Evidence-Based Practice Project Proposal

The PICOT question for this EBP project is: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)?

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments into a 4,500-5,000-word professional paper.
Final Paper

ORDER A PLAGIARISM-FREE PAPER HERE

The final paper should: Evidence-Based Practice Project Proposal
Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper

The main body of your paper should include the following sections:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model, or Framework
Implementation Plan
Evaluation Plan

General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

According to Li et al. (2019), evidence-based practice (EBP) is significant in enhancing the quality of patient care, healthcare safety, and patient outcomes because it involves the use of the best available evidence based on scientific studies. The evidence is significant in achieving informed decision-making and efficient and effective patient care. This paper intends to synthesize the various elements of the change project, including the major concepts and ideas of each section. The paper contains a detailed discussion of the problem statement for the project, problem statement, organizational culture, readiness of the hospital for change, literature review, change model to be used, plan for change implementation, and evaluation plan.

Problem Statement

The problem to be addressed in this project is related to inadequate knowledge among patients with cardiovascular diseases that impede the improvement of patient outcomes. In the author’s healthcare organization, patients with cardiovascular diseases do not receive adequate education about their condition and its management. The problem with inadequate knowledge among patients with cardiovascular diseases is that they are unable to make informed decisions about their care. Thus, the lack of knowledge has led to poor disease management and negative health outcomes. Specifically, standard health education delivered to patients with cardiovascular diseases does not adequately equip patients with sufficient knowledge, skills, and attitude to actively participate in their care. Cardiovascular diseases (CVDs) include disorders that affect the heart and blood vessels. Such diseases include coronary artery disease, hypertension, heart failure, unstable angina, and stroke.

In the past six months, the healthcare organization has witnessed increased readmissions, visits to the acute care department, and mortality related to poor self-management among patients with cardiovascular diseases. The project manager and members of the quality improvement team noted that standard health education delivered to patients with CVDs at the clinic and inpatient care settings does not significantly improve patient knowledge, self-management skills, and care outcomes among patients with the conditions. Specifically, the team noted that patients have inadequate information and skills about self-management, detecting disease or undesirable symptoms, secondary prevention, and adherence to the treatment regimen. The statistics are unacceptable, and the healthcare organization requires prompt and effective management of the problem.

At the healthcare organization, health education is delivered by any care provider who handles patients with CVDs. The lack of coordination and planning of the patient education sessions leads to inadequate delivery of information. Thus, patients have low knowledge about the illness affecting them and are less equipped to prevent complications from poor management. Besides, patients with CVDs demonstrate poor progress and care outcomes. The evidence-based practice project seeks to solve the problems of low knowledge levels and subsequent poor patient outcomes using sound evidence from research studies. The PICOT question for the project is – among patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)?

Organizational Culture and Readiness

The project manager examined the healthcare organization’s culture and noted that the facility has a culture of safety that guides each care to deliver safe and effective interventions. Thus, culture influences the interventions chosen and delivered by every care provider. Each employee at the healthcare organization is dedicated to preventing harm to self and patients seeking care at the facility. The facility boosts itself in achieving the goal of preventing several nosocomial diseases. The recently increased incidences of poor outcomes among patients with CVDs indicate the need to extend the safety culture to curb the problem. The healthcare organization promotes the safety culture by facilitating continuous professional development programs, encouraging staff members to adopt the culture, and rewarding safety champions, among other interventions. Also, efforts to promote the culture include the adoption of evidence-based practices and facilitating change projects that seek to adopt EBP. Thus, the current change project would be a beneficiary of the safety culture and intentions of the top management to support EBP change projects. Nurses, dieticians, and physicians are self-motivated and work in collaboration to offer high-quality services to patients put under their care.

Nurses make up the majority of healthcare professionals in the healthcare organization and are committed to engaging in research programs to improve care. Generally, the nurses in the facility are passionate about EBP because they acknowledge its significance in improving the quality of care and patient outcomes. Nurses are also actively involved in research to enhance health outcomes. The availability of a library with rich access to books, scholarly articles, and journals is an additional resource to help in the literature search. Thus, the organization and members of staff are ready to adopt EBP and tailor it to daily care delivery. It is worth noting that the organization has a distinctive culture in which members of staff strive to develop their competencies and avoid mediocrity in their duties.

A few human and organizational challenges are potential barriers to project implementation at our hospital. Such potential barriers include tight schedules for nurses, insufficient time to engage in project activities, inadequate experience and knowledge with EBPP, a lack of time, tight work schedules, and insufficient EBP experience among staff members. Recently, high patient acuity in most care settings, including clinics serving patients with CVDs, means that most nurses are on tight work schedules. However, the project team will engage the top management and nurse managers to redeploy more nurses in inpatient and outpatient care settings that handle patients with CVDs to promote the project’s success. Overall, the healthcare organization I ready to adopt the change. Healthcare practitioners, the hospital administrators, and leadership intend to support the discovery and execution of preventive measures to curb the problem. Besides, the hospital’s leadership supports EBP as the most sound strategy to y improve the quality of care and health outcomes. Thus, the organization is prepared to facilitate the complete adoption of nurse-led patient education to improve care outcomes among CVDs patients.

Literature Review

The project manager made a literature search in PubMed, Cochrane Library, and CINAHL databases to retrieve current evidence regarding the adoption of nurse-led education on patients with CVDs. Using keywords such as nurse-led patient education, patient outcome, patients with cardiovascular diseases, standard patient education, and clinical outcomes, the project manager yielded 12 articles. The yield was achieved after applying the set inclusion criteria comprised of studies written in English and published in the last five years.

One of the studies included in the review was a randomized controlled trial by Bagheri et al. (2022). Their study aimed to investigate the significance of nurse-led counseling and education on individuals’ belief in their capacity to execute behaviors required to produce better clinical outcomes among patients with the acute coronary syndrome. The researchers hypothesized that nurse-led counseling and education using a person‐centered care approach had effects self-efficacy of patients with the acute coronary syndrome. The study was conducted in a clinical setting in an Iranian referral and teaching hospital, with a sample size of 120 patients with acute coronary syndrome. The study used a randomized control design, whereby 60 patients were randomly assigned to the intervention group – those who received counseling and education; and 60 to the control group – those who did not receive counseling and education (Bagheri et al., 2022)Evidence-Based Practice Project Proposal.

The study found that self-efficacy increased for those who received counseling and education, but there was no difference between the groups in terms of demographic variables. There was also a trend towards increased self-efficacy over time for those who received counseling and education. The study found that a variety of factors, including age, sex, education, and social support, influenced self-efficacy (Bagheri et al., 2022). The researchers recommended that intervention programs be implemented to improve and quicken cardiac self‐efficacy among acute coronary syndrome patients. Besides, the intervention requires a higher nurse‐patient ratio and staff training. Bagheri et al. (2022) also recommend healthcare organizations analyze the costs and benefits when implementing such projects to improve the care quality. Overall, the article supports the proposed EBP practice project proposal that focuses on increasing self-efficacy and other patient outcomes for patients with CVDs.

ORDER HERE

Another RCT by Cui et al. (2019) reviewed in this paper hypothesized that a nurse-led structured education program would improve self-management skills and reduce hospital readmissions in patients with chronic heart failure. Thus the study intended to determine the impact of nurse-led education on self-management skills, symptom control, and hospital readmissions in patients with chronic heart failure. The researchers randomly assigned the ninety-six participants into either intervention or control groups. The setting of the study was a rural Chinese population, whereby patients with CHF were recruited into the program. The intervention group was managed on a structured education program, while the control group was put on standard clinical guidelines without nurse-led education. The methodology also involved the evaluation of medication adherence, symptom control, social support, and dietary changes in the twelfth month after the intervention.

The key findings of the RCT by Cui et al. (2019) were that the nurse-led structured education program improved self-management skills and reduced hospital readmissions in patients with chronic heart failure. The rate of readmission was lower in the intervention group (10.4%) than in the control group (27.1%). Besides, the average score of symptom control, dietary modification, adherence to the treatment regimen, and social support was higher among participants in the intervention group than those in the control (p<0.01). The authors of this study recommend that nurse-led structured education programs be implemented in hospitals to improve self-management skills and reduce hospital readmissions in patients with chronic heart failure (Cui et al., 2019). The study provides evidence that a nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure. This information supports the EBP practice project proposal to improve self-management skills in patients with chronic heart failure.

