This document discusses preparing an intensive care unit for a practice change to early patient mobilization. It assesses factors that influence readiness for change, including leadership support, resources, and staff buy-in. Barriers like attitudes, beliefs, and lack of skills are addressed. Strategies are proposed to enhance consistency in mobilization through training, communication, and stakeholder involvement. The goal is to improve patient outcomes by reducing length of stay and complications through more effective implementation of evidence-based early mobilization.

1. 1
4
Application 1: Identification of a Practice Issue for the
Evidence-Based Practice (EBP) Project
Note: Have an APA Level 1 header for Each Area Noted below
in Blue (a level 1 header is centered, bolded, using upper and
lower case letters—see APA manual area 3.03)
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue
Summary of practice issue. (Note: The issue you select must be
suitable for completing the entire EBP Project in 8410.)
2
1.5
Header: Exploration of Research Literature
Exploration of the research literature on
this issue.
3
2.75
High level of scholarship commensurate with doctoral level
evident
1
1
Potential areas for losing points:
Grammar, Spelling, and APA errors
Up to 2 pt. deduction
-0
Went Over Page Limit (2 pages max)

2. Up to 2 pt. deduction
-0
*Improper credit & citation issue
1-6 pt. deduction
-0
Sent back to re-do
1 pt deduction
-1
Late Submission
(posted X.XX.20XX, due X.XX.20XX )
20% deduction (1.2 pts) per day late (per syllabus)
n/a: posted on time
6 Total Points possible
4.25 Total Points Earned
In this assignment you were consider a practice issue at your
practicum site, summarize that issue, and outline the research
literature associated with it. Please see my edits/notes below.
Good job!
Some things for ALL to remember/consider (you may have done
this already-this is just a gentle reminder):
· Use a heading for each of the main areas noted in the
assignment grading rubric for all assignments (I posted the
rubrics in the announcement area-the headers to be used are in
blue font).
· Related to your topic of interest, does the agency have a
process/policy/clinical practice guideline/practice
approach/nurse education/patient education in place already?
All of them? Are they being implemented according to the best
evidence? If not, could that be an appropriate focus for your
project?
· How will you go about updating the
processes/policies/education materials so they are more
consistent with national recommendations/guidelines/research?

3. · What is your revised PICOT for this EBP (PICOT was not a
mandatory part of the paper—but it is nice to tie this all
together at the end of your paper with that information).
· *All students should review their Safe Assign reports
regularly (use the draft folders to run a report prior to
submitting your assignment). You should not have more than 3
words in a row that are the same as another source unless you
use quotation marks and properly cite that source (with author,
year, and page number). You need to reword your paper to
avoid this. You should reserve using quotations for the rare
instances wherein you cannot reword information without losing
meaning. Also, you need to cite each sentence with information
that a layperson would not know. There are many resources
online that you can use to review proper citation and common
plagiarism errors. All students should review the Walden
Plagiarism Tutorial at
http://academicguides.waldenu.edu/ASCtii/ASCtiitutorial.
Please explore these topics.
Thank you! Tracy

4. Practice Issue for the Evidence-Based Practice (EBP) Project
Anne Marie WouapetName
Walden UniversitySchool
NURS 8410 Section 01, Best Practices in Nursing
SpecialtiesClass
September 12, 2018Date
Summary of Practice Issue
Patients in need of critical care have a lot of demands for
the safety and quality of their care to be maintained. One
clinical issue that has been identified in care for critically ill
patients is hospital admission over an extended period. Several
patients in the intensive care unit (ICU) are admitted for too
long leading to negative impacts on their experiences and health
outcomes. Delayed discharge of ICU patients is a problem that
affects many healthcare facilities. Many researchers have
studied the effects of delayed discharge, and some studies
indicate a close relationship between delayed discharge and
factors such as hospital readmission and patient mortality.
Throughout this paragraph—you have made several statements
that are not well-known concepts by a lay person—thus you
need to cite each of those sentences. This evidence-based
project aims to prove that early mobilization of ICU patients
can speed up their recovery process and lessen the time of
admission leading to positive patient outcomes and experiences.
Comment by Tracy Wright: This is not in line with an EBP
project. EBP project are not research…they are not to “prove”
anything. Rather, they take high-level and multi sources of
research that have already proved a concept and implement that
evidence in a practice setting.
Exploration of Research Literature
A longer length of stay has been confirmed as a serious practice
issue in healthcare by numerous studies—you can’t say this
without giving citations. For example, Schneider et al. (2012)
conducted a study investigating how a longer hospital stay
affected patients of colon cancer who had undergone a

