reply1  As discussed earlier in this class (week five discu

reply1  As discussed earlier in this class (week five discussion one), it is misleading to assume that implementing evidence-based change is simply a question of organization and theories. Even though these may be important, developing and successfully implementing an evidence-based change proposal requires adequate planning. Consequently, after discussing with my preceptor, we agreed that there is need to take financial, quality, and clinical aspects into consideration for developing the evidence-based change proposal. The financial aspect of this change proposal requires adequate budgeting for efficiency and effectiveness. The purpose of my evidence-based change proposal is to help decrease nurse burnout; to achieve this purpose, it is pertinent for management to ease nurses’ workloads during a work shift by encouraging less than twelve (12) hours per shift (Banakhar, 2017), increasing nurse-to-patient ratios as necessary, and introducing the electronic nursing documentation and the electronic health record to facilitate the documentation and retrieval of patients’ information with ease. Furthermore, introducing a proper stress management intervention policy would require adequate financial implication especially for remunerating the psychotherapist and/or physiotherapist who would be in charge. These activities require financial backing, and the management of PowerBack Acute Center should be able to provide adequate financial backing for this purpose. In addition to fulfilling the financial aspect for developing the evidence-based change proposal, the quality aspect must also be considered. In fact, there is a relationship between the financial aspect and the quality aspect. In other words, without adequate financing no health facility can improve on quality. The quality aspect that must be considered for developing a proper stress management intervention for addressing the problem of burnout at PowerBack Acute Center will include adequate nurse-to-patient ratios, adequate nurse staffing to check working hours beyond ten hours per shift, electronic nursing documentation and electronic health record; and the clinical aspect that needs to be taken into account will include nurse stress levels and the availability of stressors within the facility’s environment. My proposal which is the introduction of a combined stress management intervention (progressive muscle relaxation technique (PMR) and mindfulness-based stress reduction) will directly and indirectly impact each of the aspects. For the financial aspect, this proposal will indirectly reduce the direct and indirect costs of burnout on the nursing staff, patients, and the health organization. It will directly impact on the quality aspect because it can reduce burnout and consequently facilitate the retention of nurses within the health facility. Lastly, by helping to reduce stress levels and stressors within the organization, my proposal will directly and indirectly enhance nurse satisfaction and positive patient outcomes.                                                                                       References Banakhar, M. A. (2017). The Impact of 12-hour Shifts on Nurses’ Health, Well-being, and Job Satisfaction: A Systematic Review. Journal of Nursing Education and Practice, 7(11): 69. http:s//doi.org/10.5430/jnep.v7n11p69 reply2 After talking with my preceptor regarding the points of this topic we decided that the financial aspect for my project would be very little for the hospital to implement since the discharge education checklist is just a piece of paper for nurses to follow. The only financial cost may be in training hours for the champions. The financial benefit for the healthcare system from decreased readmissions, would far out weight the initial cost. The quality aspect for this project is to improve the quality of care in the patient with heart failure and to give them the tools they need to adequately manage their chronic illness. Multidisciplinary team collaboration in managing drug and diet regimens will be a key component in providing the education needed for these patients to manage their heart failure at home (Glogowska et al., 2015). The clinical aspect of this project is to improve discharge education by first thoroughly assessing the patient’s health literacy and then tailoring the discharge education to meet the individual needs of the heart failure patient. By doing this, my hope is that it will eventually reduce the rate of readmission. Studies show that HF patients’ understanding of their discharge instructions is limited, particularly with respect to their knowledge of follow-up appointments and discharge medications, despite receiving discharge instructions (Regalbuto et al., 2014). Regalbuto, R., Maurer, M. S., Chapel, D., Mendez, J., & Shaffer, J. A. (2014). Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?. Journal of cardiac failure, 20(9), 641–649. https://doi.org/10.1016/j.cardfail.2014.06.358 Glogowska, M., Simmonds, R., McLachlan, S., Cramer, H., Sanders, T., Johnson, R., Kadam, U. T., Lasserson, D. S., & Purdy, S. (2015). Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses. Annals of family medicine, 13(5), 466–471. https://doi.org/10.1370/afm.1845

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