EBP Journal Article Implementation Through: The Transtheoretical Model: Stages of Change Precontemplation Discuss report issues with charge nurses and ha

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Implementation Through: The Transtheoretical Model: Stages of Change 

Precontemplation

Discuss report issues with charge nurses and harvest nurses, asking them for ideas.

Contemplation

Charge and harvest nurses sit with knowledge of the problem. Offer them research on SBAR.

Present plan to stake holders. Invite CNO, directors, harvest nurses and PCTs.

Preparation

Supply staff with SBAR templates, offer in-services on SBAR communication education, and educate on SBAR during pre-shift meetings.  

Action

Implement SBAR template during hand-off report.

Maintenance

Continue buy-in from harvest nurses and other staff by asking them to help personalize the form for the unit

Set performance goals related to hand-off associated errors.

Highlight problems related to hand-off report during pre-shift report and how SBAR could circumvent those.

PDF- page 96 management theory 

PDF- page 107 leadership theory

Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit. 

Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it.  
Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings. 

Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system. 
Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff. 

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Evaluation

Desired Outcome Actual Outcome  Maintain Goals and Desired Outcomes
Lower amount of time giving report by < 45 minutes
Implement standardized SBAR throughout the unit, structuring the process 
Nurses will be able to demonstrate standardized process of hand-off report
Statistical significance in decreasing the rate of communication errors that leads to errors in patient care
Amount of time giving report has decreased by using a standardized process (Stewart & Hand, 2017) 
Standardized process of giving report increased efficiency of verbal communication (Stewart & Hand, 2017) 
Decrease in the rate of callbacks for information clarification (Robins & Dai, 2017)
Use of the SBAR tool during handoffs in a quasi-experimental study decreased the proportion of incident reports related to misunderstanding, misinterpretation, or omission of information from 31% to 11% (Stewart & Hand, 2017
Provide continuous education throughout clinical experience on usage of the standardized process of giving report (Stewart & Hand, 2017) 
Standardized process for reporting reduces hierarchical barriers (various career stages) increases confidence of the users, decreases length of report time and accuracy of exchanged information. (Stewart & Hand, 2017)

– Use of the SBAR tool during handoffs in a quasi-experimental study decreased the proportion of incident reports related to misunderstanding, misinterpretation, or omission of information from 31% to 11% (Stewart & Hand, 2017)

-Discuss if this is successful and why? The reasons

Nurses are encouraged to seek new ways to implement best practices as they work (Eberhardt, 2014) 

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Implementation Barriers

Medical personnel have personal bias on giving report (Ghosh et al., 2018) 

Different nurses have different approaches to how they perform report (Ghosh et al., 2018)

Some staff are unreceptive to change (Robins & Dai, 2017) and it is difficult to [enforce a] change in practice for long time staff (Eberhardt, 2014) 

Majka – Our 3 main hurdles that prevent implementation is different nurses give report in different ways and personnel being biased with giving report, as well as, some staff don’t want to change their styles of giving report such as more seasoned nurses that have been in the profession for many years.

With that being said here are some questions to think about…

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Questions to Think About

Why is SBAR preferred to personalized hand off reporting?

What limitations do you think SBAR represents when giving report?

Is it more beneficial to use a single standard SBAR tool or to personalize the tool to match specific units? Why? 

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