5. colorectal surgery. The study found that the length of stay is
directly proportional to readmission and mortality rates
(Schneider et al., 2012). This evidence shows that it is crucial
to develop strategies to speed up patients' recovery process to
reduce their admission length of stay in critical care. This
project recommends that early mobilization of the patients be
used as a strategy to reduce the length of ICU stay and in turn
cause positive patient experiences and outcomes.
This intervention has been studied in the past and found to
have positive effects on critical care patients. Adler and Malone
(2012) conducted a study that found that enhanced physical
activity in critical care patients improves the recovery process.
Similarly, Denehy, Lanphere and& Needham (2017) evaluated
various positive effects that mobilization of ICU patients can
have on their health outcomes. These studies confirm that the
proposed intervention for this project will yield positive results.
This literature evidence also shows that early mobilization of
patients can aid in quick recovery. Nonetheless, this method has
been applied in my clinical area; however, but there has not
been any significant change in the patients' speedy recovery,
and hence, length of ICU stays. Therefore, there is a need to
implement some changes in the way this intervention is
implemented to yield positive results.
What makes this intervention different is that it puts focus on
the challenges and barriers that have prevented previous
mobilization strategies from being effective. Holdsworth (2015)
found that the perceptions of clinicians and the limitation of
staff members prevent consistent mobilization of patients. This
project will pay attention to these barriers by focusing on
assigning specific health workers to critical care patients and
educating them on the importance of the process so that they
can do it efficiently. The consistency of this intervention is
likely to yield better results that have been done in the past.
Conclusion
It is essential to reduce the length of stay for ICU patients to
increase the rate of positive outcomes in critical care. As this

6. paper demonstrates, research shows that longer hospital
admissions are associated with adverse outcomes. This
evidence-based project proposes a strategy of early patient
mobilization to speed up the recovery process so that patients
can be ready for discharge within a shorter period.
References
Adler, J., & Malone, D. (2012). Early mobilization in the
intensive care unit: a systematic review. Cardiopulmonary
physical therapy journal, 23(1), 5. Retrieved from: https://eds-a-
ebscohost-com.ezp.waldenulibrary.org
Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten
reasons why ICU patients should be mobilized early. Intensive
care medicine, 43(1), 86-90. doi:10.1007/s00134-016-4513-2
Holdsworth, C., Haines, K. J., Francis, J. J., Marshall, A.,
O’connor, D., & Skinner, E. H. (2015). Mobilization of
ventilated patients in the intensive care unit: An elicitation
study using the theory of planned behavior. Journal of critical
care, 30(6), 1243-1250. doi: 10.1016/j.jcrc.2015.08.010
Schneider, E. B., Hyder, O., Brooke, B. S., Efron, J., Cameron,
J. L., Edil, B. H., ... & Pawlik, T. M. (2012). Patient
readmission and mortality after colorectal surgery for colon
cancer: impact of length of stay relative to other clinical
factors. Journal of the American College of Surgeons, 214(4),
390-398. doi: 10.1016/j.jamcollsurg.2011.12.025
Quality Improvement and Patient Safety Initiatives
NAME
SCHOOL
DATE

7. 1
The Practice Issue
The quality and safety of care for intensive care patients
Patients are admitted for extended periods of time
Evidence shows that this increases chances of negative
outcomes.
Early mobilization can be used to increase chances for positive
outcomes
Some barriers and challenges influence the implementation of
the new practice approach.
This presentation develops strategies to deal with the barriers to
improve patient safety.
The practice problem that requires intervention is the care for
patients in the ICU. The patients in intensive care are admitted
for extended periods of time. According to research, the length
of stay in the ICU increases the chances of negative outcomes.
Patients tend to have a higher chance of readmission, mortality,
and negative experiences (Schneider et al., 2016). The
intervention that is recommended to deal with this problem is
early mobilization of patients. Early mobilization reduces issues
such as muscle atrophy and speeds up the recovery process.
Therefore, patients have a higher chance of positive outcomes
when this recommendation is implemented. However, there are
some challenges and barriers that prevent the successful
implementation of this practice approach. The purpose of this
presentation is to demonstrate how quality can be improved to
enhance patient safety. The presentation will evaluate some of
macro and micro systems that effect the implementation of the
intervention and the strategies that can be used to increase
chances of success.
2

8. Macro Systems
Unavailability of resources
There may be a limitation of resources to implement the new
approach successfully.
Inadequate staff members
Mobilization of patients may require new nurses.
Lack of knowledge and skills on mobilization
Nurses lack adequate training on effectively mobilizing
patients.
The macro factors that influence the successful implementation
of the new practice approach include the unavailability of
adequate resources, inadequate staffing, and the lack of
knowledge and skills to effectively mobilize the patients as
recommended. First, the unavailability of resources could limit
the effective implementation of new standards of practice that
will help to improve patient safety. Secondly, the standard of
mobilizing patients will require more working time for nurses.
There is already a limitation of healthcare professionals. Adding
more work will increase the problem of burnouts, which reduce
the quality of care. Therefore, there may be need to add more
personnel. Lastly, effective mobilization of patients may require
training to be done effectively. Patients in the ICU are quite
delicate. It is important that the nurses are equipped with the
rights skills to manage such responsibilities. These are all
macro factors that need to be handled on the organizational
level.
3
Micro Systems
Personal beliefs and attitudes