Nurse-led education could be significant in reducing risk for patients with CVDs such as heart failure. Son et al. (2020) conducted a systematic review of studies and meta-analyses to determine whether or not nurse-led heart failure self-care education effectively improves heart failure patients’ health outcomes. The authors hypothesized that the education would be effective and improve health outcomes. The study was a systematic review and meta-analysis whereby the researcher conducted a literature search in SCOPUS, PubMed, Embase, Cochrane Library, and Web of Science. The researchers employed random-effects methods to assess and analyze each eligible study independently.

Data analysis for the eight studies reviewed in the systematic review revealed that nurse-led heart failure self-care education was effective in significantly improving heart failure patients’ health outcomes and reducing all-cause readmissions (RR = 0.75, 95% CI). According to Son et al. (2020), the intervention significantly reduced readmissions caused by heart failure (RR = 0.60, 95% CI) and all-cause mortality (RR = 0.71, 95% CI). The researchers recommended that nurse-led heart failure self-care education be offered to all heart failure patients in order to improve their health outcomes. Besides, the education should be tailored to the individual patient’s needs and delivered in a way that is comfortable and easy to understand. Further research is needed to explore the potential benefits of nurse-led heart failure self-care education on other health outcomes.

Awoke et al. (2019) also conducted a study that sought to determine the impact of nurse-led education on care outcomes for patients with CVDs. The study included 29 patients with heart failure and accessing care from an urban hospital in North Eastern part of the USA. The researchers implemented a systematic education led by nurses that adhered to practice guidelines. Patients in both intervention and control groups completed the Dutch Heart Failure Knowledge and Self-care Heart Failure evaluations. The study’s key findings were that nurse-led education resulted in improved knowledge and self-care practices and a reduction in readmission rates for heart failure patients (Awoke et al., 2019). The study provides evidence that nurse-led education effectively reduces readmissions and improves knowledge and self-care measures; hence supporting the current EBP project.

A nurse-led education program could also significantly improve patients’ outcomes with atrial fibrillation. Hickey et al. (2019) conducted a study that sought to investigate the impact of nurse-led education programs on the outcomes of patients’ cardiac lifestyles among atrial fibrillation patients. The sample size was 53 patients with the condition treated in a healthcare facility at Columbia University. The methodology included completing a pre-implementation test, providing telehealth communication, conducting nurse-led interviews, and providing learning resources to the participants. The researcher chose the intervention to help improve self-management and behavior modification. The study outcome included a mean of 3-lb ± 13-lb decrease in body weight and an average of 5mmHg reduction in systolic B.P (Awoke et al., 2019)Evidence-Based Practice Project Proposal. Overall, the study supports the current EBP and is vital in answering the PICOT question because it affirms that nurse-led education is effective in enhancing clinical outcomes for patients with CVDs

More evidence from current scientific literature backs nurse-led education to improve care outcomes for patients with CVDs. Nurmeksela et al. (2021) conducted a study on nurse‐led counseling for coronary artery disease patients. The study aimed to assess whether nurse‐led counseling effectively reduces cardiovascular risk factors, reduces heart disease‐related symptoms, and improves patient outcomes. The methodology involved nurse-led educational and counseling sessions that took two to four weeks before discharge from the hospital. The study was conducted over a 1‐year period, including follow-up for the sample population of 78 patients. Follow-up was facilitated by the use of phone calls whereby nurses would communicate with the patients. Data were collected through clinical assessments, self‐reported questionnaires, and Health Assessment Questionnaires. The study found that nurse‐led counseling effectively reduced cardiovascular risk factors and heart disease‐related symptoms. Data analysis also revealed that patient outcomes were better when nurse‐led counseling was provided in addition to usual care.

The researchers also analyzed the impact of nurse-led education on lifestyle changes and risk reduction. The intervention caused a significant reduction in risk reduction and waist circumference (Nurmeksela et al., 2021). Besides, nurse-led education improved total cholesterol levels, low-density lipoproteins, and triglycerides. The article provides support for the use of nurse‐led counseling as an effective means of reducing cardiovascular risk factors and heart disease‐related symptoms in patients with coronary artery disease. The researchers recommend that nurse‐led counseling be offered as part of usual care for coronary artery disease patients. This would provide better patient outcomes and reduce cardiovascular risk factors. Thus, the study by Nurmeksela et al. (2021) is significant in informing the current EBP project and answering the PICOT question by providing evidence that nurse‐led counseling is moderately effective in reducing cardiovascular risk factors and heart disease‐related symptoms.

Rice et al. (2018) conducted a systematic review of the literature to determine the effectiveness of nurse-led patient education on the care outcomes of patients with CVDs. Specifically, the aim of this systematic review of RCTs was to evaluate the effectiveness of nurse-led education in adults with heart failure. The authors searched five electronic databases, including CINAHL, PubMed, and Google Scholar. The studies included in the review were randomized controlled trials, cluster randomized controlled trials, and controlled trials with a pre-post design that evaluated the effect of nurse-led education on hospitalization, readmission, quality of life (QOL), and cost. Besides, only primary studies whose sample population included patients aged 18 and above. The researchers then determined how nurse-led education influenced hospital readmissions, clinical outcomes, and quality of life.

The study found that nurse-led education was effective in reducing hospitalization, readmission, and QOL (Rice et al., 2018). However, the authors found that nurse-led education was not effective in reducing costs. The study provides evidence support for the use of nurse-led education in adults with heart failure. The authors provide recommendations for further research on the effectiveness and cost-effectiveness of nurse-led education in this population. The systematic review by Rice et al. (2018) provides evidence supporting r the adoption of nurse-led education in adults with heart failure as proposed in the current EBP project.

Huesken et al. (2021) also conducted an interventional study to investigate the persistent impact of nurse-led education on patients’ self-care behavior and knowledge about the disease among heart failure patients. The study was conducted in a hospital setting and included 150 heart failure patients who received either nurse-led education or usual care. The study methodology also included the completion of a questionnaire with questions regarding self-care behavior and disease knowledge by the patients. The evaluation occurred during the pre-implementation and post-implementation (six months after intervention) periods. After the intervention, the total self-care behavior and knowledge score improved significantly ( P < 0.001). The most improvement was noted in patients’ weight control and knowledge about heart failure. The study found that the patients in found that following the intervention, patients were more likely to engage in self-care activities and had a better understanding of their disease than the patients who received standard care (Huesken et al., 2021)Evidence-Based Practice Project Proposal. The authors suggest that nurse-led education may be a viable strategy for improving heart failure patients’ self-care behavior and disease knowledge.

Rahmani et al. (2020) also conducted a study to determine the impact of nurse-led education, including teach-back methods, on knowledge levels, skill performance, QoL, and readmissions among patients with HF. The researchers hypothesized that the teach-back method would improve knowledge, skills, and QoL and reduce readmission rates among heart failure patients. The study design was quasi-experimental, with intervention and control groups who did not undergo randomization. The study population included 70 adult patients with mild to moderate heart failure who were admitted to an academic hospital in Tehran, Iran, between January and December 2018. The control group received regular discharge education, whereas the intervention group received teach-back self-care education. In the third month after discharge from the hospital, they were given a cardiac self-care assessment to determine their knowledge and habits.

The data analysis revealed a significant difference in the effects of the teach-back method on knowledge levels, skills, readmission rates, and QoL among different types of patients (Rahmani et al., 2020). Patients with more severe heart failure showed the greatest improvement in knowledge and quality of life. Rahmani et al. (2020) recommend that the teach-back method be used more frequently to improve heart failure patients’ knowledge, performance, and quality of life. Overall, the article provides evidence that supports the proposed EBP practice project proposal that the teach-back method could be used during nurse-led education to improve knowledge, the performance of skills, and the quality of life in HF patients.

Luo et al. (2018) also conducted a study to investigate the effectiveness of nurse-led education. The aim of this study was to determine whether a nurse-led education, including offering support and lifestyle management for coronary artery disease patients, would significantly enhance psychological outcomes among the patients. To do this, the researchers searched for randomized controlled trials that compared the psychological outcomes of patients who received the nurse-led program with those who did not. The study used a meta-analysis to determine whether the nurse-led program had a statistically significant impact on psychological outcomes.

