Deactivated Kelie Hein  2 posts Re:Topic 4 DQ 1 In considering this question, I have decided that understanding the local health care system to implement EBP is similar to understanding the patient to implement interventions.  The nurse must first assess the patient in order to implement appropriate interventions; local health care systems must be assessed in order to know where to start in implementing EBP. In discussing this concept with my mentor, she seems to agree.  One point she made is that we must first know the culture and level of EBP exposure, of the facility and staff.  If the facility has not had much exposure, implementation must "start with the basics at a much slower pace" (Rosshirt, 2017, n.p.).  After assessment, we can begin to determine interventions that will create staff buy-in, and lead to successful EBP implementation. In conducting research for this post, sources seem to agree with the position that the system must be understood in order to use relevant strategies and interventions.  Individual and organization culture are social systems that must be understood.  Change and EBP implementation are complex so communication is essential.  We must understand the current relationship between researchers and practitioners.  Knowledge gaps are how we determine relevant interventions.  Relevance is the first step to creating staff buy-in, and successful implementation.  Factors that may effect implementation include organization size, staffing levels, resources, and facility location; we must understand those things before we develop any interventions.  Titler (2008) posits that "the strength of evidence alone will not promote adoption" (pg. 11); we must make the evidence relevant to the system.  For example, "clinicians tend to be more engaged in adopting patient safety initiatives when they understand the evidence base of the practice" (Titler, 2008, pg. 12), as opposed to adminstrators forcing it upon them. What works for one agency may not work for another.  Warren, et al. (2016) educates that different systems have different barriers, and need different types and levels of support.  Demographics, suchs as Magnet designation, staff education level, and employee role, effect successful implementation of EBP practice.  We "must consider the work environment and the culture...across the system" (Warren, et al., 2016, pg. 22) as well, when developing strategies to implement EBP. In my change proposal, I will consider all of the things discussed in this post.  Motivators must be considered, and staff will want to know "so what?".  In assessing motivators and culture, it will put me in a better position to write a proposal relevant to my audience, which will inspire motivation, and lead to a more successful transition. Rosshirt, J. (2017). Personal correspondence. Titler, M. (2008). The evidence for evidence-based practice implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 7. Warren, e.

1. Deactivated
Kelie Hein
2 posts
Re:Topic 4 DQ 1
In considering this question, I have decided that understanding
the local health care system to implement EBP is similar to
understanding the patient to implement interventions. The
nurse must first assess the patient in order to implement
appropriate interventions; local health care systems must be
assessed in order to know where to start in implementing EBP.
In discussing this concept with my mentor, she seems to agree.
One point she made is that we must first know the culture and
level of EBP exposure, of the facility and staff. If the facility
has not had much exposure, implementation must "start with the
basics at a much slower pace" (Rosshirt, 2017, n.p.). After
assessment, we can begin to determine interventions that will
create staff buy-in, and lead to successful EBP implementation.
In conducting research for this post, sources seem to agree with
the position that the system must be understood in order to use
relevant strategies and interventions. Individual and
organization culture are social systems that must be
understood. Change and EBP implementation are complex so
communication is essential. We must understand the current
relationship between researchers and practitioners. Knowledge
gaps are how we determine relevant interventions. Relevance is
the first step to creating staff buy-in, and successful
implementation. Factors that may effect implementation
include organization size, staffing levels, resources, and facility
location; we must understand those things before we develop
any interventions. Titler (2008) posits that "the strength of
evidence alone will not promote adoption" (pg. 11); we must
make the evidence relevant to the system. For example,
"clinicians tend to be more engaged in adopting patient safety
initiatives when they understand the evidence base of the

