Clinical Practice: The Implementation of Change

Evaluation Methods

Evaluation is a critical process because it provides valuable information about the performance of health programs and changes in the clinical processes (Oman, Duran, & Fink, 2008). According to Polit and Beck (2008), this process begins at the planning phase and continues throughout the lifespan of the project. The evaluation plan will include both the quantitative and qualitative methods. First, the use of a survey will play a fundamental role in identifying the factors that affect the nurses’ attitudes, as well as their level of satisfaction and dissatisfaction. The patients will also participate in the survey to evaluate clinical outcomes before and after the planned change. Finally, the survey will be useful to assess the rate of turnover and the intention to leave prior to and after the implementation of the proposed solutions.

Second, the impact evaluation is another method that will be essential to assess whether the proposed project is feasible and efficacious. This approach will also ascertain if the intermediate results (clinical outcomes) are reflective of the proposed change. Conversely, it is critical to ensure that these assessment tools are both reliable and valid (Polit & Beck, 2008). Third, the outcome evaluation will provide feedback on the performance of the proposed solutions. One of the deleterious effects of inadequate nurse-patient ratios is the rising rates of medication errors (Oman et al., 2008). Although adequate staffing may not generate immediate results, it will enhance the safety and quality of care.


Variables are imperative indicators that examine the extent to which the introduced interventions are meeting the outlined objectives (Acheterberg, Schoonhoven, & Grol, 2008). First, it will be essential to determine if the nurses have changed their attitudes and perceptions regarding the new policies and procedures. According to Gallagher-Ford (2008), the previous elements are the most significant barriers to the effectual management of change. In the same vein, the patients’ perceptions and attitudes will form the benchmark for assessing the effect of the changes on the clinical outcomes. Second, the change agent will ascertain whether the evidence-based practice (EBP) initiative has reduced the incidences of adverse clinical events. Acheterberg et al. (2008) have argued that heavy workloads, coupled with prolonged nursing shifts increase the risk of medication errors. Thus, it will be necessary to evaluate whether the adequate nurse-patient ratios will enhance the quality of care and reduce the risk of staff turnover.

Education Tools

The proposed solution will entail the standardization of patient outcomes and staffing levels. This proposal will facilitate the delivery of health care that is nursing-sensitive. The primary objective of these initiatives will be to provide patient-centered care, which will enhance the quality and safety of care. The health facility has to appraise the current work functions and reassign the nurses to develop an efficient staffing mix. Nonetheless, not all the nurses may be receptive to these transformations. The newly hired nurses may not adjust to the organizational culture immediately. These challenges necessitate the education of both the current and new nurses to ensure the successful implementation of the EBP initiative.

The first education approach will be the use of interactive media tools, which will include computer-based simulators and animations. These technologies will enable the participants to conceptualize the different nursing scenarios in real settings (Polit & Beck, 2008). Second, seminars and workshops are other crucial techniques that will expose the nurses to instructional materials. These forums will complement the continuing education initiatives for the practicing nurses (Oman et al., 2008). Third, the hospital will also provide a series of clinical hours to enhance the skills and competencies of the nursing trainees. The nurse preceptor will guide the individuals through the learning process. This initiative will ensure that the nurse students have the requisite knowledge and proficiencies that are necessary to meet the current demands (Gallagher-Ford, 2008).

Assessment Tools

The outcomes of a project determine the extent to which the evidence-based practice has met its objectives (Polit & Beck, 2008). The main results from the proposed solution will include a reduction in medication errors and other adverse events. Surveys and interviews represent the assessment tools that will be necessary to measure the impact of adequate staffing (Finkel & Kenner, 2013). The nurses will have to complete a survey that will contain questions regarding the effects of the changes. For example, the use of the questionnaires will establish whether rational working hours reduces the risk of medication errors and staff turnover.

The implementation of change in the clinical practice does not always generate immediate results. By contrast, change is a continuous process that produces results in the long-term (Polit & Beck, 2008). As such, the impact evaluation process may not portray a clear picture of the findings. The change agent will address this limitation by using quantitative assessment methods that are more rigorous. According to Oman et al. (2008), experimental designs provide more meticulous results than surveys do. Thus, a randomized control trial will form the foundation for assessing the outcomes of the new project.


Acheterberg, T., Schoonhoven, L., & Grol, R. (2008). Nursing implementation science: How evidence based nursing requires evidence based implementation. Journal of Nursing Scholarship, 40, 302–310.

Finkelman, A., & Kenner, C. A. (2013). Learning IOM: Implications of the IOM reports for nursing education. Washington, DC: American Nurses Association.

Gallagher-Ford, L. (2008). Nurses’ skill level and access to evidence-based practice. The Journal of Nursing Administration, 38(11), 494–503.

Oman, K. S., Duran, C., & Fink, R. M. (2008). Evidence-based policies and procedures: An algorithm for success. Journal of Nursing Administration, 38(1), 47–51.

Polit, F. D., & Beck, T. C. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.

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