capstone discussion 4 2

please respond to the main discussion DQ1 and DQ2 and also respond to the Peers Discussions


Why is understanding the health care system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course mentor that you will take into consideration for your own change project.


Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP project. Why? Has your mentor used either theory, and to what result?

Peer DQ1

According to ( Li, Jeffs, Barwick, Stevens 2018) understanding the health care system at the local level is important to consider when planning an EBP implementation because our population is growing and changing and the delivery of our health care system is trying to meet the needs of the population. Therefore, when you understand the health care system, you can better identify the problem, critique the evidence, implement evidence-based recommendations, evaluate the change, and disseminate results. Implementation of evidence is essential for patients to receive the best care possible. Implementation is the fourth step in the EBP process and requires moving from a focus on finding and evaluating the evidence to actively using it to produce quality outcomes.


Shelly-Anne Li, Lianne Jeffs, Melanie Barwick, & Bonnie Stevens. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Systematic Reviews, Vol 7, Iss 1, Pp 1-19 (2018), (1), 1.…

Peer DQ2

It enables you to have a quality approach towards the integration of clinical experts, patients value work effectively when research evidence is inclusive. Patients value differ from one patient to another and as a health practitioner you must understand how each of them with their expectations. This will led to improved decision making as the desired result is based on the analysis and evaluation of data.


The ability to review and align resources so as to get a desired decision. Understanding of health care at local levels will enable for critical analysis of data so as to evaluate their performance. You get to know how their data is and based on research or not and whether the evaluation is being done by competent power. When you realize a defect address it to enable for effective evidence based decisions.

Peer DQ3

It is important to understand the health care system at the local level when planning an EBP implementation. Evidence- based practice is meant to be the best thing or action to take to that can enhance proper or normal physiological functioning, to protect, promote, optimize health and abilities, prevent illness and injury, facilitate healing, and alleviate suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities and populations (ANA, n d). Any change in the practice of nursing should be able to improve the present situation better than the previous practices. It is imperative to understand the present situation, the present situation and the expected outcome which is the future situation -after changes are made. To implement EBP, one must know what the expected accomplishments are, set up standard of knowing if the change is an improvement or not, and exactly what to do that would result in improvement (Institute for Healthcare Improvement, 2018) It helps in the

  • Planning
  • Implementation
  • Studying the result(Institute for Healthcare Improvement, 2018)

Understanding the health care system at the local level will help to know the improvement that is needed. How much of the change needed, to decide if the propose change will work in that environment / system? It also enables one to know the cost, social impact, side effects from the anticipated change and to minimize resistance during implementation. (Institute for Healthcare Improvement, 2018) Example, in any health care settings Medicare / Medicaid / insurance cover most health care health care services, one must inquire about what services the coverage and payment

Planned change in nursing practice is necessary for a wide range of reasons. Understanding and using a change theory framework can help managers or other change agents to increase the likelihood of success. This article considers three change theories and discusses how one can be used in practice (Mitchell, 2013) Theory of Change calls for a comprehensive description and illustration of how and why a desired change is expected to happen in a context, and how these lead to desired goals being achieved. It also involves the Outcomes Framework which provide the basis for identification of activity or intervention that will lead to the outcomes identified as requirements for attaining the long-term goal (Center for theory of Change,2018) Example Dogs Trust Worldwide, an international Non-Governmental Organization which works to improve canine welfare, apply Theory of Change framework to identify challenges faced when collaborating with local partners to achieve its mission. Theory of Change approach and its importance to Human Behavior Change within this. Questions which need to be addressed were identified as a conduct of working with partner organizations and acknowledging issues around producing evidence to measure the impact our work has on the ultimate beneficiaries (Karen Reed and Melissa M Upjohn,2018)


American Nurses Association(ANA): Scope of Nursing Practice retrieved from…

Center for theory of Change, 2018: What is Theory of Change retrieved from…

Karen Reed, & Melissa M. Upjohn. (2018). Better Lives for Dogs: Incorporating Human Behavior Change Into a Theory of Change to Improve Canine Welfare Worldwide. Frontiers in Veterinary Science, Vol 5 (2018).…