2. practice" (Titler, 2008, pg. 12), as opposed to adminstrators
forcing it upon them.
What works for one agency may not work for another. Warren,
et al. (2016) educates that different systems have different
barriers, and need different types and levels of support.
Demographics, suchs as Magnet designation, staff education
level, and employee role, effect successful implementation of
EBP practice. We "must consider the work environment and the
culture...across the system" (Warren, et al., 2016, pg. 22) as
well, when developing strategies to implement EBP.
In my change proposal, I will consider all of the things
discussed in this post. Motivators must be considered, and staff
will want to know "so what?". In assessing motivators and
culture, it will put me in a better position to write a proposal
relevant to my audience, which will inspire motivation, and lead
to a more successful transition.
Rosshirt, J. (2017). Personal correspondence.
Titler, M. (2008). The evidence for evidence-based practice
implementation. Patient Safety and Quality: An Evidence-Based
Handbook for Nurses, Chapter 7.
Warren, et al. (2016). The strengths and challenges of
implementing EBP in health care systems. Worldviews on
Evidence-Based Nursing, 13 (1): 15-24.
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Deactivated
Kelie Hein
2 posts
Re:Topic 4 DQ 2
The two change theories I chose for this discussion post are
Lewin's change theory and Rogers' change theory. Lewin's
change theory is well-known, and often utilized, in nursing.
The three phases are unfreezing (recognizing a need for change
and finding motivation), moving (making the change), and
refreezing (normalizing the new status quo). Rogers' phases of
change include awareness, interest, evaluation, trial, and
adoption.
The two change theories are similar because the theorists
understood that change must be gradual, occurring in stages.
The theories also respect that people must realize the need for
change in the first place, and then have the motivation to do so.
In contrasting the theories,, Rogers and Lewin have different
phases. However, Mitchell (2013) provides a framework that
shows how the phases are comparable: Lewin's unfreezing
coincides with Rogers' awareness; moving with interest,
evaluation, and trial; and refreezing with adoption.
For me, the theory that makes the most sense for the
implementation of my change proposal is Rogers' change
theory. It makes sense to me because it is closely related to the

4. nursing process, something we utilize every day. Rogers'
awareness coincides with assessment and diagnosis; interest,
evaluation, and trial with planning, implementation, and
evaluation; and adoption also with implementation and
evaluation. By utilizing the nursing process, it already adds
relevance to implementation. With assessment and
diagnosis/awareness, I can determine the knowledge gaps and
needs. In terms of planning, implementing, and
evaluation/interest, evaluation, trial; I can plan interventions,
implement them, and evaluate for effectiveness. Adoption
occurs at the successful implementation of the change proposal.
My mentor most closely relates with Lewin's change theory.
She is a nurse residency progam facilitator, and must first
assess needs and motivators of the nurse residents. She then
mentors and facilitates change, and continues to provide support
as refreezing occurs. Part of the nurse residency program is the
completion of a EBP project, and Lewin's change theory is
utilized in those projects. There has been much success, with
some nurse residents even presenting their projects at national
conferences.
Mitchell, G. (2013). Selecting the best theory to implement
planned change. Nursing Management-UK, 20 (1): 32-37.
Rosshirt, J. (2017). Personal correspondence.
Deactivated
Wendy Santos
1 posts
Re:Topic 4 DQ 2
Social cognitive theory is based on the individual’s
ability to learn by direct experiences, interactions, observation,
and human dialogue (Rural Health Information Hub, 2017).
Social cognitive theory, states that behavior change is affected
by personal factors, and environmental influences (Rural Health
Information Hub, 2017). With social cognitive theory

5. individuals must believe that in order to perform the behavior
there is an incentive, and believe that behavior is a result of
consequences (Rural Health Information Hub, 2017). The
consequences would be considered as outcomes that could be
beneficial such as a longer life span or better quality of life, and
this positive belief would outweigh the negative expectations
(Rural Health Information Hub, 2017). The most important
characteristic of social cognitive theory is the belief in one’s
ability to succeed (Rural Health Information Hub, 2017). In
order to increase an individual’s self-efficacy, three methods
would need to be applied by providing clear instructions,
provide opportunity to train, and model the desired behavior
(Rural Health Information Hub, 2017).
The theory of reasoned action and planned behavior,
is determined by an individual’s intention to perform that
behavior (Rural Health Information Hub, 2017). With this
theory one must take into account the individual’s attitude
towards the desired behavior, and influences of the individual’s
social environment that shape the individuals attention (Rural
Health Information Hub, 2017). The theory of reasoned action
and planned behavior, is close to the concept of self-efficacy, as
behavioral change process is perceived control over skills,
opportunities, and resources (Rural Health Information Hub,
2017).
The comparison of these two theories is that a belief
in one’s ability to be successful, is the most important
characteristic in social cognitive theory, and must be present in
order for the results to be successful in change (Rural Health
Information Hub, 2017). Where theory of reasoned action and
planned behavior, is predicted by an individual’s attitude
towards the behavior, and believes if the individual has a
positive attitude, then the change in behavior is more likely to
increase the interventions (Rural Health Information Hub,
2017).
The theory that makes the most sense for my EBP is
the social cognitive theory, because of being involved with my

