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Capstone discussion 4

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

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.


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
, (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

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)

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

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)


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

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

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).

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 (
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 (
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.

Expert Solution Preview

Introduction: As a medical professor in charge of creating college assignments and answers for medical college students, it is essential to provide a comprehensive understanding of the health care system and change theories in EBP implementation. In response to the discussions, it is evident that understanding the health care system at the local level is important in planning an EBP implementation, making it possible to identify the problem, critique evidence, implement recommendations, evaluate the change, and disseminate the results. Furthermore, it’s essential to compare and contrast change theories to determine the most suitable for implementing EBP projects.

DQ1 Response: Understanding the health care system at the local level is vital when planning an EBP implementation. According to Li et al. (2018), population growth and changes require the healthcare system to meet the needs of its people, and implementing evidence is crucial for patients to receive the best care possible. Therefore, understanding the health care system enables identification of potential challenges, establishing a basis for critiquing relevant evidence, implementing evidence-based recommendations, evaluating progress, and disseminating results. By understanding the different stakeholders and issues affecting the local healthcare system, one can identify ways of reducing resistance and achieving successful change.

DQ2 Response: Change theories enable healthcare practitioners to increase the success of implementing EBP projects. The Theory of Change seems most suitable for my EBP project. According to the Center for Theory of Change (2018), this theory provides a comprehensive overview of how and why change can occur in a particular setting, and what interventions are required to achieve the required outcomes. The principle ideas behind the theory of change involve identifying the anticipated end-goal outcomes, setting up conditions that lead to the desired outcomes, and conducting an evaluation process to gauge the effectiveness of the intervention. My mentor has not used this theory yet.

Peer DQ1 Response: I agree with the peer that understanding the health care system at the local level is crucial since it enables identification of the specific needs of the local population, which is essential in planning for the implementation of EBP. Additionally, the peer has emphasized the importance of the implementation stage in EBP by calling for a robust evaluation process to gauge the effectiveness of the intervention.

Peer DQ2 Response: I agree with the peer in their analysis of change theories and that the Theory of Change seems appropriate for implementing an EBP project. The ability to identify and analyze the interventions required to achieve the desired outcomes is critical to the success of an EBP project.

Peer DQ4 Response: I concur with the peer that it is essential to understand the existing health care system’s vision and goals at the local level when planning for EBP implementation. This understanding ensures that the implemented EBP aligns with the existing goals and vision, making it possible to develop the right objectives and evaluate the needs of the patients and the corporate culture.

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