NURS FPX 6085 Assessment 4 Implementation Plan Design

NURS FPX 6085 Assessment 4 Implementation Plan Design 

Student Name

NURS-FPX6085

Capella University

Submission Date

Implementation Plan Design

Access to healthcare is a constant challenge for the poor and uninsured in urban communities in the United States, and a key determinant of the nature of care received and given. This document will give a guide to conducting a structured 12-week motivational interviewing (MI) training for nurses to care for low-income uninsured adults in acute care centers in urban areas. Gonzalez’s study suggests that two factors in clinical settings that exacerbate the health inequities for these disenfranchised communities are how providers communicate with their clients and their implicit biases. The paper describes the leadership approaches, approaches to delivery, technology resources, impacts on stakeholders, policy implications, and timelines for the implementation of this MI training intervention with nurses. 

Management and Leadership

Effective leadership and management will be the basis for an effective interprofessional collaboration that will then form the foundation for a successful MI (Motivational interviewing) training program amongst nurses. An implementation team, comprised of individuals from various functions, will be created to participate in all phases of the MI training program implementation, such as bedside nurses, nurse managers, certified trainers of MI, quality improvement officers, and hospital administration. The following are some of Mohammed’s research findings to enable nursing excellence and sustainability of improving clinical practice: Effective institutional leadership, shared governance, and continuous investment in continuing education of staff.

Conflicting Data and Other Perspectives

Although numerous studies have demonstrated the benefits of MI training for nurses, certain studies have offered inconclusive evidence that a single MI training program can be effective or that it provides lasting benefits to healthcare professionals’ communication skills. Using these skills regularly in relation to MI use is challenging for the healthcare provider, and Silva found a number of factors that compete with the use of MI: Time, Cultural differences between providers and patients, and lack of confidence on the part of the provider.

Implications of Change Associated with the Proposed Strategies

Profound changes will need to be made across the three levels of the unit, nurses and the care delivery process to implement a nurse-based training project for MI within the urban acute care settingThe results of Endalamaw et al. (2024) indicate that implementing patient care protocol changes that are based on structured change management frameworks had a tremendous impact on the uptake of the changes by staff and patient care protocols being adhered to over time. There is, however, no clear evidence that the MI communication behaviour changes that were coached and reinforced with nurses during the 12-week main stay after a period of 12 weeks remain for the long term. Yet, it is not understood whether the MI communication behaviour changes that were coached and reinforced by nurses after a 12-week period or whether the institutional accountability mechanisms that benefit nurses remained over extended periods of time.

Areas of Uncertainty or Knowledge Gaps

There is evidence that MI training programs are effective, but additional research is needed to document MI training’s effectiveness before attempting implementation in the acute care setting to move forward. It is unknown as yet how many nurses in large volume urban hospitals will be able to build up the necessary MI skills to be able to perform their patients’ clinical needs as well as complete their nursing work in the clinical role of their choice. These gaps need to be filled through future research aimed at determining the optimal frequency of MI training, the duration of the MI training sessions, as well as the method to facilitate the ongoing implementation of MI skills by nurses in an urban acute care setting.

Delivery Methods

The program of nurse MI training will be delivered using a blended delivery approach, which will include weekly 60-minute (group) in-person training, individual role-play training, and bi-weekly feedback from certified nurse MI trainers. Core MI skills (i.e. open questions, reflection, affirmation, goal setting) practiced in group sessions during which the skills were applied to examples from urban acute care will be used to demonstrate how to apply skills to real-life scenarios and will be contextualised within these examples; Cunnington et al. (2023) found that using a blend of training and practice resulted in better knowledge retention, skill application and confidence across health workers. This way, it is assumed that nurses will be given protected time in the week for their training and that it will not affect their care provision for patients; and that the organisation will provide trainers who will be certified to deliver the training as well as provide protected time for nurses and other resources required for quality improvement. Fidelity audits, staff workload assessments, and staff attendance will be actively monitored and addressed throughout the 12 weeks, as staff motivation and readiness to adopt successful evidence-based practice are key predictors of effective adoption, according to Watson.