The study’s results showed that the nurse-led program had a statistically significant impact on psychological outcomes, including improved mental health and reductions in depressive symptoms, anxiety levels, and physical health complaints (Luo et al., 2018)Evidence-Based Practice Project Proposal. The article recommends that nurse-led programs like this be used to improve psychological outcomes for patients with coronary artery disease. This would be a useful EBP practice project proposal because it would provide patients with improved mental health and well-being, which would likely lead to longer life spans. It is also important to note that the study was conducted using a randomized controlled trial design, which is the best type of study to determine the impact of interventions on psychological outcomes. Therefore, this article supports the use of nurse-led programs for improving psychological outcomes among patients with coronary artery disease.

To recapitulate, the literature review demonstrates that nurse-led enhances the clinical outcomes of patients with CVDs. Furthermore, the evaluated studies confirm that by implementing the evidence-based practice advocated in this initiative, the nurse and healthcare institution will see improved patient care results for their CVD client population. According to the literature, nurse education could involve phone calls, and in-person counseling sessions for patients discharged to home therapy. As a result, the nurse will consider using the procedures because research shows that they work well for patients with CVDs.

Change Model

The change model chosen for the current EBP project is the Kurt Lewin unfreeze-change-refreeze model, which addresses three stages of managing change. Kurt Lewin’s unfreeze-change-refreeze model is a widely used approach to organizational change (Hussain et al., 2018). In the unfreeze stage, employees may be resistant to change or not open to new ideas. They may be hostile or uncooperative. The goal of this stage is to change the employees’ attitudes and beliefs so that they are open to new ideas and are willing to work collaboratively. In the changing stage, employees start to explore new ideas and try out new approaches. They may be tentative at first, but they eventually become more committed to the new way of doing things. The goal of this stage is to enable employees to experiment and learn new skills (Hussain et al., 2018). In the refreeze stage, the new way of doing things becomes entrenched, and employees are able to reproduce it without much difficulty. This stage is crucial because it allows the change to take hold and reach its full potential.

The project manager will use Kurt Lewin’s unfreeze-change-refreeze model to help implement nurse-led patient education among patients with cardiovascular diseases. In the unfreeze stage, the PM will attempt to change the employees’ attitudes and beliefs about nurse-led patient education. Besides, the PM will convince them that nurse-led patient education is a valuable tool that can improve patient outcomes. The first step towards unfreezing the current EBP project would be to establish the need for change (Hussain et l., 2018). This would entail priorities of patient care that need to be improved and developing a strategy to address them. The project manager will help nurses who work with patients who have cardiovascular problems agree on the need for modification. Nurses must also build mutual trust among themselves in order to execute changes successfully. The PM will also create a safe and comfortable environment for nurses to try out and learn new ways presented by the change project.

In the changing stage, the project team would work with the employees to experiment with new ideas and approaches to nurse-led patient education. It would be impotent to help them learn new skills and develop a working knowledge of nurse-led patient education. The second stage would also involve the implementation of new patient education procedures and policies. Nurses will use new approaches and practices in the second stage to increase nurse-led education for patients with CVDs. Changes could impact how patients are educated, how their learning is judged, and how care is delivered. The second stage will ensure that the new way of patient health education delivery is both safe and effective. According to Burns (2020)Evidence-Based Practice Project Proposal, the second stage, change, demands increasing employee participation in the change endeavor. As a result, the leader will consider the nurses’ feedback, empower them to engage in the project, and share or provide information, competence, and skills. The transition stage will also incorporate rewards and resistance management.

In the refreeze stage, the new way of doing things will become entrenched and will be able to be implemented without much difficulty (Hussain et l., 2018). This stage is crucial because it allows the change to take hold and reach its full potential. The third phase would also entail ensuring that the new procedures and policies are implemented after the changing stage time is over. Nurses will integrate nurse-led education into their everyday activities while applying what they learned in the second level. Following the successful execution, the leader will evaluate the outcomes and make any necessary adjustments. The PM believes that using Kurt Lewin’s unfreeze-change-refreeze model will help implement nurse-led patient education among patients. Using Kurt Lewin’s unfreeze-refreeze model will successfully help in implementing nurse-led patient education among patients with cardiovascular diseases.

Implementation Plan

A tertiary hospital with a heart unit will serve as the implementation site. The unit has 50 beds and sees an average of 12 patients per day. Around 100 patients will be involved in the effort. This EBP initiative’s stakeholders include nurses, nurse administrators, hospital administration, patients, and families. All patients with cardiovascular diseases, including children, their parents, caregivers or guardians, and adults, will be included in the study. The project manager will send an invitation to each patient via email and phone to the hospital’s email and phone numbers. The message will include participant information and a consent form.

ORDER NOW

It will take around nine months to complete the project. Following the approval to proceed with project implementation, the PM will gather pre-implementation data on patient knowledge about specific CVD affecting each one of them and self-management practices while at home. After nurses and all key stakeholders have been briefed on how to proceed with the program, implementation will commence. The program is designed to give nurses the knowledge and skills they need to implement nurse-led patient education about CVDs.

Journals, reading materials, writing supplies, a projector, whiteboard, marker pens, and incentives in form of notebooks will all be used in the project’s execution. The PM will get a whiteboard, projectors and marker pens from the hospital administration. Nurses will use charts, whiteboards, journals, and writing equipment to teach the lesson. The materials will help to promote learning through hearing and sight. eight nurses working in shifts will help deliver nurse-led education, while two hospital managers will oversee the program. The project manager will ask four nurses to volunteer to be patient trainer to help achieve a total of eight nurses. Volunteering will assist in avoiding high cost of human resources, which could have a significant impact on the EBP project’s cost. More expenditure will be associated with travel costs because the project manager will be traveling to and from the project setting.

In the ninth month, the project manager will assess the impact of the intervention on patients’ knowledge and clinical results. The project manager would choose a quantitative data collection design to aid in the collection of data concerning numerical values of patient outcomes and assessment of knowledge levels. The initiative does not seek to ascertain the perceptions, thoughts, or opinions of patients, nurses, or other stakeholders regarding the project. Thus, only a quantitative design will aid in data collection. Evidence-Based Practice Project Proposal

Evaluation Plan

Evaluation is a key component of any quality improvement initiative, and the purpose of the evaluation is to provide feedback that can be used to improve the effectiveness of the intervention. The evaluation plan for the current EBP project that seeks to implement nurse-led education among patients with CVDs will help determine the intervention’s effectiveness in improving knowledge levels, self-care efficacy, and clinical outcomes. The expected outcomes of the E BP project include an increase in knowledge levels among patients with CVDs, an improvement in self-care efficacy, and a decrease in clinical outcomes.

The project will be evaluated using a questionnaire survey that will be administered to patients who have participated in the EBP program. The PM and project team committee will oversee the evaluation phase, consisting of representatives from various stakeholder groups, including patients with CVDs, healthcare providers, and research institutions. The committee will monitor the project’s progress and make any necessary modifications to the evaluation plan. The data collectors will be nurses trained in the EBP program and responsible for administering the questionnaire survey to participants. The questionnaire survey will be designed to measure the knowledge levels, self-care efficacy, and clinical outcomes of patients with CVDs.

The data collection tool used in the evaluation of the EBP project is a valid and reliable questionnaire survey. This instrument is reliable since it assesses the target group’s knowledge, self-management, and self-efficacy. Totten et al. (2020) highlight that the validity of a tool is the degree to which the tool depicts the phenomenon of interest and makes the outcomes comparable with those of previous studies. The instrument is trustworthy since the results appropriately reflect the participants’ knowledge of CVDs. Finally, the tool is applicable in the sense that it can be utilized in a variety of situations and with a variety of populations.

The survey will gather information on patients’ CVD knowledge, self-management, and self-efficacy. Data from the survey will be collected by nurses working in outpatient and inpatient care settings that handle patients with CVDs. Patients will complete open-ended questionnaires that will be distributed. Pantaleon (2019) highlights that using patient-reported outcomes is important for improving clinical care since it fosters relationships between care providers and patients. As a result, patients will complete the questionnaires during planned visits. Notably, data collection will occur during the project’s final month. As a result, the questionnaire will be distributed to patients receiving cardiovascular therapy. The survey data will be used to measure and evaluate the project’s outcomes. Evidence-Based Practice Project Proposal

The Statistical Package for Social Sciences (SPSS) software will be used to analyze the data collected from the questionnaire survey. The statistical test to be used in the evaluation of the EBP project will be a t-test. The t-test is an appropriate test to use in the evaluation of knowledge levels, self-care efficacy, and clinical outcomes because it is a measure of statistical significance. The results of the t-test will provide information about the degree to which knowledge levels, self-care efficacy, and clinical outcomes have changed among patients with CVDs as a result of the EBP program. The methods used to collect data using the questionnaire survey would include the administration of open-ended questionnaires to patients with CVDs, and the collection of data will be monitored throughout the evaluation process.

