(3), 169.

Schober, P., Bossers, S. M., & Schwarte, L. A. (2018). Statistical significance versus clinical importance of observed effect sizes: what do P values and confidence intervals really represent?. Anesthesia and analgesia, 126(3), 1068.

Evidence-Based Practice Proposal

Section A: Organizational Culture and Readiness Assessment

The “organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice” is the organizational culture survey tool that was utilized during the assessment. This tool has been shown to be effective in assessing and determining the organizational readiness to adopt evidence-based practice (EBP) (Yoo et al., 2019).

The survey findings show that the organization is ready to participate and adopt evidence-based practice. Nurses at the Managed Care organization are knowledgeable about EPB and are adequately equipped with EBP skills. The management and leadership in the organization are supportive of EBP and provide the necessary resources and finances to support EBP projects. The survey also identified that there are nurse scientists in the organization who generate evidence and actively search and locate research evidence. There are nurse practitioners who mentor nurses about EBP and support the implementation of EBP projects. There is the availability of computers, electronic devices, and the internet, where the staff can effectively search for evidence to support EBP.

However, the survey identified barriers to EBP, where some staff members were not ready to embrace changes and innovations due to time limitations and busy schedules. The staff members were generally resistant to changes. The resistance is attributable to heavy workload, and thus the staff may lack time to participate in EBP projects. This barrier can be addressed by using change champions to educate the staff members about the importance of EBP changes. Secondly, the organizational leadership should consider recruiting more staff members to reduce the workload among the staff. (Harper et al., 2017).Topic 6 Discussion Question 2

References

Harper M, Gallagher-Ford L, Warren J, Troseth M, Sinnott L &Thomas B. (2017). Evidence-Based Practice and US Healthcare Outcomes. Journal for Nurses in Professional Development. 33(4), 170-179.

Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness, and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS one, 14(12), e0226742. https://doi.org/10.1371/journal.pone.0226742

Section C: Solution Description

Type 1 Diabetes (T1D) is a chronic disease that limits the pancreas from producing enough insulin (Kahanovitz, Sluss & Russell, 2017). Insulin is an essential hormone in the body. It is required to allow sugar or glucose to enter body cells to produce energy. Although T1D is commonly diagnosed in childhood, its incidence has been rising in the elderly population. The condition predisposes them to hypoglycemia, which is associated with seizures, loss of consciousness, and altered mental status. An effective way to manage T1D in the elderly is the application of continuous glucose monitoring (CGM). According to Health Quality Ontario (2018), CGM is more effective than self-monitoring of blood glucose in T1D management. In light of this, the paper describes CGM as the proposed solution, explains how CGM is consistent with the organization’s culture, and expounds the expected outcomes. The paper also provides insights on methods used to achieve the outcomes and describes the impact of the outcomes.

Proposed Solution

Several factors, including certain viruses, age, environmental factors, and genetics, contribute to T1D. The condition may lead to neuropathy, heart attack, stroke, atherosclerosis, nephropathy, high blood pressure, blindness, skin and mouth infections, and damage to the foot. To manage type 1 diabetes and prevent the mentioned complications, the Managed Care organization should use a continuous glucose monitoring strategy on elderly patients.

Continuous glucose monitoring tracks blood glucose levels or blood sugar all day (Heinemann & Stuhr, 2018). An individual can see their glucose levels anytime when using a continuous glucose monitoring device. In healthcare organizations, CGM devices can be used to review how a patient’s glucose changes over a specified period; for instance, over a few days or hours to note the trends. As healthcare providers have glanced at a patient’s glucose levels in real-time, they can make more informed decisions, such as administering drugs, conducting physical therapy, or balancing the patient’s food (Sørgård, Iversen & Mårtensson, 2019). Elderly patients with T1D are unable to reach or maintain the recommended A1C targets. However, evidence shows that real-time CGM devices potentially help users enhance diabetes control as it reduces hypoglycemic and hyperglycemic exposures (Wood, O’Neal, Furler & Ekinci, 2018). The proposed solution is realistic in the Managed Care organization since staff members are willing to participate and adopt evidence-based practices. Additionally, the organization is knowledgeable and equipped with EBP skills.