9. Nurses’ beliefs and attitudes on early mobilization will affect
how effectively they perform the intervention.
Willingness to improve patient safety
The nurses must naturally be willing to engage in the new
practice model for effectiveness to be achieved.
Personal beliefs on capabilities
It is important that professionals believe in their capabilities to
make a difference to the patients.
The micro factors are issues at the individual level that can
affect the implementation of the new practice approach.
According to Maclusky and Middleton (2010), transferring
knowledge to practice can be challenging because of factors on
the individual level such as personal beliefs and attitudes
towards the new practice approach. The micro factors that can
affect this project include personal beliefs and attitudes,
willingness to improve patient safety, and the professionals’
personal beliefs of their capabilities. Nurses’ beliefs and
attitudes on early mobilization will affect how effectively they
perform the intervention. If nurses believe that they are actually
making a difference then they are more likely to participate in
the change. The nurses must naturally be willing to engage in
the new practice model for effectiveness to be achieved. It is
important that professionals believe in their capabilities to make
a difference to the patients. They should understand the ways in
which they are improving patient safety by practicing the
recommended approaches.
4
Strategies for Resolving the Issue
Involving external stakeholders
Implementing this approach will need support from external
stakeholders to help with the funding.

10. Training and development
Nurses need to be trained to increase understanding and
confidence in the practice approach.
Open communication
There should be open and direct communication of information
on the change to increase engagement.
The only way to achieve success when implementing new
evidence based practice approaches is to develop strategies to
deal with the challenges and barriers. The following are the
strategies that can be used to deal with the barriers and
challenges to this implementation. The first strategy is
involving external stakeholders. Implementing this approach
will need support from external stakeholders to help with the
funding. There are governmental and non-governmental
organizations that can assist in the funding of such a project to
enhance patient safety. The second intervention is training and
development. Nurses need to be trained to increase
understanding and confidence in the practice approach. Training
is one of the important strategies required in managing change
because employees need to understand the new practice
approaches before they can participate. Lastly, open
communication is required for the success of this project. There
should be open and direct communication of information on the
change to increase engagement.
5
How it will Improve Quality and Patient Safety
Increased consistency in patient mobilization
Increased speed of recovery
Reduced length of stay
Improved patient outcomes;
Lower readmission rates
Lower mortality rates

11. Dealing with the barriers to the implementation of this evidence
based approach will be helpful in improving care for the
patients in intensive care. One of the changes that will be
enabled is increased consistency in patient mobilization. Once
the patients are mobilized more effectively, they will have a
faster rate of recovery. Research shows that early mobilization
is an effective way of improving the recovery process for the
people in intensive care (Denehy, Lanphere & Needham, 2017).
There will also be reduced lengths of stay because of the faster
recovery processes. In the end, the patients will end up having
better outcomes. The rates of readmission will be reduced
significantly. Similarly, this practice approach can help to
reduce the mortality rates for the ICU patients. Therefore, it is
important to ensure that the barriers to the implementation of
this project are effectively dealt with for the benefit of the
patients in intensive care.
6
References
Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten
reasons why ICU patients should be mobilized early. Intensive
care medicine, 43(1), 86-90.
McCluskey, A. & Middleton, S. (2010). Delivering an
evidence-based outdoor journey intervention to people with
stroke: Barriers and enablers experienced by community
rehabilitation teams. BMC Health Services Research, 10(18).
doi: 10.1186/1472-6962-10-18.
Schneider, E. B., Hyder, O., Brooke, B. S., Efron, J., Cameron,
J. L., Edil, B. H., ... & Pawlik, T. M. (2012). Patient
readmission and mortality after colorectal surgery for colon
cancer: impact of length of stay relative to other clinical
factors. Journal of the American College of Surgeons, 214(4),

12. 390-398.
Running head: EVIDENCE-BASED PRACTICE 1
EVIDENCE-BASED PRACTICE 2
Preparing for Change
Student’s Name
Institution
Date
Preparing for Change
Even when a new practice approach has been approved for
implementation, it may still fail to materialize because of poor
management of the change process. It is important to analyze
the organization’s readiness for change, deal with the barriers to
change, and develop the best framework to implement a given
change process (Darling, 2016). The following is an analysis of
my organization’s readiness to change and the specific
strategies to be used to ensure that the proposed practice change
is successful.
Assessing Readiness for Change
There are various factors that either facilitate or limit my
organization’s readiness for change. One of the factors that
makes the organization ready for change is the great leadership.
Leadership plays a big role in facilitating change. Once the
leaders believe in the need for change and are willing to
motivate the rest of the organization, it is easier to implement

