The writer will have to read each of this articles and react to them by
commenting, analyzing and supporting with relevant articles. The writer will
have to read carefully before giving constructive comments on the article. The
writer should write a one paragraph of at least 150 words. APA and in text
citation must be use as each respond to the two articles must have in text
citations. The writer will have to use an article to supports his comments in
each of the article. Address the content of each article below in a one
paragraph each, analysis and evaluation of the topic, as well as the integration
of relevant resources.
The work done that pertain to steps 1-3 change model that link back to clinical excellence
reflects the involvement of nurse practitioner (NP) that primarily educate their patient by
following evidence base practice. Evidence-informed decision making (EIDM) depends on
clinical expertise to integrate the best quality research evidence along with information about
patient preferences, clinical context, and resource (Yost et al., 2014). There are many avenues
that could be incorporated into my change for clinical excellence in the clinical setting. The
factors or variable that will help me focus on the design in my practice change would be on the
amount of children being immunized coming through the clinic. Documenting all education that
was given to the family to help with getting the children/adults get immunized. Maintaining
and/or decreasing the amount of patients that has not been immunized for preventable childhood
disease. Monitoring the patient that was admitted for preventable childhood disease is also a
way to tell if immunization is being effective to the community (Singleton & Levin, 2008). I
will also have to focus on cost and admission to the hospital and medication given at any time. I
could evaluated the impact my practice change to ensure that my plan for change is going in a
positive outcome will be acknowledge by the patients and their feedback from there visit.
Survey and monitoring the patients at well child visits to make sure that they are staying healthy.
Data that has been used to evaluate to see if change has made a difference in a positive outcome
or if it has been a negative outcome. The model for my evidence based practice is Dorothea E.
Orem: Known as the Self-Care Theory, Orem’s vision of health is a state characterized by
wholeness of developed human structures and of bodily and mental functioning (Olin, 2011).
Olin, J. (2011). 7 Nursing theories to practice by.
Singleton, J., & Levin, R. (2008). Educational innovations. Strategies for learning
evidence based practice: critically appraising clinical practice guidelines. Journal of
Nursing Education, 47(8), 380-383 4p. doi:10.3928/01484834-20080801-07
Yost, J., Thompson, D., Ganann, R., Aloweni, F., Newman, K., McKibbon, A., & … Ciliska, D.
(2014). Knowledge Translation Strategies for Enhancing Nurses’ Evidence-Informed Decision
Making: A Scoping Review. Worldviews on Evidence-Based Nursing,
Include the one paragraph comments hear using a pear review article to support your
comments. Also include in text citations in APA.
My work reflects the change model by 1. Assessing the need for change, 2. Locating the best
evidence, and 3. Critical analysis of the evidence (Larrbee, 2009). I am able to collect much of
the data that led to assessing the need for change in my patient encounters. I always ask patients
about their medical history, their allergies and their medications. Often times I am told. “it is in
the compute” to which I reply “I have to update it each time you come in, just in case you have
been to another healthcare provider who has given you some medication, like maybe to the ER?”
This is usually an icebreaker technique and often times the patient will have a “light bulb
When I review patient’s medications, I ask them how many times a day they take the medication.
For example, if a pill is supposed to be twice a day, do they take it at even intervals or do they
take it sporadically? Many times patients will tell me that they take 2 pills at once because it is
easier. If the patient is at the clinic for a follow up visit for an infection, I will bluntly question if
they took all of the antibiotics, especially if they are not better, or have gotten worse. I get quite
a few sheepish looks and answers of “no” to this question. It is at this point I can educate the
patient about antibiotic resistance. Antibiotic resistance is the ability of bacteria to resist the
effects of an antibiotic (cdc.gov, 2015). Antibiotic resistance occurs when bacteria mutate, which
changes the effectiveness of drugs, chemicals, or other agents designed to cure or prevent
infections. The bacteria live, multiply, and cause more harm. Antibiotic resistance has been
called one of the world’s most pressing public health problems (cdc.gov, 2015). Antibiotic
resistance can cause illnesses that were once easily treatable with antibiotics to become
dangerous, prolonging suffering for children and adults. Antibiotic-resistant bacteria are often
more difficult to kill and more expensive to treat. In some cases, the antibiotic-resistant
infections can lead to serious disability or even death (cdc.gov, 2015). The number of people
who cannot communicate about their medications or take them incorrectly is huge. So, by my
interviewing technique, I have developed my own way to collect data on the need for change.
Namely, health literacy and the need to better educated patients.
My focus on the teach back method is simply based on evidence that it works. We actually all
use it in our everyday communications with our husbands or significant others (“were you
listening? What did I just say to you?) and especially with our children (tell me WHAT did I just
say to you?). When a person repeats instructions, they now own those instructions. They have
validated the receipt of the instructions and acknowledged this via vocalization of the
Finally, simply asking patients if they understand is good practice. You can’t drop a bucket of
instructions into a person’s lap and expect them to retain everything. Asking a patient if they
have question on the medications or anything discussed in the visit allows time for the patient to
be involved in their care. When an atmosphere of honest caring has been established between
provider and patient, the patient will trust us with very sensitive information. It has always been
my practice to review histories, allergies and medications with every patient (maybe it is an ER
nurse thing), and I will always do this because it truly is the only “script” I have in my head and
it has worked for over 20 years. Why stop a good thing?
Plus, it is a simple way to collect data from patients from varying socioeconomic sectors on their
literacy and comprehension level. Again, once that caring atmosphere is established, patients will
open up and tell you what you need to know. This then gives us, the healthcare provider, a snap
shot of the patient’s baseline comprehension and we can tailor design their care plan.
I will continue to collect data during my initial patient assessments to build on the need for the
patient to own their plan of care and not just be a passive recipient. I will do this by using closed
loop communication: Having the patient tell me, in their own words, why they are taking a
medication, for how long they need to take this medication, and the frequency of doses and side
effects. “Ask me 3” an initiative by the National Patient Safety Foundation to improve
communication between the patient and the provider (npsf.org).
I will evaluate the impact of my plan in the routine follow up telephone calls we make to our
patients in this clinic. “Did you get the medication? “, “Did you take the medications?” and “Are
you feeling better?” The answers to three questions will allow me to collect data that point to a
need for better education to promote medication adherence.
Ask Me 3. National Patient Safety Foundation.