NU702 Unit 3 Implementation Framework Paper Example

Where the Change Will Stall: A Unit 3 Implementation Framework Paper Applying the Iowa Framework to Insulin Pen Discharge Teaching

[Student Name]

Purdue University Global

NU702: Translating Evidence into Nursing Practice

Unit 3 Implementation Framework Paper

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[Date]

The hospital, units, staff and figures are composite and illustrative; the frameworks and sources cited are real.

The Change to Be Implemented

The planned change is an insulin pen discharge readiness bundle for patients on 5 West and 6 West who start insulin or switch to a pen during their stay. It has four parts: nurse-supervised self-dosing begins on insulin day two; before discharge the patient, and any helper who will share the job at home, must show a correct injection using the very pen prescribed, with the result recorded; the pen and needles are delivered to the bedside by pharmacy before the patient leaves; and a diabetes educator calls within 72 hours. Baseline data show return demonstration documented for 18 percent of these patients and a 30-day emergency visit or readmission rate for glucose problems of about 14.5 percent.

Evidence supports the core element. Talevski and colleagues' review of teach-back reported benefit in nearly every included study, from recall to readmissions, yet most of those studies left out how the method became routine (Talevski et al., 2020). That gap is the reason for an implementation framework.

Why the Iowa Framework

Iowa's evidence-based practice model, revised in 2017, walks a project team from its starting concern through piloting, then integration and dissemination (Iowa Model Collaborative, 2017). Its companion, the Iowa Implementation for Sustainability Framework, focuses on the stretch of that process where many projects fail: getting a change adopted and keeping it. Cullen et al. (2022) refined the framework with input from more than a hundred users and an expert panel, specifying 75 implementation strategies across four phases and ten domains. Its four phases, used as the headings below, run from first awareness to sustained use. The framework suits this project because it was built by nurses for hospital practice and because it treats sustainability as a phase to plan rather than a hope.

Phase 1: Create Awareness and Interest

Staff on both units believe they already teach well, so the first task is to show the gap without blame. Strategies in this phase include presenting local data and telling a patient story. At the monthly staff meeting, the unit educator will present the two numbers side by side, 92 percent of charts saying education was complete and 18 percent showing a demonstration, followed by a composite case of a patient who doubled his evening dose at home two days after discharge. Two respected night-shift nurses will be invited to be unit champions, chosen because night staff do much of the insulin administration.

Phase 2: Build Knowledge and Commitment

Nurses know how to use insulin pens but have little practice coaching a patient through one. A fifteen-minute skills session on each shift will practice the return demonstration with a checklist of five steps: prime, dial, inject, hold for ten seconds and dispose of the needle. A pocket card will carry the steps and three teach-back questions about lows. The bundle will be piloted on 5 West for four weeks before 6 West, so that staff on the second unit can hear from colleagues who have used it.

Phase 3: Promote Action and Adoption

This is the phase where the change is most likely to stall. Discharge days on these units are crowded: rounds finish late, transportation arrives early and teaching is compressed into the last hour. If the return demonstration is attempted only on discharge day, it will be skipped whenever the day is busy.

A demonstration scheduled for the last hour will be the first thing cut.

The framework's strategies for this phase include changing the workflow, building reminders into the record and auditing with feedback. The bundle therefore moves practice earlier: once insulin day two arrives, every dose is self-given under a nurse's eye, so that by discharge he has injected several times and the formal demonstration is a confirmation rather than a first attempt. The electronic discharge navigator will include a required field recording the demonstration result, pass or needs more practice, which also gives the team clean data. Pharmacy will deliver pens through the existing bedside delivery program by noon on the day before an expected discharge. Each week, the champions will share each unit's demonstration rate at the shift huddle, and the educator will follow up individually, and privately, on missed cases.

Phase 4: Pursue Integration and Sustained Use

Changes that depend on a project lead often fade when the lead moves on. The strategies for this phase are to embed the practice in structures that outlast the project. The return demonstration will be added to new-nurse orientation and to the annual competency for both units. The demonstration rate and the 30-day glucose-related return rate will appear on the units' monthly quality dashboard, and the unit practice council, rather than the educator, will own the measure after six months. A three-month and twelve-month review will check whether rates have held.

Anticipated Resistance

Two objections are likely, and the plan answers each in advance. Some nurses will say that supervised self-injection slows medication passes, because coaching a patient takes longer than giving the dose. The pilot will time ten supervised doses to show the real cost, which the champions expect to be a few minutes per patient for two or three days. Others will worry that patients who are ill or anxious should not be asked to inject. The bundle allows a nurse to defer the first supervised dose by a day when the patient is too unwell, as long as the reason is recorded, so the rule protects patients rather than pressuring them. Hearing these concerns early, through the champions, is part of the second phase.

Measuring Implementation

Implementation will be measured separately from patient outcomes. Adoption will be the proportion of eligible patients with a recorded return demonstration, with a goal of 85 percent by the end of the pilot. Fidelity will be checked by a monthly observation of five discharges per unit using the five-step checklist. Reach will include whether caregivers were included when the patient reported that someone would help at home. The patient outcome will remain the share of patients who return within a month with a glucose emergency.

Conclusion

The Iowa Implementation for Sustainability Framework gives the project a sequence: show the gap, build skills and commitment, change the workflow so the practice happens before discharge day, and hand ownership to the units. Its value here is in predicting the stall point, the crowded discharge day, and choosing strategies that move the work away from it.

References

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa Implementation for Sustainability Framework. Implementation Science, 17(1), Article 1. https://doi.org/10.1186/s13012-021-01157-5

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350