References

Awoke, M. S., Baptiste, D. L., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemporary Nurse, 55(1), 15-26.

Bagheri, H., Shakeri, S., Nazari, A. M., Goli, S., Khajeh, M., Mardani, A., & Vlaisavljevic, Z. (2022). Effectiveness of nurse‐led counselling and education on self‐efficacy of patients with acute coronary syndrome: A randomized controlled trial. Nursing Open, 9(1), 775-784.

Burns, B. (2020). The Origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32–59. https://doi.org/10.1177/0021886319892685

Cui, X., Zhou, X., Ma, L. L., Sun, T. W., Bishop, L., Gardiner, F. W., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: A randomized and controlled trial in China. Rural and Remote Health, 19(2), 47-54.

Hickey, K. T., Wan, E., Garan, H., Biviano, A. B., Morrow, J. P., Sciacca, R. R., Reading, M., Koleck, T. A., Caceres, B., Zhang, Y., Goldenthal, I., Riga, T. C., & Masterson Creber, R. (2019). A nurse-led approach to improving cardiac lifestyle modification in an atrial fibrillation population. The Journal of Innovations in Cardiac Rhythm Management, 10(9), 3826–3835. https://doi.org/10.19102/icrm.2019.100902

Huesken, A., Hoffmann, R., & Ayed, S. (2021). Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients. International Journal of Nursing Sciences, 8(2), 161-167.

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://sci-hub.mksa.top/10.1016/j.jik.2016.07.002 Evidence-Based Practice Project Proposal

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209

Luo, Z. C., Zhai, L., & Dai, X. (2018). Does a Nurse-Led Program of Support and Lifestyle Management for patients with coronary artery disease significantly improve psychological outcomes among the patients?: A meta-analysis. Medicine, 97(35), e12171. https://doi.org/10.1097/MD.0000000000012171

Nurmeksela, A., Pihlainen, V., Kettunen, T., Laukkanen, J., & Peltokoski, J. (2021). Nurse‐led counseling for coronary artery disease patients: A 1‐year follow‐up study. Nursing & Health Sciences, 23(3), 678-687.

Pantaleon L. (2019). Why measuring outcomes is important in health care. Journal of veterinary internal medicine, 33(2), 356–362. https://doi.org/10.1111/jvim.15458

Rahmani, A., Vahedian-Azimi, A., Sirati-Nir, M., Norouzadeh, R., Rozdar, H., & Sahebkar, A. (2020). The effect of the teach-back method on knowledge, performance, readmission, and quality of life in heart failure patients. Cardiology Research and Practice, 2020.

Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalization, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Education and Counseling, 101(3), 363-374.

Son, Y. J., Choi, J., & Lee, H. J. (2020). Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 17(18), 6559. https://doi.org/10.3390/ijerph17186559

Totten, V., Simon, E. L., Jalili, M., & Sawe, H. R. (2020). Acquiring data in medical research: A research primer for low- and middle-income countries. African journal of emergency medicine : Revue Africaine de la Medecine D’urgence, 10(Suppl 2), S135–S139. https://doi.org/10.1016/j.afjem.2020.09.009

The PICOT question for this EBP project is: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)?
Organizational Culture and Readiness

The current evidence-based practice (EBP) project seeks to implement nurse-led education to help improve the clinical outcomes for patients with cardiovascular diseases treated in the Advocate Illinois Masonic Hospital. This paper aims to describe the findings of organizational culture and readiness assessment to determine the potential for successful implementation of the EBP project.

Organization’s Culture

Advocate Illinois Masonic Hospital has a longstanding reputation as a leader in providing high-quality patient care. The organization’s mission is to provide “exceptional care, without exception,” and its values include “integrity, compassion, excellence, and commitment.” The hospital has a culture of patient safety and evidence-based care. According to Mannion & Davies (2018)Evidence-Based Practice Project Proposal, an organization’s culture encompasses shared beliefs, ways of thinking, and behaving among members in the organization. The Advocate Illinois Masonic Hospital culture significantly supports change in practice to adopt strategies informed by the best evidence from scientific research to improve patient care outcomes. The hospital’s organizational structure includes a leadership team and a system of governance that enables employees to exercise their authority in ways that support the organization’s mission and values.

The nursing staff at Advocate Illinois Masonic Hospital has a strong belief in the importance of teamwork, collaboration, and evidence-based practice. They view themselves as part of an interprofessional team whose members are committed to providing quality care for their patients. Nursing staff frequently engage in interprofessional collaboration, research, and team engagement activities, such as developing protocols, setting standards, and providing feedback to one another. They also use communication tools, such as patient registries and electronic health records, to analyze trends, share information and collaborate on care plans. Given the hospital’s longstanding commitment to providing high-quality patient care, it is not surprising that the nursing staff views their job positively.

Organizational Readiness Tool and Readiness for Change

The organizational readiness tool that was used in assessing the readiness level for our organization, Illinois Masonic Medical Center, is the Evidence-based Practice Attitude Scale (EBPAS). The tool has fifteen items that assess the likelihood of adopting the evidence-based practice, people of the EBP, openness to new interventions, and perceived differences between current practice and EBP (Rye et al., 2017). Using the tool, I identified that our organization has supportive leadership, patients who require the best care informed by EBP, and a more constructive organizational culture. The EBP also fits the values of nurses committed to implementing the best care. The culture of patient safety and evidence-based care will support and sustain an evidence-based practice change because it emphasizes the importance of safety and quality care. According to Miake-Lye et al. (2020)Evidence-Based Practice Project Proposal, culture provides a framework for change based on evidence-based medical principles.

The organization’s strengths include its emphasis on safety and quality care, its focus on evidence-based practices, and its ability to create a supportive environment for change. The organization also has potential barriers that include resistance from some stakeholders, difficulty timing changes with current operations, insufficient knowledge among nurses regarding implementing EBP, and limited resources. According to Gabutti, Colizzi & Sanna (2022), stakeholder support for the practice change should be strong, and the proposal’s timing should be appropriate to facilitate successful change. The organization is at a point where it is experiencing increased visits to the emergency department, readmissions, and poor outcomes among patients with cardiovascular diseases due to poor self-care practices while at home. The statistics are unacceptable, and an intervention is required to strengthen patient education and improve clinical outcomes.

Health Care Process and Systems to Improve Quality, Safety, and Cost-Effectiveness

I would recommend a healthcare process and system that focuses on nurse-led patient education before the patient’s discharge. This would include educating patients on their condition, treatment options, and expected outcomes. It would also include providing support and guidance, and follow-up care throughout the treatment process. This would help improve your organization’s quality, safety, and cost-effectiveness. Nurses are uniquely positioned to provide this type of care and can provide a valuable resource to patients and their families. By focusing on nurse-led patient education, the organization can ensure that its patients receive the best care.

Strategies to Better Facilitate the Organization’s Readiness

The strategies that can employ to better facilitate the readiness of the Advocate Illinois Masonic Hospital to adopt nurse-led education include the identification of key stakeholders and building a consensus around the benefits of adopting nurse-led education. This includes engaging with key decision-makers, such as CEOs, medical directors, nurse leaders, managers, and nurses working with patients suffering from cardiovascular diseases. Building a consensus around the benefits of adopting nurse-led education will ensure everyone is on board with the change. Another strategy will be creating a structure and governance model conducive to adopting Nurse-led education. This includes creating an executive leadership team, setting up committees, and appointing champions. The strategies will also include creating a communication plan to help deliver health education messages through in-person meetings, facts sheets, and educational videos, among other ways.

Stakeholders and Team Members

The EBP project will include stakeholders such as the project manager, hospital administrator and leadership, nurses, and patients with cardiovascular diseases. In this case, the project manager, myself, will be responsible for leading the team and ensuring that the project stays on track. The PM will also be responsible for communicating with stakeholders and keeping them updated on the project’s progress. The nurses leading the patient education sessions will be responsible for developing and delivering the sessions. They will also ensure that patients are engaged and learn from the sessions. The patients participating in the patient education sessions will be engaging with nurses and learning from the sessions. Patients will also be responsible for providing feedback to nurses on how they enjoyed the sessions and what they learned from them. The hospital administrator will be responsible for providing the resources and support needed to implement nurse-led patient education in the hospital. Evidence-Based Practice Project Proposal

Information and Communication Technologies

The following Information and Communication Technologies are required to implement the project on adopting nurse-led patient education for patients with cardiovascular diseases: To begin with, a computer system with Internet access for the nurses involved in the project will help create and manage the patient education materials. In addition, electronic health records (EHRs) for all patients with cardiovascular diseases at the hospital will allow the nurses to track patient progress, health messages, and care delivery. Furthermore, electronic health information systems (EHRs) for the hospital’s medical staff to access and share patient data will help improve care delivery by ensuring consistency in treatment and health education.

