Describe the Implementation Plan in nursing

Describe the Implementation Plan in nursing;Overall plan for implementing the proposed solution. The process of implementation will be held in one of the Vitus team, where the patients live in assisting living facilities. The plan starts with the recognition of the clinical practical need in the workplace.

Once the need is identified, the next step is selecting the group of stakeholders who will be involved in the implementation process. The multidisciplinary team is composed of the case manager, physician, social worker, chaplain, one mentor, and registered nurses. It is important to emphasize that each member of the team contributes to the success of the project.

An initial training that addresses depression and tool content will be given to all staff of the team and will be included in the orientation for the new employees. The Detection of Depression in Older Adults with Dementia Knowledge Test (Appendix B) will be administered to all staff members two times; before and after the training regarding the use of the CSDD (Brown, Rue, & Halpert, 2007). This test has seven questions and should be used as a learning tool only. The training will be addressed by the Mentor of the team, who has a complete control of the theme.

Assessing the environment readiness for the plan is another task (Brown, Rue, & Halpert, 2007). During this phase it is important to recognize the needs of the stakeholders and the barriers to better assess depression, at the same time, maintaining job satisfaction should be a priority at all times.

The communication systems and the relationships between multidisciplinary groups should be adequate, because sometimes the limited communication is the reason a solution might fail (Brown, Rue, & Halpert, 2007). Equally important in the process is the target population, because the high risk for depressive disorders is older adults from diverse populations (Institute for Clinical Systems Improvement, 2011). Therefore, the implementation should be adaptable to culturally diverse populations with different education levels (Burns & Grove, 2009).

Moreover, adequate organizational and administrative support is essential to develop a plan (Spector, 2010). In order to ensure implementation and monitoring, the action plan needs to be presented to executive management for the approval and included it into individualized care plan for Vitas Hospice patients with dementia. Therefore, the company policies and procedures related to depression should be reviewed and updated to incorporate missing aspect of the depression guideline, such as the implementation of the CSDD in the plan of care.

Finally, when the stakeholders, the environment, as well as the organization are prepared, it is time to administer the CSDD (Appendix A) to all patients admitted with dementia as terminal diagnosis. The assessment of depression in all patients admitted with dementia should be done by the registered nurse during the initial assessment and should be part of the patient’s medical record.

The patient and caregiver should be informed about the assessment tool to facilitate the integration in the health care (Brown, Rue, & Halpert, 2007). The results should be evaluated and documented in the patient records. The tool should be administered in a culturally appropriate way to address the values and beliefs of specific population groups (Institute for Clinical Systems Improvement, 2011).

The CSDD uses two semi-structured interviews, one for the caregiver and one for the patient. The caregiver interview should be conducted first and this person should have frequent contact with the patient. CSD consists of 19 questions about depression symptoms. The responses can be absent, mild, and severe, given score from zero to two, respectively, and a total score of eight or above indicates that depressive symptoms are present. Then the interviewer scores the CSDD.

The signs and symptoms occurring during one week before will be collected in the interview. The scale takes approximately 20 minutes to administer (Brown, Raue, Roos, Sheeran, & Bruce, 2010). No specific facility or equipment is required, as the intervention takes place in the patient’s home. Once depression has been identified by the CSDD, a comprehensive interdisciplinary evaluation should occur .

Resources needed. The company has an identifiable budget destined to improve clinical care and support services to each specific diagnosis and allocates resources for the implementation of the tool. All the materials, including an agency program manual, an intervention manual for staff, tools and resources for staff and clients, and a training curriculum, will be provide for the company.

The organization should assure the availability of the tool to assess depression,; the CSDD should be included in the initial assessment package. The initial orientation to the interdisciplinary group will be during the weekly team meeting, in the same conference room, and only requires a computer for the power point presentation and copy of the test for each member.

The mentor will prepare the service using internet resources .
Methods for monitoring solution implementation. The multidisciplinary team will create interactive meetings were each member discuss the findings and doubts. As stated above, a good communication should exist between all stakeholders. Each member should be in contact to help each other using email or phone calls. Some strategies such as direct observation of the results which are exchanged by each staff as well as the opportunities for reflection on individual and organization experience contributing to monitor and improve the solution implementation.

Theory of change. Lewin’s theory is used as a framework in this project to make a change in Vitas Hospice organization. According to Spector (2010) this theory is useful in nursing organization to promote change and increase the quality of care. The Lewin’s theory has three stages. The first one is called unfreezing and it is influence by the resistance to change.

The objective of this phase is identifying the barriers that prevent the solution implementation. In Vitas Hospice, the symptoms of depression in older with dementia are sometimes masked and patients are unable to report. In addition there are biases and misconceptions among the staff about depression. Applying this theory, the organization in this phase will motivate the staff to implement the change, increasing their knowledge, and as a result decrease the resistance (Spector, 2010).

The second stage of the Lewin’s theory is the moving stage. In this phase the limiting forces will be overcome. During this phase, the company will find strategies to overcome resistance. The organization has solutions to resolve the problem, gather the resources needed for the plan and start the solution implementation of the CSDD. The last stage of the theory is called refreezing. This phase occur when the change is evaluated to see if the plan is accepted, and then establish it into the organization. In this phase the stakeholders are starting to note the benefits brought about the system (Spector, 2010 ).

Feasibility. The Vitas nurses can implement the tool because it is easy to perform, and has low cost. The implementation doesn’t imply any risk for the staff, since the CSD is easy to implement (Institute for Clinical Systems Improvement, 2011). There is some cost related with providing educational materials for staff. There is no change in the time for staff to deliver the intervention and possible mileage expense in comparison with the visit schedule at the initial assessment.

Neither the staff involved in the administration of the tool or the mentor responsible for the initial training, require any special certification. The training given by the mentor does not require any extra pay because the mentor has fixed salary .


 

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