Which translation model provides a framework for practice change?
The Knowledge to Action (KTA) model provides a framework for the practice change related to cardiac rehabilitation in the acute inpatient rehabilitation hospital setting. This is applicable from the perspective that KTA is an iterative process consisting of seven steps with the outcome of each step informing actions for succeeding steps (Moore et al., 2020). For example, the KTA framework could be used to implement and sustain use of clinical practice guidelines (CPGs) relative to cardiac rehabilitation. Furthermore the model also allows for assessment of clinician compliance with CPG recommendations and its impact on clinician perceptions. This is in alignment with a study conducted by Moore et al. (2020) using the KTA framework and focusing on gait and balance assessment for stroke rehabilitation in a similar setting and measuring effects of clinician compliance and perceptions. Findings from their study showed successful implementation and high levels of clinician adherence with the study intervention, likewise changes in practice were sustainable, after a four year follow up.
What is the value of an inter-professional team to address this practice problem?
The value of the interdisciplinary team cannot be understated in addressing cardiac rehabilitation, as the team works in a coordinated manner to implement best practices at the point of care taking into consideration feasibility to setting as well as other resources. While patients admitted for cardiac rehabilitation work extremely closely with physical therapists, dieticians and psychologists to promote lifestyle modifications such as diet and exercise (American Heart Association, 2021), other team members include nurses, physicians, pharmacists, occupational therapists, educators and case managers. It is imperative that the expertise and unique roles of each discipline be integrated into the planning process (White et al., 2016), likewise steps should be taken by the team to minimize barriers which could impede implementation of interventions, as discussed by Rathore et al. (2020), such as from the standpoint of the patient or provider. It is noteworthy that this collaborative team approach along with identified strategies must have leadership support in an effort to move the process forward.
In influencing improvement outcomes to address this problem, what strategies can you implement to inspire others to embrace change?
Strategies that can be implemented to embrace change in influencing improvement outcomes with addressing cardiac rehabilitation include identification of early adopters as change agents or super-users, and training that group who will subsequently motivate others (Dobbins et al., 2018). Additionally, promoting standardization and integrating processes into everyday practice while making it user-friendly for end-users, which is alluded to by Puchalski et al. (2019) in their study looking at facilitators to evidence based practice to optimize clinical care and patient outcomes.
American Heart Association (2021). Cardiac rehabilitation tools and resources. https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation/understanding-your-heart-condition (Links to an external site.)
Dobbins, M., Traynor, R.L., Workentine, S., Yousefi-Nooraie, R., Yost, J. (2018). Impact of an organization-wide knowledge translation strategy to support evidence informed public health decision making. BMC Public Health. 18 (1412), 1-16. https://doi.org/10.1186/s12889-018-6317-5
Moore, J.L., Virva, R., Henderson, C., Lenca, L., Butzer, J.F., Lovell, L., Roth, E., Graham, I.D., Hornby, T.G. (2020). Applying the knowledge-to-action framework to implement gait and balance assessments in inpatient stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2020.10.133 (Links to an external site.).
Puchalski, R., Debebe, F., Azazh, A., (2019). Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study. BMC Health Services Research. 19(1), 181. https://doi.org/10.1186/s12913-019-4008-2 (Links to an external site.)
Rathore, S., Kumar, B., Tehrani, S., Khanra, D., Duggal, B., Pant, D.C. (2020). Cardiac rehabilitation: Appraisal of current evidence and utility of technology aided home-based cardiac rehabilitation. Indian Heart Journal, 72(6): 491–499. doi: 10.1016/j.ihj.2020.08.013 (Links to an external site.)
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.
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