References

Gabutti, I., Colizzi, C., & Sanna, T. (2022). Assessing Organizational Readiness to Change through a Framework Applied to Hospitals. Public Organization Review, 1–22. Advance online publication. https://doi.org/10.1007/s11115-022-00628-7

Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality improvement. BMJ (Clinical research ed.), 363, k4907. https://doi.org/10.1136/bmj.k4907

Miake-Lye, I. M., Delevan, D. M., Ganz, D. A., Mittman, B. S., & Finley, E. P. (2020). Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments. BMC health services research, 20(1), 106. https://doi.org/10.1186/s12913-020-4926-z

Rye, M., Torres, E. M., Friborg, O., Skre, I., & Aarons, G. A. (2017). The Evidence-based Practice Attitude Scale-36 (EBPAS-36): a brief and pragmatic measure of attitudes to evidence-based practice validated in US and Norwegian samples. Implementation Science, 12(1), 1-11. https://doi.org/10.1186/s13012-017-0573-0

Literature Review

Cardiovascular diseases (CVDs) are a significant burden among adults in the United States and are among the leading causes of death in adults in the United States (Global Burden of Cardiovascular Diseases Collaboration, 2018). CVDs are a broad category that includes conditions such as coronary heart disease, stroke, and hypertension. According to the Centers for Disease Control and Prevention (CDC), heart disease is responsible for more deaths than any other type of CVD. The problem noted among patients with cardiovascular diseases is low knowledge levels regarding disease management and prevention of complications. In the organization where the nurse works, patients with cardiovascular diseases demonstrate poor progress and increased morbidity and complications related to poor management at home. Evidence-Based Practice Project Proposal

Standard patient health education conducted for the patients by clinicians and nutritionists during reviews in our healthcare organization does not provide sufficient impact in terms of increasing patients’ knowledge and helping them to prevent disease progression and prevention of complications actively. Inadequate knowledge about CVDs, self-management, symptoms, drug use or adherence, and secondary prevention methods among patients causes negative outcomes such as morbidity and mortality. Many patients who develop CVDs do not know how to improve their outcomes besides taking the prescribed medications and diet. Besides, many people with CHD who do not receive timely treatment or notice adverse symptoms early may experience disease complications. Thus, sufficient knowledge among patients of cardiovascular diseases is critical. The current evidence-based project seeks to mitigate the problem of inadequate patient education and poor patient outcomes by adopting interventions informed by the best evidence from research studies.

Search Methods

In this case, the author, the MSN student searched for articles on nurse-led education for patients with cardiovascular disease and its effect on clinical outcomes. The literature search occurred in PubMed, CINAHL, and Cochrane Library databases. The author used the keywords selected from the PICOT question: patients with cardiovascular disease, nurse-led patient education, formal patient education, patient outcomes, and clinical outcomes. The search also involved using Boolean connector “AND” to combine searches and select articles written in English and published online within the last five years. The author included studies that compared nurse-led education to standard patient education. The search yielded 12 articles. After reading each article, the author used the above criteria to select the eight studies that best represented the research on this topic. The literature review results are as follows and are discussed in the literature synthesis section below.

Synthesis of the Literature

Awoke et al. (2019) conducted a quasi-experimental study that investigated the effect of nurse-led education on patients with cardiovascular disease. The subjects for the study were 29 patients with heart failure undergoing treatment at two urban healthcare facilities in the North Eastern region of the U.S. The intervention was a systematic education program run by nurses that followed heart associations’ recommended practices. Patients had to complete the Dutch Heart Failure Knowledge and the Self-care Heart Failure assessments. The study found that nurse-led education was associated with improved knowledge, self-care, and reduced readmission for individuals with heart failure. This article supports the PICOT by providing valuable information to help healthcare providers offer better care to their patients. It also shows that nurse-led education can be an effective way to improve patient outcomes and satisfaction.

In another study by Bagheri et al. (2022), the researcher sought to determine the impact of nurse-led education on self-efficacy and clinical outcomes for patients with acute coronary syndrome. The sample for the study was 120 patients on treatment for acute coronary syndrome. The study methods included randomization of participants into two groups, implementation of nurse-led counseling, and education for the intervention group. The study revealed that nurse-led education, compared to standard patient education, resulted in increased control of symptoms, cardiac self‐efficacy, and self-efficacy within nine months. This article is crucial for informing the project’s PICOT because it affirms that nurse-led counseling and education can improve patient self-efficacy in managing their cardiovascular diseases. This result could lead to better long-term outcomes for these patients.

A similar study by Son et al. (2020) sought to determine the effect of nurse-led interventions such as patient education on patient care outcomes for heart failure patients. In their systematic review of studies and meta-analysis, the researchers reviewed quantitative studies that sought to investigate the effect of nurse-led education on clinical outcomes. Studies were selected from online databases focusing on nurse-led self-care education as the main intervention. The total number of participants in the studies was 1167. The key findings included a 25.2% decrease in all-cause readmissions, as noted in five studies, and a 40% risk reduction for patients with heart failure. The systematic review also revealed a 29.4% risk reduction in all causes of mortality among the patients. The study supports the PICOT question by affirming how nurse-led educational programs can positively impact the clinical outcomes of patients with CVDs.

The study by Cui et al. (2019), also reviewed in this essay, entailed randomizing participants and implementing nurse-led educational programs to determine its impact on hospital readmissions and self-management for adult patients with chronic heart failure. The subjects for the study were 90 patients recruited from a rural Chinese population. The study methods included managing the control group using standard care and implementing an educational program delivered by nurses to the intervention group. Evaluation of symptoms, medication compliance, and dietary modifications occurred in the twelve months of intervention. The key findings included higher mean scores for symptom control and dietary changes in the intervention group than among participants in the control group. The study also resulted in fewer readmissions (10.3%) in the intervention group compared to (27.1%) in the control group. The article supports the project’s PICOT because it provides crucial evidence that nurse-led education on lifestyle interventions effectively improves clinical outcomes, symptom control, and dietary modifications for patients being managed for cardiovascular diseases such as CHF.

A nurse-led education and interventions to improve cardiovascular health could effectively treat patients with atrial fibrillation. The study by Hickey et al. (2019) sought to evaluate the effect of a nurse-led program on improving patients’ cardiac lifestyle for patients with atrial fibrillation (AFib). The researchers involved 53 patients with AFib and treated them at the Columbia University Medical Center. The study methods involved completing an assessment by the participants at the beginning, followed by intervention. The intervention consisted of motivational speeches, telehealth communication program assistance, nurse-led interviews, and the provision of various learning resources for the sample population to consider. All interventions sought to enhance self-management and healthy behavior. The key findings included an average of 3-lb ± 13-lb reduction in body weight and a 5-mmHg decrease in systolic B.P. for patients in the intervention group. The study backs the PICOT since it informs the nurse of the data showing that nurse-led educational initiatives successfully enhance clinical outcomes for CVDs, as envisioned by the proposed evidenced based practice. Evidence-Based Practice Project Proposal

Similarly, the study by Huesken et al (2021) sought to determine the impact of nurse-led education on the clinical outcome of patients with CVD. In their study, Huesken et al. (2021) involved 150 patients admitted with heart failure to determine the impact of led-led education on knowledge about the disease and self-care interventions. Patients participated in six months of nurse-led educational sessions after completing a baseline questionnaire with questions on self-care practices and disease awareness. Upon data analysis, the researchers found that following the nurse-led education sessions, knowledge levels of the condition and self-care considerably increased. The article supports the PICOT for the current study because it reveals that the proposed EBP practice can improve patient care outcomes when adopted in the management of CVDs.