13. the new practice approach and inspire other people to join in
(White, Dudley-Brown & Terharr, 2016). Another facilitator of
change in the organization is good communication.
Communication is an essential component of a successful
change process. There needs to be good communication of the
need and the benefits of the change process so that all the
members of the organization can understand the purpose of the
change process and be willing to be a part of it,
A major barrier for the change process in this organization
is the financial obligations for implementing the new practice
standard. There will be need to invest in a new workforce to
facilitate effective mobilization of the patients. There may be a
limitation of financial capabilities that may influence the
successful implementation of the project. Another barrier is the
possibility of resistance. Changing from one practice approach
to another may attract resistance because people may want to
stick to the usual ways of operations.
Theory/Framework to Guide Change Efforts
The change process for this project will be facilitated by the
Theory of Reasoned Action. This theory believes that people’s
actions are rational. Behavior is linked to the beliefs, attitudes,
and intentions of people towards a given action (White, Dudley-
Brown & Terharr, 2016). Therefore, the organization will
facilitate the change by developing a model to reason with the
employees to show them that changing to the new practice
approach is a reasonable thing to do.
The organization will begin by changing the beliefs and
attitudes of the workers by showing them evidence of the poor
health quality of the ICU patients in the old models of
operations. They will later change the intentions of the workers
by showing them a new model of operation that they can use to
improve the quality of care they provide to the patients. This
will help to change their behaviors when helping intensive care
patients, leading to the creation of a new norm in the care of
these patients.
Strategies to Address Barriers

14. The strategy to deal with the resistance to change is to have
open communication of details pertaining to the new practice
approach (Smith, Rice & Agrell-Kann, 2015). It is important
that all workers understand the importance of the change
process for them to want to participate. As explained by the
theory of reasoned action, people are able to change their
behaviors when they have altered their attitudes and beliefs
towards the change efforts.
Summary
The change management process is essential in implementing a
new practice approach. As this evaluation shows, it is important
to analyze the readiness for change to implement the best
change process. The theory of reasoned action will be used to
implement my project by influencing the workers’ perception to
change their behaviors.
References
American Diabetes Association. (2017). 1. Promoting health and
reducing disparities in populations. Diabetes
Care, 40(Supplement 1), S6-S10.
White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016).
Translation of evidence into nursing and health care practice
(2nd ed.). New York, NY: Springer.
Darling, F. (2016). Practitioners’ views and barriers to
implementation of the Keeping Birth Normal tool: A pilot study.
British Journal of Midwifery, 24(7), 508-519.
Smith, E.L., Rice, K.L., & Agrell-Kann, M. (2015). Improving
quality outcomes using a champion model for ancillary nursing
staff, Journal of Continuing Education in Nursing, 46(12), 539-
541
8410 Application 4: Planning for Change, Implementing and
Evaluating EBP Projects (6 points)This paper should be written
in APA format with a minimum of 8 scholarly references. All
level 1 and 2 headers must be as in table below. The paper must
also include an introduction ending with a purpose statement
and a conclusion as per APA guidelines. Do not go over 8-page.

15. The paper must be cited often and throughout.
Note: Have an APA Level 1 header for each area noted below in
blue (a level 1 header is centered, bolded, using upper and
lower case letters—see APA manual area 3.03)
Use the following THREE AS LEVEL 1 HEADERS (if not used,
the paper will be returned to be revised and points will be
deducted):
· Planning for EBP Change
· Implementing EBP Change
· Evaluating EBP Change
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Planning for EBP Change
Planning for Change
· Analyze the impact of implementing change in your practice
environment, including the factors that need to be considered
regarding stakeholders and end users.
· Summarize the methods you would use to ensure that those are
adequately addressed.
2
Header: Implementing EBP Change
Implementing EBP Projects
· Identify the desired outcomes of your EBP Project.
· Describe any macro or micro systems issues that may inhibit
implementation and strategies for resolving those issues.
· Explain how resolving your EBP Project will improve quality
and patient safety.

16. 2
Header: Evaluating EBP Change
Evaluating EBP Projects
· Describe evaluation strategies.
· Formulate new practice guidelines based on the possible
results of the evaluation of outcomes.
· Describe, if appropriate, new standards of care relevant to the
new practice guidelines.
2
Potential areas for losing points:
Returned for Revisions
1 pt. deduction
Grammar, Spelling, and APA style errors
Up to 2 pt. deduction
Went Over Page Limit (4-8 pages max)
Up to 2 pt. deduction
Improper credit & citation issue (see Safe Assign Report)
1-6 pt. deduction
6 Total Points Possible
Total Points Earned