Week 6 Assignment:
EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.
Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.
Name: __
Star Point 1: Discovery (Identify topic and practice issue)
Identify the
topic
and the
nursing practice issue
related to this topic. (This MUST involve a nursing practice issue.)
Briefly describe your
rationale
for your topic selection. Include the
scope
of the issue/problem.
PLACE YOUR ORDER HERE
Star Point 2: Summary (Evidence to support need for a change)
Describe the
practice problem in your own words
and formulate your PICOT question.
List the systematic review chosen
from the CCN Library databases
. Type the complete
APA reference
for the systematic review selected.
List and briefly describe
other sources
used for data and information. List any other
optional scholarly source
used as a supplement to the systematic review in
APA format
.
Briefly
summarize
the main findings (in your own words) from the systematic review and the
strength
of the evidence
.
Outline one or two
evidence-based solutions
you will consider for the trial project.
Star Point 3: Translation (Action Plan)
Identify
care standards, practice guidelines, or protocols
that may be in place
to support your intervention
planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).
List your
stakeholders
(by title and not names; include yourself) and describe their
roles and responsibilities
in the change process (no more than 5).
What specifically is
your nursing role in the change process
? Other nursing roles?
List your stakeholders by
position titles
(charge nurse, pharmacist, etc.).
Why are the members chosen
(stakeholders) important to your project?
What type of
cost analysis
will be needed prior to a trial? Who needs to be involved with this?
Star Point 4: (Implementation)
Describe the
process for gaining permission
to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?
Describe the
plan for educating the staff
about the change process trial and how they will be impacted or asked to participate.
Outline the
implementation timeline
for the change process (start time/end time, what steps are to occur along the timeline).
List the
measurable outcomes
based on the PICOT. How will these be measured?
What
forms
, if any, might be used for recording purposes during the pilot change process. Describe.
What resources are available to staff (include yourself) during the change pilot?
Will there be
meetings
of certain stakeholders throughout the trial? If so, who and when will they meet?
Star Point 5: (Evaluation)
How will you
report the outcomes
of the trial?
What would be the
next steps
for the use of the change process information?
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