decision making on procedure/practice modification

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Share an example from your nursing practice setting of how a decision was made to change a procedure or practice. What steps were used in the decision-making process? What evidence was considered for decision-making? Was the change effective? Provide rationale

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 


You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.

Lisa Wright

St. Thomas University

NUR 416: Nursing Research & Evidence-Based Practice

Lisbet Henriquez

September 29, 2022


Decision Making on Procedure/Practice Modification

            The decision-making process in healthcare changes is very vital. It determines the success or failure of the actions taken by the organization. When the proper process is followed, the decision can lead to the success or failure of the change initiative. For instance, if the workforce is not consulted during the research of the problem at hand, then the change initiative has the potential to address the issue inconclusively. The change team must make decisions following a predefined process (Nilsen et al., 2020). This ensures that the decision is aligned with an evidence-based algorithm to maximize success. This assignment module examines an example from my practice of how a decision was made to change a process. It also addresses the steps employed in the decision-making process, whether the evidence was considered and whether the change was effective.

Change Example of Decision-Making

            A change decision that I have been a part of in my practice was to change to an Electronic Health Records System – Medhost Cerner. The critical aspect of the decision was to ensure minimal workflow interruptions, minimization of errors, and as part of the goal, ensure that the healthcare environment and delivery were optimized. Among the criteria considered in the Medhost models included the computerized provider order entry systems, patient education, security features such as access restrictions, and pharmaceutical allergies de-conflicting. The selected system met the facility’s requirements, including the financial requirements and HIPAA regulations. 

Steps Used and Evidence Considered in the Decision-Making Process

            The system’s acquisition employed the Awareness Desire Knowledge Ability Reinforcement (ADKAR) model. This is a change model that emphasizes employee engagement by leaders to optimize the success chances of the change (Balluck et al., 2020). The first stage was awareness and addressed the workforce’s need to realize that a change is needed. It was followed by desire and involved creating a sense of want among the employees. The third was knowledge, involving educating the workforce on how to effect the change implemented. It was followed by ability, and it entailed the workforce’s process of developing new working routines and habits around the new system. Finally, were the reinforcements, where new means of getting the job done were and still are implemented involving the system.

            The evidence considered in the decision-making process included the assessment of the responsiveness of the system in addressing the issue of medical errors. Based on evidence from the practice on the incidents of errors, the adopted system needed a track record of addressing and minimizing such errors. The system also needed to be well adept in addressing managing health records. The evidence considered was its capacity to store, access safely, and transmit health information. For instance, there needed to be near real-time information communication to ensure that when imaging is done in the MRI, the information can be sent directly to the patient’s caregiver with near zero delays. There was also testing before the system was fully integrated. This sought to ensure that all the requirements were realized as promised by the developer. 

Effectiveness of the Change

            The change was very effective in integrating the facility’s information system, consistent with studies’ findings on such change processes (Aguirre et al., 2019). We realized enhanced efficiency through communication, patient information access, and payment methods. This keeps being realized to date, where updates keep being made to match the fast-changing world of technological changes. The system has become more oriented in addressing complex health issues ad decisions such as intervention analysis. It can analyze thousands of scenarios and outcomes based on interventions and help discern the ideal ones for implementation.


            As important as the system or change under consideration is, so are the steps and process of effecting the transition. There are multiple models that a leader needs to consider based on their leadership model and the dynamic of their organization. The one basic denominator to all change is the engagement of the stakeholder, especially the workforce. Without their input, the chances of full adoption, utilization, and goals realizations become slim, and patient care is lesser for it. Healthcare facilities need to adopt standard and empirically proven change models for change to meet the objectives they dreamt of. This assignment module examined an example from my practice of how a decision was made to change practice, the steps employed in the decision-making process, whether the evidence was considered and whether the change was effective.


Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: A review of resources and tools. 

Balluck, J., Asturi, E., & Brockman, V. (2020). Use of the ADKAR® and CLARC ® Change models to navigate staffing model changes during the COVID-19 pandemic. 
Nurse Leader
18(6), 539.

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. 
BMC Health Services Research
20(1), 1–8.

Kerlange, Germain

                   St Thomas University

                           NUR 416

                  Prof. Henriquez, Lisbet

                  September 29, 2022


Decision-Making on Procedure/ Practice Modification

          Decision-making on procedure or practice modification is a process that is used to determine whether or not to change a current procedure or practice within a nursing setting. This process generally begins with identifying a problem or need for change. Once a problem or need is identified, evidence is gathered to support the proposed change. This evidence can come from research studies, best practice guidelines, or input from other clinicians. Once the proof is collected, it is evaluated to determine if the proposed change is likely to be effective. If the evidence supports the difference, a plan is developed to implement the change (Lobiondo-Wood & Haber, 2021). Once the change is implemented, it is evaluated to determine if it was effective in solving the problem or meeting the need for change.

            However, decision-making on procedure can be a complicated process. There are many factors to consider, and often, there is no clear right or wrong trajectory (Dubé et al., 2022). In my nursing practice setting, we recently had to decide on whether or not to change our policy on administering vaccines. The current policy was that all staff members were required to receive their flu vaccine from work. However, many staff members were hesitant to receive the vaccine due to safety concerns. After much discussion and deliberation, we decided to change our policy to make the flu vaccine voluntary for staff members.

           Many steps go into deciding this. First, we had to gather evidence. We evaluated studies on the efficacy of the flu vaccine and considered the risks and benefits of vaccinating staff members. We also looked at the policies of other healthcare organizations and consulted with our legal team to make sure we were making the best decision (Dubé et al., 2022). Once we had all the information, we had to weigh the pros and cons of changing the policy. On one hand, we knew that the flu vaccine was an effective way to prevent the spread of the virus. However, we also knew that some staff members would be unwilling to receive the vaccine if it was mandatory. After much discussion, we decided that making the flu vaccine voluntary would be the best.

           So far, the change has been effective. We have had a high rate of staff members getting vaccinated, and we have not had any significant flu outbreaks in our facility. I believe this decision was the right one and made using a thoughtful and evidence-based process. The process of decision-making on procedure/practice modification can be a difficult one. There are many factors to consider, and often there is no clear consensus on the best course of action (Nwokedi et al., 2022). However, by carefully considering all of the options and implications, it is possible to make an informed decision that will be in the best interests of the patients and the organization.





 Dubé, M., Raven, A., McBain, T., Oishi, K., & Enokson, R. (2022). Harnessing system-focused simulation, debriefing, and FMEA to inform healthcare blood transfusion safety and policy. International Journal of Healthcare Simulation, (null), 1-9.

Lobiondo-Wood, G., & Haber, J. (2021). Nursing research: Methods and critical appraisal for evidence-based practice. Elsevier.

Nwokedi, U. J., Morris, L., & Tariq, N. (2022). Learning New Operations and Introduction into Practice. The SAGES Manual of Quality, Outcomes and Patient Safety (pp. 503–533). Springer, Cham.

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