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. Retrieved from…

Peer DQ4

Over the years, the implementation of evidence-based practice has been embraced in health care settings ( Warren et al., 2016). However, the process of planning for implementation will need to consider the health care system at the local and national levels. It is important to understand the vision and goals of the existing health care system at the local levels to ensure that the implemented EBP is in line with the goals and vision of the system. The implemented EBP should help the health care system to achieve the desired goals and vision. Without proper analysis and understanding of the local system, the implemented EBP may fail to meet the goals of the organization hence making it ambiguous. Understanding the local system will help to determine the culture and the issues that may be affecting the effectiveness of the system in delivering services ( Warren et al., 2016). Therefore, it will be possible to develop EBP that can help to solve the existing issues and respect the culture that exists.

The primary aim of the EBP is to meet the needs of the local community hence it is important to understand these needs and issues to ensure that the implementation offers a reliable solution. The understanding of the local system also allows in understanding the needs of the leaders to ensure that all stakeholders involved agree with the proposed evidence-based practice that is related to the organizational culture and goals. The leaders may be educated or made aware of the importance of implementing EBP to motivate them to participate and support this process. Therefore, it can be argued that the understanding of the local system is important since it guides the development of the objectives of the implementation. It helps to evaluate the needs of the people, corporate culture and needs in addition to goals to facilitate the implementation of a well-designed and planned evidence-based practice.


Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence ‐ Based Nursing , 13(1), 15-24

Peer DQ5

It is imperative to understand the healthcare system at the local level when planning an EBP implementation because it allows the project manager to gain better knowledge of the existing policies and changes in the policies that can be made in the organization when it comes to new practices in the delivery of healthcare to patients. Meeting the needs of the patient populations is key to the delivery of high quality patient care (Lyons, 2014). For example, the hospital where I work has a very diverse patient population with various needs, so while planning an EBP implementation project in the organization, it is essential to take the diverse patient population into account and provide culturally competent care. According to Nadeau, Pinner, Murphy, and Belderson (2017), evidence-based practice is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions. That is why it is critical to understand the health care system at the local level.


Lyons, D. L. (2014). Implementing a comprehensive functional model of care in hospitalized older adults. MEDSURG Nursing, 23(6), 379-385.

Nadeau, K., Pinner, K., Murphy, K., & Belderson, K. M. (2017). Perceptions of a primary nursing care model in a pediatric hematology/oncology unit. Journal of Pediatric Oncology Nursing, 34(1), 28-34. doi:10.1177/1043454216631472

Peer DQ6

The two change theories that are discussed are the Lewin and Rogers change theories. In the movement stage of Lewin and the interest stage of Rogers change theory, there are assessment and trial stages. These stages also include altering the agents to get all accessible information and come up with solutions regarding the problem. The refreezing stage of Lewin theory corresponds to the adoption stage of Roger change theory. In these stages, the expected change is already incorporated in the system, and approaches are created to stop the system from reverting to the old practices (Mitchell, 2013). In the unfreezing stage of Lewin change theory, the agents are inspired to make a change and members of staff that are affected are made conscious of the requirement to carry out the change. In this stage the issue is recognized and by use of collaboration selection of the best solution is made. The unfreezing stage happens when instability is familiarized to the system creating the necessity to make a change. This resembles stage one of Rogers change theory.

The theory that is most suitable to make a change in the Evidence-Based Practice is the Rogers change theory. This is because it functions as the theoretical framework in recognizing the situations that adopt innovation and linked ways of adoption (Mohammadi, Poursaberi & Salahshoor, 2018). The theory facilitates the assessment of how specific clinical actions are implemented and foster the concentration to be aimed towards the supposed innovation characteristics that promote implementation. In this theory, five traits of implementation are identified as compatibility, relative advantage, simplicity, trialability, and observability. These factors are expected to affect implementation in the EBP in a clinical practice.

My mentor has used this theory to implement change in the EBP projects. The result was that the theory facilitated in making an evaluation on the degree of the impact made by the implementation characteristics. The theory also helped in highlighting the necessity of intermediary factors like change agents, opinion leaders and gatekeepers in making the implementation successfull


Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management (through 2013), 20(1), 32.

Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R. (2018). Evaluating the adoption of evidence-based practice using Rogers’s diffusion of innovation theory: a model testing study. Health promotion perspectives, 8(1), 25.

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