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Response Length: A minimum of 180 words per post, not including references Citations: At least one high-level scholarly reference in APA per post from wi

Response Length: A minimum of 180 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from wi

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Response Length: A minimum of 180 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years Discussion Number 1:RC

Evidence-based practices (EBP) are used in many medical facilities as a tool to provide high quality healthcare to their patients.  Therefore, there has been an increase of research studies in different health care sectors to help improve patient outcomes and quality of health care delivery.  However, evidence from reliable research must be practiced along with effective execution to achieve significant positive outcomes (Chien, 2019).
As a brand-new nurse, I found that the implementation of Situation, Background, Assessment, and Recommendation (SBAR) tool during transition of care increased patient safety and provided effective communication throughout the health care team.  The SBAR tool was a simple guide that the nurses continuously used during change of shift and patient report.  Despite of being inexperienced in nursing, this tool helped my fellow new nurses and I in providing substantial information regarding the patient for the oncoming nurses and the other health care staff involved in the patient’s care.  This EBP is proven effective as most military treatment facilities are now using the SBAR tool.  Per Bonds (2018), a study was conducted where utilization of the SBAR method was practiced for seven consecutive weeks in a surgical setting.  The results were an increase of 100% hand off communication and 43% increase on documentation of intraoperative antibiotics on the electronic medication administration record. 
The four models of organizational change play important roles when implementing a new EBP.  The organizational change that I plan to incorporate in my advanced nursing role to sustain EBP initiative is the transtheoretical model of health behavior change.  By knowing its five stages, I will better understand the patient’s current state when recommending a new way to manage their care.  If a patient is in the stage of precontemplation, I would offer an alternative plan of care until the patient is ready to comply with the initial recommendation.  For example, if the female patient is on precontemplation stage in regards to permanent sterilization; as a provider I can offer some reversible birth control method.  In this manner, the patient will buy some time to decide what is best for her while still being protected from pregnancy.   

Discussion Number 2:MS

Working as a float nurse in Long Term Care can be very challenging.  Besides not knowing the staff, getting to know the patients and the patients getting to know the nurse presents many difficulties.  Nurses often times can have up to 30 patients per shift, which makes a med pass extremely difficult.  One thing that I have used to make this time a little easier is the use of music therapy.  Evidence Based Practice (EBP) proves that music therapy and music activities have been known to improve mood, as well as positive impacts on well-being (Ray & Gotell, 2018). 
As the residents move about I like to have music on from the general era of the age of the residents.  I will take requests or ask them their favorite songs and add them to the playlist.  This helps me to build a rapport with many residents.  When it comes times for med pass, especially for some of the “grumpy” or “difficult” residents it makes it easier to accept their medications from me. The general mood also lightens up from what sometimes seems to be very somber. 
In this type of setting, as an advanced nursing roles, the model of organizational change I would use would be Roger’s Diffusion of Innovations.  This type of organizational change starts slow, them increases with popularity, per say (Melnyk & Fineout-Overholt, 2019).
Because of the variety of residents, nurses, and tastes in music I would start with the most popular genre, and play it during lunch three times a week.  As more residents show an interest, add another genre for the remaining two days.  This also helps the residents something to look forward to during the day, just as any other activity.  Personally, I would add to the exercise schedule and add some of the common line dances that are very popular, but not too difficult or exerting.  The nurses hopefully can also identify with some the popular genres to make that connection with the residents. Eventually, the overall mood will change to make the long term care facility feel warm and inviting to both residents and other float or part time nurses who have the same difficulties.

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