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RESEARCH PROJECT 1 Change Theories and Healthcare Innovations Jenna Best Ellis Liberty University BUSI 505 August 7, 2021 Respectfully submitted to: Professor Lawrence Johnson

RESEARCH PROJECT 2 Abstract There have been significant advances in healthcare technology that have allowed for improved communication between physicians and their patients to address and provide improved patient outcomes. Advances in technology has shown many benefits for patients at risk for falls, heart failure, diabetes, hypertension, and gastrointestinal disorders. Nurse leaders play an important role in implementing changes to improve patient outcomes. Change theories examine how the process of implementing will happen. It is important that nurse leaders understanding theories of change to understand what to expect when introducing new initiatives.

RESEARCH PROJECT 3 Change Theories and Healthcare Innovations There are many factors that have an impact on the need for change within the healthcare environment. These factors include the increase healthcare costs, nursing shortages, new technology, and the growing elderly population. With the continued advancements in healthcare technology, understanding and application of change theories are necessary to implement in healthcare informatics that will allow for improved communications between physicians and patients which will ultimately improve overall patient care (Wagner, 2018). Change Theories Change is essential to providing quality patient care in a constantly evolving field of healthcare. Nursing leaders must execute the ability to maneuver change throughout their environment. Successful change initiatives incorporate the application of change theories to use the best process available to achieve a desired outcome. Application of the appropriate change theory will allow for a more sustainable change within the organization. Change theories provide the necessary framework to implement, manage and evaluate change within the desired environment (Shirey, 2013). Planned Change Theory Theorist Kurt Lewin developed the Planned Change Theory that encompasses recognizing why individuals and organizations act in certain ways and what resources would strengthen or weaken an action of change. There are three phases of planned change theory: unfreezing, moving, and refreezing (Shirey, 2013). The unfreezing phase involves getting ready for change by recognizing an opportunity for improvement. The nurse manager will assess their current environment with the desired state to determine what gaps are present. The moving phase requires a plan of action for implementing change. This phase requires the manager to engage

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RESEARCH PROJECT 4 associates in the plan of change. Often, people are hesitant to change which is what makes this phase often difficult. Lastly, the refreezing stage requires nurse leaders to institutionalize changes into current practices and policies. This theory is the oldest change management theory and still is used in practice today (Shirey, 2013). Diffusion of Innovation Theory Innovation is defined as new ideas, thoughts, and practices and includes the adoption of these ideas. On the other hand, diffusion includes the sharing of these new innovations and applying them in real world situations. The Diffusion of Innovation Theory seeks to understand how innovations are adapted within different cultures and populations (Dearing & Cox, 2018). Diffusion is defined as “a social process that occurs among people in response to learning about an innovation such as a new evidence-based approach for extending or improving health care (Dearing & Cox, 2018, p.183-4).” This theory has been assessed in understanding the rate of how new ideas are adopted and applied. Diffusion is impacted by the advantages and disadvantages of innovations and the characteristics of those adopting innovation. There are five different people explained in the Diffusion of Innovation Theory based on their willingness to adopt an innovation. These five people include innovators, early adopters, early majority, late majority, and laggards. Innovators are the first to accept change and adopt new ideas. They are not afraid to take risks and going against the social norms. Early adopters adopt an idea because the innovation or ideas has more advantages than disadvantages. The early and late majorities adapt because of the social pressure to do so. Those in the early and late majority categories are part of the general population. Last to adapt are the laggards. Laggards are typically set in their ways which make them slower to adapt