6. student’s daily, and long periods of time, gives me the
opportunity to allow the students to observe, interact, and vie
me serving as a role model of desired behaviors (Rural Health
Information Hub, 2017). By acting as a role model, you can
change and shape behaviors and lifestyle choices of the students
we serve. My mentor has used social cognitive theory daily to
shape health behaviors of her students daily in chronic disease
management. My mentored discussed that she uses the theory
daily with dietary observation, and changes of her students with
diabetes by reviewing the menu, and calculating proper
carbohydrate counts, and healthy meal choices, thus shaping the
behaviors of her students.
Rural Health Information Hub. (2017). Social Cognitive Theory.
Retrieved from https://www.ruralhealthinfo.org/community-
health/health-promotion/2/theories-and-models/social-cognitive
Rural Health Information Hub. (2017). Theory of Reasoned
Action/Planned Behavior. Retrieved from
https://www.ruralhealthinfo.org/community-health/health-
promotion/2/theories-and-models/reasoned-action
Deactivated
Wendy Santos
1 posts
Re:Topic 4 DQ 1
Local healthcare systems can play an important role
in implementing an evidence based practice for diabetes
prevention that is culturally appropriate, as local healthcare
systems are interested in protecting the health of the community
(CDC, 2016). Each state sub-awards half of the funds they
receive to support prevention activities in four to eight
communities to reach high-burden priority populations with the
largest disparities in diabetes (CDC, 2016). CDC funds 17 states
and 4 large cities to plan, implement, and evaluate type 2
diabetes prevention interventions addressing environmental,

7. health care system, and community-clinical linkage strategies
(CDC, 2016). Areas of focus from the local healthcare system,
are Increase coverage for evidence-based supports for lifestyle
change under the National DPP by working with network
partners, Increase engagement of community health workers to
promote linkages between health systems and community
resources for adults with prediabetes, and diabetes (CDC,
2016).
The anecdotal evidence provided by my mentor, was
the recommendations of the community preventive services task
force, which stated to engage community health workers to help
patients manage their diabetes, across all diversities (The
Community Guide, n.d.). Interventions engaging community
health workers in diabetes management are typically
implemented in underserved communities and can improve
health, reduce health disparities, and enhance health equity (The
Community Guide, n.d.). Community health workers are
frontline public health workers who serve as a bridge between
underserved communities and healthcare systems. Interventions
that focus on diabetes prevention aim to reduce one or more risk
factors for type 2 diabetes among members of the community by
improving their diet, physical activity, and weight management
(The Community Guide, n.d.). Community health workers may
work alone or as part of an intervention team comprising school
nurses, counselors, clinicians, or other health professionals (The
Community Guide, n.d.).
Healthcare systems together with local healthcare
communities can integrate the elements of community-based
programs that are effective across the continuum of the care to
enhance patient-centered outcomes, enable patient acceptability
and ultimately lead to improved patient outcomes, across all
diversities (Philis-Tsimikas & Gallo, 2014). Translating
evidence-based programs such as the Diabetes Prevention
Program into a community-based format can assist people at
risk for diabetes in developing and maintaining behaviors that
can prevent or delay the onset of diabetes (Philis-Tsimikas &

8. Gallo, 2014). Identifying additional community resources that
will assist patients in achieving their clinical and behavioral
goals are critical since these systems may be more easily
available to patients in their neighborhoods, and the local
healthcare system (Philis-Tsimikas & Gallo, 2014).
Strategies to address delivery of culturally
appropriate diabetes prevention programs can be identifying and
addressing language, numeracy, or cultural barriers to care;
integrating evidence-based guidelines and clinical information
tools into the process of care; and incorporating care
management teams including nurses, and local healthcare
systems working together in roles that strengthening the
intervention as well as delivering it (Philis-Tsimikas & Gallo,
2014).
Center for Disease Control [CDC]. (2016). CDC’s
Funded State & Local Programs to Address Diabetes. Retrieved
from
https://www.cdc.gov/diabetes/programs/stateandlocal/cdcfunded
.html
The Community Guide. (n.d.). Diabetes Management:
Interventions Engaging Community Workers. Retrieved from
https://www.thecommunityguide.org/findings/diabetes-
management-interventions-engaging-community-health-workers
Philis-Tsimikas, A., & Gallo, L. C. (2014). Implementing
Community-Based Diabetes Programs: The Scripps Whittier
Diabetes Institute Experience. Current Diabetes Reports, 14(2),
462. http://doi.org/10.1007/s11892-013-0462-0