More studies demonstrate that nurse-led education and counseling could improve cardiovascular health for patients with CVDs such as coronary artery disease (CAD). In a study by Nurmeksela et al. (2021) that included a one-year follow-up, the researchers included 78 patients to investigate the impact of nurse-led education on risk reduction for patients with CAD. The study methods included nurse-led counseling sessions for patients two to four weeks before discharge and one-year follow-up. Nurses communicated with the patients via phone calls after discharge and counseled them. Data analysis revealed that nurse-led education resulted in increased adoption of lifestyle changes, decreased waist circumference, and risk reduction. The intervention also improved patients’ blood levels of total cholesterol, triglycerides, and low-density lipoproteins. The article supports the PICOT by affirming the significance of nurses in leading patient education to improve the clinical outcomes for patients with cardiovascular diseases.

The study by Rice et al. (2018) also supports the PICOT for the current EBP project because it demonstrates the effectiveness of nurse-led patient education in improving patient-care outcomes in managing cardiovascular diseases. In their systematic review of randomized controlled trials, Rice et al. (2018) included studies whose samples were patients aged 18 years and above and on treatment for CHF. Following the search and selection of relevant RCTs from PubMed, Google Scholar, and CINAHL, the researchers analyzed how nurse-led patient education on heart failure affected patients’ quality of life, readmission rate, and clinical outcomes. The researchers found that nurse-led education on H.F. reduced hospitalization and improved patients’ quality of life and clinical outcomes.

Comparison of Articles

The articles reviewed in this essay support the proposed EBP intervention for the current project by demonstrating how nurse-led education for different CVDs resulted in improved patient care outcomes. The similarities among the studies included the adoption of nurse-led education and the inclusion of patients with CVDs. The differences across the studies include the inclusion of varying numbers of study participants, interest in varying CVDs, and the use of different study designs and methods. For example, some studies involved randomization of participants, follow-up, and systematic review. The articles addressed different themes ranging from the impact of nurse-led education on self-efficacy, self-management, clinical outcomes, and knowledge about the disease. The study methods also varied from baseline patient assessment on knowledge, evaluation of perceived self-efficacy, implementation of nurse-led education and counseling, search for literature from online databases, follow-up, laboratory tests, and assessment of patient symptoms.

The researchers conclude by recapitulating how nurse-led education, counseling, and patient management programs improved clinical outcomes. The literature review has noted no controversies regarding the methods, designs, participants, analysis, or findings. However, a few limitations are noted. Several studies, such as Cui et al. (2019)Evidence-Based Practice Project Proposal, were limited by small sample sizes that could not represent the greater patient population. Besides, the study by Awoke et al. (2019) only involved 29 patients from the North Eastern region of the U.S. The studies by Nurmeksela et al. (2021) and Awoke et al. (2019) were limited by sample selection that involved convenience selection of patients, unlike random or systematic sampling that could result in unbiased representation. The study by Bagheri et al. (2022) was limited by a small sample size (75) chosen from a single academic hospital hence reducing its generalizability to the patient population in Iran and other parts of the world. Other limitations of the study were the short time (up to 1‐month) between intervention and evaluation, the use of the same researchers in nurse-led education and evaluation (which could result in bias), and the use of self‐report data.

The literature review reveals gaps in knowledge regarding the cost implication of replacing standard patient education with nurse-led education and how to improve nurse-led education practice. Suggestions for future studies include the need for randomized controlled studies and more studies to provide sufficient data. Nurmeksela et al. (2021) proposed that future studies should seek to provide more data on how nurses can strengthen counseling and patients’ self-management. According to Bagheri et al. (2022)Evidence-Based Practice Project Proposal, further studies should provide more longitudinal regarding the impact of nurse‐led education on long‐term cardiovascular health self‐efficacy, prevention of adverse events, and objective clinical outcomes.

Conclusion

In summary, the literature review reveals that nurse-led education effectively improves the clinical outcomes of patients with cardiovascular diseases. Besides, the reviewed studies affirm that by adopting the evidence-based practice proposed in this project, the nurse and healthcare organization will witness improved patient care outcomes for their client population diagnosed with CVDs. The literature highlighted that nurse education could include follow-up for patients discharged to home treatment, phone calls, and in-person counseling sessions. Thus, the nurse will consider adopting the approaches because evidence from the studies reveals positive outcomes when implemented for patients with CVDs.

References

Cui, X., Zhou, X., Ma, L. L., Sun, T. W., Bishop, L., Gardiner, F. W., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and Remote Health, 19(2), 47-54.

Global Burden of Cardiovascular Diseases Collaboration. (2018). The Burden of Cardiovascular Diseases Among U.S. States, 1990-2016. JAMA Cardio, 3(5):375–389. doi:10.1001/jamacardio.2018.0385

Hickey, K. T., Wan, E., Garan, H., Biviano, A. B., Morrow, J. P., Sciacca, R. R., Reading, M., Koleck, T. A., Caceres, B., Zhang, Y., Goldenthal, I., Riga, T. C., & Masterson Creber, R. (2019). A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population. The Journal of innovations in cardiac rhythm management, 10(9), 3826–3835. https://doi.org/10.19102/icrm.2019.100902

Huesken, A., Hoffmann, R., & Ayed, S. (2021). Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients. International journal of nursing sciences, 8(2), 161-167.

Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Education and Counseling, 101(3), 363-374.

Son, Y. J., Choi, J., & Lee, H. J. (2020). Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 17(18), 6559. https://doi.org/10.3390/ijerph17186559

Framework or Model for Change

A well-defined framework or model for change is important in facilitating successful and reliable evidence-based practice implementation (Duff et al., 2020). An appropriate framework or model for change provides practitioners with a clear understanding of how to implement the change. The purpose of this paper is to describe in detail the selected change model, its stages, and the model’s application in the proposed implementation.

Selected Model for Change

The Kurt Lewin unfreeze-change-refreeze model is a three-step process used in organizational change (Hussain et al., 2018). The Lewin unfreeze-change-refreeze model can be used in the current EBP project on nurse-led patient education for patients with cardiovascular diseases. The model is relevant to my project because it will help nurses and care professionals at the hospital understand why the change is needed and assist in implementing the necessary changes. The model will help guide normalizing changes in the hospital’s day-to-day operations. According to Harrison et al. (2021)Evidence-Based Practice Project Proposal, the model is beneficial because it provides nurses with the focus to contemplate the entire change process and how it progresses actively.

Stages in the Change Model

The first step, unfreezing, is about getting people ready to change by understanding the need for change. As people get ready to move from the status quo or current comfort zone, the change agent o leaders should create a new environment where people are free to experiment and take risks. For example, unfreezing is when nurses and physicians feel that a change is necessary or urgent and are motivated to make it happen. Kurt Lewin proposed that successful implementation of change may require planning and getting the system unfrozen from its current status quo. The first stage l increases the target group’s behaviors and attitude toward the proposed change. Lewin postulated that unfreezing may increase the leaders’ or change agents’ pressure for change or create resistance and tension. Thus the leader would need to overcome resistance to facilitate successful implementation.

ORDER TODAY

The second step in the process is ‘change,’ which is about implementing new policies and procedures. At this stage, stakeholders and significant others can implement new strategies and practices designed to improve care for patients or the target population. The third step, refreezing, is about establishing stability in the changes. At this stage, the change becomes a new norm as people maintain the new policies or procedures after implementation. Although refreezing may take time, the phase helps evaluate and modify the change made if necessary.

Applying Each Stage of the Model in Proposed Implementation

In the current EBP project, the first step, unfreezing, would involve creating the need for change. This would involve identifying areas of patient care that need improvement and developing a plan to address them. The project manager will initiate change by helping nurses working with patients suffering from cardiovascular diseases agree on the need for change. Nurses must also establish trust and collaboration between themselves to make changes successfully. The project manager will also create a safe and comfortable environment where nurses can experiment and learn new techniques proposed in the change project.

The second step, change, would involve implementing new patient education policies and procedures. In the second stage, nurses will implement new strategies and practices designed to adopt nurses-led education care to improve knowledge levels for patients with cardiovascular diseases. The changes may include how patient education is conducted, how patients’ learning is evaluated, and how care is delivered. The second stage will also ensure that the change in patient health education delivery is safe and effective. According to Burnes (2020)Evidence-Based Practice Project Proposal, the second stage, change, requires employee involvement to increase their input into the change project. Thus, the leader will consider the inputs of nurses, empower them to be active in the project, and share or provide information, knowledge, and skills. The change stage will also involve giving rewards and managing any resistance.