Current and Emerging Technological Options

In the urban acute care setting, the nurse MI training intervention will be complemented by EHR systems, AI capabilities for MI, and video training tools, which will allow for measuring patient adherence, outcomes, and appointment information throughout the 12-week intervention. AI-powered MI tools greatly improve the scalability, affordability, and engagement with patients, compared to the traditional in-person approach, while video-based MI training systems allow for role-play simulations, fidelity checks, and coaching between a nurse and an MI certifier to be provided remotely. There is still a lot of uncertainty around the long-term evidence of the effectiveness of AI and video-based MI coaching, however, as there are currently no large RCTs to support this approach to increasing nurse communication skills. Potential to exacerbate healthcare disparities with less human interaction with vulnerable populations with AI communication tools highlights the need for further research on optimal technology combinations that will support nurse MI skill development with low-income, uninsured urban patients.

Relevant Stakeholders and Healthcare Regulations

Those key stakeholders attending the training sessions, such as RN’s on the floor, nurse managers, MI trainers, quality improvement officers, and hospital administrators, will shape the internal elements of the training program. In the process of quality improvement, Alzoubi’s research points out that attention should be directed towards the fact that the nursing workload and the professional ethics that influence the commitment of the nursing staff could also contribute to the occurrence of staff burnout during implementation. The needs of CMS and The Joint Commission will include evidence-based accreditation practices, measurable outreach efforts, and improvements to patient-centered communication to address healthcare disparities. This implementation plan assumes that nurse MI training would be prioritized by the hospital executive team, CMS and Joint Commission healthcare disparities regulations would not change during the 12-week period, and a nurse MI would not cause a disconnect in quality improvement activities between the changing federal, state, and/or organization regulations. (Mohammed’s research)

Existing and New Policy Considerations

Several federal and institutional policy frameworks in support of nurse MI training programs designed to improve low socioeconomic status uninsured adults’ access to healthcare exist. That’s one of the policies that has been mandated by the ACA, which is to provide greater access to low socioeconomic status populations. The compliance requirements imposed on nurses when caring for the most vulnerable individuals have created an additional compliance burden in the nurse’s professional development, particularly regarding MI training as mandated by Institutional Policies that require certain nurses to receive training in MI (McMullen et al.,2022), and documentation requirements that could prevent faculty members from participating in the MI training program. Additionally, changing federal policies and organizations’ unwillingness to pay for and implement newly developed training programs are huge obstacles to the successful implementation of MI training programs that are funded by federal and organizationally-based policies.

Timeline

The 12-week implementation of motivational interviewing (MI) training is a component of the unit’s quality improvement (QI) calendar – weeks 1-2 consist of activities outlined below: Stakeholder engagement, trainer orientation, baseline training assessments for MI, and patient data collection for patient satisfaction and adherence to MI. Offering flexible departmental schedules, regulatory audits, and availability for employees was important for maximizing participation rates, Pescari found, and keeping fidelity across all disciplines. The MI Core Training weeks are Weeks (3-10) followed by the last 2 weeks (11-12) for the assessment of the intervention, the evaluation of the outcomes, and planning for sustainability. Any healthcare improvement is likely to be particularly vulnerable to organisational instability where there has been a growth in patient numbers, turnover of staff, and unplanned inspections by regulatory bodies.

Conclusion

A twelve (12) week training program for an MI nurse to work in an urban, acute care setting has been developed with a low-income, uninsured adult population. The overall methodology (policies, technology integration, stakeholders, modes of delivery, and leadership strategies) was built upon using the PICOT format and literature reviewed for assessment 2 in the current capstone. This implementation plan is a comprehensive and viable guide for the understanding of the MI Nurse Training Intervention as an evidence-based practice that can be used to evaluate the enhancement of communication skills of providers and access to care for low-income adults who are uninsured in an acute care, urban setting.