Organizational Culture

The organization’s culture acknowledges the adoption of evidence-based practices that help improve the quality of life. Staff members are willing and have the knowledge required to implement the proposed solution. In the case of healthcare workers displaying resistance, the Managed Care organization has a change champions program that educates about the significance of EBP changes. Additionally, the CGM project is consistent with the organization’s resources in that leadership and management provide necessary finances and resources such as electronic devices, computers, and the internet in support of the EBP.Topic 6 Discussion Question 2

Expected Outcomes

Based on research, the use of continuous glucose monitoring in the organization will address the problem of older adults with type 1 diabetes. CGM will lower hypoglycemia, a crucial aspect of T1D management. Thus, minimizing complications associated with hypoglycemia. Also, since the elderly do not recognize signs and symptoms of low or high blood glucose levels, CGM will assist providers in determining the appropriate time for medication or balanced diets, hence increasing patient satisfaction.

Methods to Achieve Outcomes

Outcomes will be achieved by interprofessional collaboration in the treatment and management of elderly patients with T1D. The interprofessional collaboration will reduce workload or burn-outs when checking real-time data from CGM devices. CGM data will inform healthcare providers about the patient’s glucose trends and levels and the rate of change. Alarms will constitute the second method, through which healthcare providers will be alerted to administer subcutaneous insulin infusion or insulin injection therapies.

Outcome Impact

The outcomes of implementing continuous glucose monitoring will impact quality care improvement. Healthcare providers will provide care that abides by the six domains of quality that comprise timeliness, safety, efficiency, effectiveness, patient-centeredness, and equitability. Through CGM alerts, providers will provide medication on time and generate informed decisions on the effective and patient-centered approach in managing patients’ conditions.
References

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Health Quality Ontario. (2018). Continuous monitoring of glucose for type 1 diabetes: a health technology assessment. Ontario health technology assessment series, 18(2), 1.

Heinemann, L., & Stuhr, A. (2018). Self-measurement of Blood Glucose and Continuous Glucose Monitoring – Is There Only One Future?. European Endocrinology, 14(2), 24. doi: 10.17925/ee.2018.14.2.24

Kahanovitz, L., Sluss, P., & Russell, S. (2017). Type 1 Diabetes—A Clinical Perspective. Point Of Care: The Journal Of Near-Patient Testing & Technology, 16(1), 37-40. doi: 10.1097/poc.0000000000000125

Sørgård, B., Iversen, M., & Mårtensson, J. (2019). Continuous glucose monitoring in adults with type 1 diabetes: A balance between benefits and barriers: A critical incident study. Journal Of Clinical Nursing, 28(17-18), 3318-3329. doi: 10.1111/jocn.14911

Wood, A., O’Neal, D., Furler, J., & Ekinci, E. (2018). Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Internal Medicine Journal, 48(5), 499-508. doi: 10.1111/imj.13770

Section D: Change Model

The Selected Theoretical Framework: Roger’s Diffusion of Innovation Theory

The proposed EBP aims to introduce continuous glucose monitoring (CGM) strategy to decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions in the long-term among elderly patients with type 1 diabetes mellitus (T1DM). Roger’s Diffusion of Innovation Theory will be utilized to guide the implementation of the proposed change.

E.M. Rogers developed the Diffusion of Innovation (DOI) Theory in 1962 (Aizstrauta et al., 2015). It is ranked among the oldest theories in the social science field. This theory was based on communication regarding how a particularly new idea, behavior, or product diffuses or gains momentum after a certain period. Therefore, the idea spreads out over a particular social system or population. Consequently, part of a social system adopts the new idea, behavior, or product. Individuals tend to abandon their old behavior and practices and implement what is proposed by the new idea. However, people must consider the idea as new before adopting it. Diffusion is only possible if the new idea is considered as innovative.

