Nursing Change Project
The organization at focus in this nursing change project and the nursing managers in cohesion implemented an evidence-based nursing practice model in the health care organization. As noted in the work of Keele (nd) there has been several models that have provided contributions on the conceptual level to the implementation of evidence-based nursing. One of these models is the Stetler model (Stetler, 2001), also included is the Iowa model (Titler, et al., 2001), the John Hopkins Evidence-Based Practice Model (Newhouse, et al., 2007), the ACE Star Model (Stevens, 2004), the Caledonian Development Model (Tolson, Booth & Lowendes, 2008), and the Evidence-Based Practice Model for Staff Nurses (Reavy & Tavernier, 2008). (p.75) The model chosen by the organization and reported in this work in writing is most similar to the Evidence-Based Practice Model for Staff Nurses (Reavey & Tavernier, 2008). The process utilized for the Evidence-Based Practice Model for Staff Nurses is one that greatly mirrors the nursing process in terms of the assessment, diagnoses, planning, implementation, as well as the components used in evaluation. Added are analysis and synthesis of evidence, as well as integration and maintenance of practice change to complete this model.
II. Overview of the Model
The model of Reavey & Tavernier (2008) is such that involved staff nurses, a unit nurse manager, and the research staff of the hospital. In the present project, implementation the past research conducted on the procedure of change has served to document the necessity of the change as well as have institutional records on errors in this area. Reavey & Tavernier (2008) is reported by Keele to include ten important strategies as follows: (1) Identification of the practice problem/issue; (2) Collection and appraisal of the empirical evidence; (3) Collection and appraisal of the nonempirical evidence; (4) Summary across all evidence; (5) Integration of the evidence with clinical expertise, client preferences, and values in making a proposed practice change or decision; (6) Development of the proposed practice change in detail; (7) Consideration of the feasibility and organizational issues; (8) Evaluating the practice change; (9) Marketing the practice change; (10) Strategies for successful implementation and sustainability of practice change. (Reavey and Tavernier, 2008, paraphrased)
Telemedicine implementation was the change at focus in the study reported. Implemented in this project was a Telemedicine camera system in one of the school health-based clinic with the goal of assessing students from another school, by a physician direct link as well as other providers. This change took place due to funding cuts and each school nursing being required to acquire three or four schools to oversee the clinics rather than one or two in schools years before the economic problems began.
IV. The Evidence
Telemedicine is defined in the work of Puchala and Wozniak (2001) to be "the investigating, monitoring and management of patients and the education of patients and staff, using systems, which allow ready access to expert advice and patient information no matter where the patients or relevant information is located." (p.1) The work of Yellowless (nd) reports seven principles for the development of telemedicine systems including those stated as follows:
1 Telemedicine applications and sites should be selected pragmatically, rather than philosophically
2 Clinician drivers and telemedicine users must own the systems
3 Telemedicine management and support should be from the 'bottom up', rather than from the 'top down'
4 The technology should be as user-friendly as possible
5 Telemedicine users must be well trained and supported, both technically and professionally
6 Telemedicine applications should be evaluated in a clinically appropriate and user-friendly manner
7 Information about the development of telemedicine must be shared (Yellowless, nd, p.3)
From a functional point-of-view telemedicine, system configuration means that remote diagnosis takes place as well as "remote patient registration in addition to remote registration, monitoring, and transmission of EKG signals and other biomedical signals, remote measurement of blood pressure and pulse, body temperature and other physiological parameters." (, p.8)
One of the primary aspects of the telemedicine system is the teleconsulting module, which enables the physician the ongoing access to medical data on the remote server or to the experts in the medical center. The database must be able to guarantee "easy access and update from the different site on the Internet." (Yellowless, nd, p.9) The work of Mackert and Whitten (2009) reports the successful adoption of a school-based telemedicine system and state that a case study of the Telekidcare makes use of interactive television systems "located in the school health office to let school nurses interact with KUMC physicians to provide consultations to sick children." (p.1) The results of the study are stated to "point o factors to success both in...
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