The third step, refreezing, would involve ensuring that the new policies and procedures are maintained after the change period. Nurses will integrate nurse-led education into day-to-day activities while using the knowledge and skills regarding the intervention as taught in the second stage. After the change has been successfully implemented, the leader will evaluate the results and make any necessary modifications.

References

Burnes, B. (2020). The Origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32–59. https://doi.org/10.1177/0021886319892685

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation science communications, 1(1), 1-9. https://doi.org/10.1186/s43058-020-00070-0

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of healthcare leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176

IMPLEMENTATION PLAN

Evidence-Based Practice Project Proposal: Implementation Plan

The current evidence-based practice (EBP) project proposal targets patients with cardiovascular diseases (CVDs) being treated at the project manager’s (the author) healthcare organization. Cardiovascular diseases were the leading cause of death in the US in 2018. Roth et al. (2020) highlight that stroke and ischemic heart diseases are leading causes of mortality and significant contributor to disability. Policy support and patient education are needed to reduce adverse events in people with CVDs (Rippe et al., 2018). The project manager seeks to adopt nurse-led patient education to improve the knowledge levels about the disease and improve patient outcomes. The PICOT question for this EBP project is: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)? Evidence-Based Practice Project Proposal

Setting and Access to Potential Subjects

The setting of implementation is a tertiary hospital with a cardiac unit. The unit has 50 beds, with an average of 12 patients per day. Eight full-time registered nurses and two part-time registered nurses are on the team. The unit would be a good candidate for this intervention due to its high volume of patients and its proximity to other institutions with experience in nurse-led education. Additionally, the unit’s nurses are experienced in providing care to patients with cardiovascular disease and are likely to be receptive to adopting a nurse-led educational approach. Given the high volume of patients and experienced nurses on the unit, a project could be conducted to assess the potential benefits of such an intervention. The access to likely subjects will involve providing patients with details about the project, requesting each patient to sign up for the educational program, and giving consent to participation throughout the project. About 100 patients are expected to take part in the project. The author has included a draft of the consent in the appendix section.

Timeline

The project will take approximately nine months. The project manager will implement the plan at any date after the project’s approval. Following the approval by the hospital administration, the project manager will collect pre-implementation data about patient knowledge and the incidence of poor outcomes related to low literacy levels, lack of knowledge, and poor self-management at home. The collection of such data will occur in the first two weeks. The implementation of nurse-led education will commence whereby the project manager will allow the team for the project to cause gradual changes in knowledge, attitude, and practice among the patients. Nine months will be ideal to allow the project implementation to bear outcomes. In the ninth month, the project manager will evaluate the outcomes to determine the impact of the intervention on patients’ knowledge and clinical outcomes. The project manager has included a timeline draft in the appendix section.

Budget and Resource List

The project implementation will utilize several resources, including patient reading materials, journals for nurse educators, writing materials, a projector, a whiteboard, marker pens, and notebooks. However, the hospital will provide a whiteboard, marker pens, and a projector. The human resources utilized in the project will be four nurses conducting nurse-led education in shifts and two hospital administrators. The project manager will request four nurses to volunteer to take positions as patient trainers. Volunteering will help avoid the cost of human resources, which could have a considerable cost implication for the EBP project. More costs will be related to travel expenses because the project manager will travel to and from the implementation setting; hence such costs is captured in the budget. The project manager has included a budget and resource list draft in the appendices section.

Qualitative or Quantitative Design

The project manager would select a quantitative design in data collection to help collect data about numerical values of clinical outcomes and knowledge levels. The project does not intend to determine patients’ or card providers’ experiences, perceptions, or opinions regarding the project. Thus, quantitative design alone will help collect the required data. According to Smith & Hasan (2020)Evidence-Based Practice Project Proposal, quantitative methods help explore the extent of change caused by implementation strategies. The rationale for choosing the design is that the project manager seeks to determine the change in knowledge after implementation and note the incidence of poor outcomes documented in numerical values. Besides, the quantitative design will help determine trends, averages, patterns, and cause-effect relationships between the intervention and outcomes. The current EBP project is practical because it chooses the appropriate design to help determine the effectiveness of an intervention and help make predictions about the outcome of the same intervention when generalized to a broader patient population.

Methods and Instruments

The inclusion criteria for the sample will be all patients with cardiovascular diseases, including children, their parents or guardians, and adults. The author will invite each patient by sending them a message via email addresses and phone numbers provided at the hospital. The attachments of the mail will be the participant information and consent form. Implementation of the project will be monitored by the project manager and nurse administrators. Data collection will utilize a questionnaire to help elicit responses from the patients regarding their diagnosis and knowledge of disease management.

Process for Delivering the Intervention

Implementation will commence after nurses and all key stakeholders are trained to implement the plan. The training is expected to equip nurses with the knowledge and skills to implement nurse-led patient education about the different CVDs. Nurses will use charts, the whiteboard, journals, and writing materials to help deliver the content. The resources will help promote learning via hearing and seeing.

Stakeholders that Are Needed

Stakeholders are several individuals directly interested in a project (Boaz et al., 2018). Nurses, nurse administrators, hospital administration, patients, and relatives make the list of stakeholders to implement the plan in this EBP project. Relatives or guardians of children recruited in the project will help implement the knowledge gained on behalf of children who would not capture the content taught. Nurses will deliver the content while other care team members continue with nurse-led education to ensure sustained intervention and help prevent poor patient outcomes. Evidence-Based Practice Project Proposal

Potential Barriers to Implementation Plan and Strategies for Overcoming Them

Mathieson, Grande & Luker (2019) highlight that the common barriers to project implementation include negative attitudes and beliefs, insufficient time, and staff shortage. The potential barriers to the current project include tight work schedules and insufficient time for nurses to implement patient teaching. The project manager will overcome the barriers by working with nurse managers to reschedule nurse duty shifts to allow more patient education time. Besides, the project manager will work with nurse managers to recruit four nurses from other departments to work with the cardiovascular disease department. Another barrier is insufficient knowledge about EBP among nurses. The project manager will overcome the barrier by ensuring that nurses’ training equips them with knowledge and skills for implementing effective and comprehensive nurse-led education.

Feasibility of the Implementation Plan

The project manager foresees that full implementation of the project will positively impact patients’ knowledge and clinical outcomes. The data collection design, methods, and instrument offer a practical approach that will lead the project manager to conclude whether nurse-led education is effective for enhancing good clinical outcomes. Thus, the project manager believes that the implementation plan is feasible and will be approved to help move forward with the change project.

Appendices

Appendix I: Consent

Consent form for participation in the evidence-based practice project

Study Description: You are invited to participate in the project mentioned above. The project aims to implement nurse-led education to improve cardiovascular health and overall clinical outcomes.

Risk/Discomfort: There is no risk or discomfort imposed on you in participating in this study despite spending 10-20 minutes filling in the questionnaires.

Benefits: Your information will help us identify the gap in knowledge, changes in learning, and improvement of your status

Confidentiality: Your responses will be kept confidential; therefore, you are not required to indicate your name on the questionnaire.

Voluntary Participation: You can refuse to participate in this study. You are not forced to respond to the questions asked. You also have the full right to withdraw from participation without penalty.

Contact information: If you have any concerns about this project or if any problem arises, contact the cardiovascular disease department or the hospital administration

Consent

I have read this consent form and am allowed to ask questions. I give my consent to participate in this EBP project.

Participant’s signature…………………………………… Date………….

Appendix II: Timeline

Activity	First month	Second month	Third month	Fourth month	Fifth month	Sixth month	Seventh month	Eighth month	Ninth month
Approval of project plan and collection of pre-implementation data
Training of nurses Begin project implementation
Continuing implementation with monitoring
Monitoring
Monitoring
Collection and analysis of data
Evaluation

Appendix III: Budget and Resource List

Resource	Item	Cost
Planning and preparing the project proposal	Library, stationery, and printing	$ 10
Training equipment	Marker pens, projector, whiteboard, pens,	Provided by the hospital
Training staff	Cost of training session’s meals	$40
Data collection	Questionnaires and refreshments	$40
Data analysis, computer costs	SPPS, Ms. Excel	$12
Incentives	Notebooks, pens	$12
Miscellaneous	Traveling	$ 10
Total		$ 124

Appendix IV: Methods

Inclusion – patients with cardiovascular diseases, including children, their parents or guardians, and adults

Sending messages of invitation

Recruiting patients or subjects

Training nurses

Pre-implementation assessment

Implementing nurse-led education

Monitoring – through the help of nurse administrators

Data collection – incidences of adverse events, readmissions, and visits to the emergency department with exacerbations of CVD symptoms.