The DOI theory is relevant to the selected project. The idea of using continuous glucose monitoring (CGM) strategy to manage diabetes among elderly patients with type 1 diabetes mellitus (T1DM) will diffuse through the healthcare facility. Care providers will consider the new idea as innovative, thus embracing it. Consequently, they will stop using the old strategies of managing diabetes among this patient population but instead adopt the new approach. This move will, in turn, decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions in the long-term among elderly patients with type 1 diabetes mellitus (T1DM).Topic 6 Discussion Question 2

Stages of the Diffusion of Innovation (DOI) Theory and their Implementation to the Proposed Project

The model constitutes of five major stages. These stages play a significant role in determining the new model’s impact on nurse practitioners in the healthcare facility. The first stage is innovators, which entails the practitioners willing to take risks and implement a new idea that they consider as innovative in their practices (Dang & Dearholt, 2018). The level of convincing required in this stage is not much. These nurses only need to understand the logic behind the new concept. Early adopters are the second stage of this change model. It involves practitioners involved in convincing and influencing other healthcare staff, including the management and opinion-makers about the new idea. They are willing to support the new concept since they know its effectiveness in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) in the long-term.

The third stage of this model is the early majority, which involves subordinate nurses. This group of practitioners requires evidence for them to adopt the new idea in their practices. The new idea’s previous success stories determine their willingness to embrace it Grinspun & Bajnok, 2018). They are convinced by success stories and evidence of the concept being effective before they adopt it. Therefore, statistical data about the effectiveness of continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) would be required to influence them to adopt the new approach.

The fourth stage of this model is known as the late majority, which involves skeptical nurses. This group of practitioners is only willing to adopt the new idea once it has gained popularity in the nursing practice, and many other nurses having already implemented it (Dibra, 2015). Therefore, success stories of the nurses who have used continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) are required to convince these nurses to adopt the new approach in their practices. The final stage is known as laggards. This stage involves a group of conservative nurses who are reluctant to adopt the new idea (Dearing & Cox, 2018). This group of practitioners is only willing to implement the new idea if no other option is available. In other words, they require pressure from workflow and procedures changes for them to embrace any new idea or behavior. Thus, influencing these nurses to adopt the continuous glucose monitoring (CGM) strategy in managing diabetes among elderly patients with type 1 diabetes mellitus (T1DM) would require workflow pressure.

Therefore, each stage of the Diffusion of Innovation (DOI) theory can be implemented in the proposed project. However, the results vary significantly depending on the implemented stage. More positive results would be obtained if stage one was implemented since the nurse would be willing to adopt the new idea without much convincing. The possibility of getting positive results declines once other stages of this change model are implemented. Consequently, very minimal positive results can be obtained once stage five is implemented. In this stage, nurses are unwilling to adopt the new idea unless they are pressurized to do so either by the management or by the workflow.Topic 6 Discussion Question 2

References

Aizstrauta, D., Ginters, E., & Eroles, M. A. P. (2015). Applying the theory of diffusion of innovations to evaluate technology acceptance and sustainability. Procedia Computer Science, 43, 69-77.

Dang, D., & Dearholt, S. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (3rd ed.). Sigma Theta Tau International.

Dearing, J, W & Cox, J, G. (2018). Diffusion Of Innovations Theory, Principles, And Practice. Health Affairs, 37(2):183-190

Dibra, M. (2015). Rogers’s theory on the diffusion of innovation-the most appropriate theoretical model in the study of factors influencing the integration of sustainability in tourism businesses. Procedia-Social and Behavioral Sciences, 195, 1453-1462.

Grinspun, D., & Bajnok, I. (2018). Transforming Nursing Through Knowledge: Best Practices for Guideline Development, Implementation Science, and Evaluation. Sigma Theta Tau International. Topic 6 Discussion Question 2