Evidence-Based Practice Proposal – Section D: Change Model

Evidence-Based Practice Proposal – Section D: Change Model

Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.

In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:

1. Identify the selected model or theoretical framework and discuss its relevance to your project.

2. Discuss each of the stages in the change model/framework.

3. Describe how you would apply each stage in your proposed implementation.

–In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Please, Please look at the papers uploaded to continue with Section D.

This is a continuous proposal

I live in el Paso, Texas

I work in a Managed Care organization. I look at Hierarchical Condition Category coding (HCC codes) and proper documentation for accurately diagnosing and reimbursement. More specific, I work for WellMed Medical Management. I am a clinical nurse coding consultant.

I have been working my papers around diabetes, elderly with Type 1 diabetes and continuous glucose monitor

PICOT question

In elderly patients with type 1 diabetes mellitus (T1DM), how does continuous glucose monitoring (CGM), when compared to the traditional self-monitoring of blood glucose (SMBG) levels decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions or admissions in the long-term.

Evidence-Based Practice Proposal – Section D: Change Model

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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