Post-implementation assessment of patient’s or caregiver’s knowledge

Evaluation – evaluation of patients’ knowledge levels and changes in clinical outcomes

References

Boaz, A., Hanney, S., Borst, R., O’Shea, A., & Kok, M. (2018). How to engage stakeholders in research: Design principles to support improvement. Health Research Policy and Systems, 16(1), 60. https://doi.org/10.1186/s12961-018-0337-6

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. https://doi.org/10.1017/S1463423618000488

Rippe J. M. (2018). Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease. American Journal of Lifestyle Medicine, 13(2), 204–212. https://doi.org/10.1177/1559827618812395 Evidence-Based Practice Project Proposal

Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., … & GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. (2020). Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. Journal of the American College of Cardiology, 76(25), 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010

Smith, J. D., & Hasan, M. (2020). Quantitative approaches for the evaluation of implementation research studies. Psychiatry Research, 283, 112521. https://doi.org/10.1016/j.psychres.2019.112521

Evaluation Plan

The current EBP project seeks to implement nurse-led education for patients with cardiovascular diseases to improve their care outcomes. The PICOT question is: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)? This paper intends to describe the evaluation plan, including the expected results, data collection tool, statistical test, methods of data collection, and strategies to modify intervention after implementation.

The Expected Outcomes

According to Bagheri et al. (2022), nurse-led education among patients is effective in enhancing self-efficiency, perceived self‐efficiency in controlling the symptoms, and maintaining function among patients with CVD such as cardiac diseases. The expected outcome of this project is that patients will have improved clinical outcomes due to nurse-led education. Patients will have increased knowledge about how CVD affects them, be more self-sufficient in managing their health, and have increased self-efficacy in preventing or managing CVD. Additionally, nurse-led education will engender trust and collaboration among patients, nurses, and healthcare providers. Ultimately, the goal of this project is to improve patient care.

Data Collection Tool

The data collection tool that would be effective for this research design is a questionnaire survey. This tool is valid because it can measure the target population’s knowledge, self-management, and self-efficacy. According to Totten et al. (2020)Evidence-Based Practice Project Proposal, the validity of a tool is the degree to which it represents the phenomenon of interest, making the results comparable with those of prior studies. This tool is reliable because the responses would accurately reflect what the participants know about CVD. Finally, it is applicable in that it can be used in multiple settings and with various populations. For example, the survey measures CVD patients’ knowledge, self-management skills, and self-efficacy in managing their condition.

A survey can also be an effective data collection tool for the research design that seeks to implement nurse-led education to improve the clinical outcomes of patients with cardiovascular diseases. The survey can help assess patients’ knowledge about how CVD affects them, self-management, and self-efficacy. Additionally, the survey can provide valuable information about patient preferences for nurse-led education interventions.

Statistical Test

The statistical test chosen for this data would be a t-test. The t-test is used to compare the means of the two groups and determine the statistical significance of the difference between the two groups (Wadhwa & Marappa-Ganeshan, 2022). This test would allow us to compare the mean scores of the two groups (those who received the intervention and those who did not) and determine if there was a significant difference. In this case, the project manager will compare patient outcomes between patients who received traditional and nurse-led education. The information would help us understand whether the intervention impacted knowledge about CVD, self-management, and self-efficacy. Additionally, this test would help us determine if specific areas of knowledge were improved more among those who received the intervention. This information would help plan future interventions to improve clinical outcomes for CVD patients. The t-test is most appropriate for this survey because it will allow us to compare the mean results of the two groups. Additionally, the t-test is easy to use and can be performed quickly. Finally, the t-test is a reliable statistical test. These factors make the t-test a good choice for this survey.

Methods that will be applied to Data Collection Tool

The questionnaire and survey will collect data on patients’ knowledge about CVD, self-management, and self-efficacy. Nurses working in the medical inpatient and outpatient clinics that serve patients with CVD will be involved in collecting data from the survey. Patients will respond to open end questionnaires, which will be administered. Pantaleon (2019)Evidence-Based Practice Project Proposal states that using patient-reported outcomes is crucial for enhancing clinical care because it promotes the relationship between care providers and patients. Thus, patients will respond to the questionnaires during scheduled visits in the last month of the project when the evaluation phase occurs. Therefore, the survey will be administered to patients in the cardiovascular care setting. The project outcomes will be measured and evaluated based on the survey data. The data will be analyzed to measure patient knowledge, self-management, and self-efficacy changes after they have undergone nurse-led education. Subsequently, the results of the analysis will help to improve patient care and outcomes.

Strategies That Will Be Taken if Outcomes Do Not Provide Positive or Expected Results

If the outcomes of this project are not positive or as expected, a few different strategies could be taken. One option would be to analyze why the project did not produce the desired results and then make changes to the intervention or design to improve outcomes. Another option would be to expand the project beyond its original goals to address other areas of patient knowledge and self-management that may be important for improving CVD outcomes. Additionally, partnering with other institutions or organizations may be necessary to increase the project’s impact. Finally, the project could only be successful if it engages patients or caregivers. If this is the case, it may be necessary to alter the intervention or outreach strategy to better connect with patients and their caregivers. Overall, if the project does not produce positive or expected results, it is important to analyze why this is the case and make changes to improve outcomes.

Plans To Maintain, Extend, Revise, and Discontinue a Proposed Solution after Implementation

A comprehensive plan is essential to the success of any EBP project. Maintaining the proposed solution of nurse-led patient education for cardiovascular disease should include regular monitoring and assessing the intervention’s impact on patient outcomes. The hospital will implement a feedback loop to optimize the intervention’s effectiveness. Ongoing development and refinement of the intervention help ensure that it results in improved patient outcomes and remains beneficial to the healthcare organization (O’Cathain et al., 2019)Evidence-Based Practice Project Proposal. Also, the ongoing development and refinement of the intervention will ensure that the intervention is updated and adapted as new knowledge becomes available. A continuous evaluation of the intervention’s impact on patient outcomes and modifications to the intervention will be needed. To ensure patient engagement and satisfaction with the intervention, the hospital will adopt continual communication with patients, their caregivers, and the healthcare team. Each of these steps should be well planned and executed to ensure the intervention is effective and continues to benefit patients.

According to Marzo et al. (2021), project outcomes are significant in determining the need for modifications to the intervention. For the current EBP project, the plans to extend, revise, and discontinue the proposed solution will include a project revision to include a control group to compare the intervention results. Also, the intervention will be changed to include more nurse-led modules and sessions. The intervention will also be extended to other diseases besides cardiovascular diseases to help achieve better patient outcomes in patient populations where lack of knowledge and poor self-management practices contribute to patients’ poor outcomes. However, the intervention will be discontinued if it does not improve the clinical outcomes of patients with cardiovascular diseases. The plans to extend and revise the proposed solution are intended to improve patient outcomes by providing effective nurse-led education for a broader population of patients.

Conclusion

In summary, this paper discussed the evaluation plan, including the expected results, data collection tool, statistical test, methods of data collection, and strategies to modify intervention after implementation for the proposed PICOT question: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)? This evaluation plan will be utilized to determine if nurse-led education improved the clinical outcome for cardiovascular disease patients. Lastly, this plan gives a clear blueprint to help researchers determine if this project yields significant results or needs revision.

References

Marzo, R. R., Bhattacharya, S., Ujang, N. B., Naing, T. W., Huong Fei, A. T., Chun, C. K., Xue Ting, C. P., Rajah, P. A., & Shanmuganathan, K. A. (2021). The impact of service quality provided by health-care centers and physicians on patient satisfaction. Journal of education and health promotion, 10, 160. https://doi.org/10.4103/jehp.jehp_979_20

O’Cathain, A., Croot, L., Sworn, K., Duncan, E., Rousseau, N., Turner, K., Yardley, L., & Hoddinott, P. (2019). Taxonomy of approaches to developing interventions to improve health: a systematic methods overview. Pilot and feasibility studies, 5, 41. https://doi.org/10.1186/s40814-019-0425-6

Pantaleon L. (2019). Why measuring outcomes is important in health care. Journal of veterinary internal medicine, 33(2), 356–362. https://doi.org/10.1111/jvim.15458

Wadhwa, R. R., & Marappa-Ganeshan, R. (2022). T Test. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553048/ Evidence-Based Practice Project Proposal