RESEARCH PROJECT 5 change. In most cases they are forced to adapt to the new idea or innovation because it is used by the majority population (Dearing & Cox, 2018). Stages of Change Model The Stages of Change Model, otherwise known as the Transtheoretical Model for Change, focuses on understanding the decision-making process that leads a person to adapting change. There are five stages of this change model: precontemplation, contemplation, preparation, action, and maintenance (Raihan & Cogburn, 2021). The precontemplation stage usually involves an individual that is typically in denial that change is needed. People in this stage focus more on the negatives of changing rather than the advantages. Contemplation stage is the stage when needed change is recognized and the pros and cons are assessed logically. Those in this stage often remain indecisive on implementing changed behavior. The next stage of change is the action phase. Change happens in this phase and plans are developed to help overcome potential obstacles. When a person jumps to this stage without preparing for possible obstacles can lead to potential failure. The maintenance phase is when the change behaviors are sustained. There is often a fear in this phase of relapsing but evaluating the progress that has been made keeps the individual from relapsing. Contingency plans should be created in this phase and are helpful in preventing relapse. Termination is the final stage of this change model and is often difficult to achieve. The termination stage is not typically achieved because this stage requires individuals to have zero desire to return to their old habits and requires zero temptation to return to their old habits. It is common for most people to remain in the maintenance phase rather than progressing to the termination phase (Raihan & Cogburn, 2021).

RESEARCH PROJECT 6 Use of Change Theories Application of change in the field of nursing is essential in promoting quality patient care. Change agents are individuals who initiate and guide change within an organization. Nurse leaders are often change agents that implement new ideas and processes for nurses to apply in their practice that leads to improved patient outcomes. The responsibilities of change agents are to assess the need for change, collaborate with others to incorporate the need change and educate others on the process of change. Often there is resistance to change so it is imperative that nurse leaders anticipate potential barriers to change and take action to remove these barriers. Leaders must have a clear understanding of change theories and learn to constructively address the reasons for resistance to improve overall patient outcomes. (Wagner, 2018). Innovations in Healthcare Informatics Healthcare informatics is defined as “the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information (Sweeney, 2017, p. 1)”. Healthcare professionals utilize informatics in both the inpatient and outpatient settings for a variety of different reasons. This can vary from vital sign machines, to monitoring blood pressures and blood sugars, to developing fall prevention programs, and to monitoring the effects of a specific treatment plan. These are just the few ways that healthcare informatics can be applied in patient care. Overtime we have only continued to advance in technology that optimizes our abilities to provide efficient, high-quality care. Healthcare informatics is important because it allows for the analysis of data collection and provides healthcare providers with the opportunity to provide the appropriate treatment plan to enhance patient outcomes (Sweeney, 2017). In this paper, a variety of innovations in healthcare technology are discussed and their impact on improving patient outcomes.

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RESEARCH PROJECT 7 Continuous Blood Sugar Monitoring Patients with uncontrolled diabetes are at higher risk for developing other co-morbidities and even mortality (Boyce, 2020). As technology has continued to advance, there has been a shift from the traditional blood glucose monitoring checks towards continuous glucose monitoring. One example of this method is the FreeStyle Libre. These continuous glucose monitoring devices have been shown to be beneficial and can detect and alert those that are at risk for developing a hypoglycemic or hyperglycemic event. These continuous glucose monitoring devices attach to the subcutaneous tissue in the arm or abdominal tissue and provide continuous glucose readings using interstitial tissue. Much research has been done on the impact that continuous blood glucose monitoring has been beneficial in blood glucose control in pediatric patients. The continuous monitoring of blood sugar levels allows for tighter control of insulin administration (Boyce, 2020). The advantages of this method are that the patient does not have to endure the painful sticks checking their blood sugars, there are minimal supplies used, and the physician can analyze their blood glucose trends to adjust their medication regimen based on results. Continuous glucose monitoring devices have allowed patients to feel more in control of their diagnosis. Continuous blood glucose meters remain a leading technology for diabetes diagnosis and treatment (Boyce, 2020). Remote Blood Pressure Monitoring Remote blood pressure monitoring involves a cuff that is placed at the wrist that measures a patient’s blood pressure. There are many factors that can impact a patient’s blood pressure, such as environment, stress, and physical activity. These wearable devices can assess the impact that these factors have on blood pressure reading. Typically, a patient’s blood

RESEARCH PROJECT 8 pressure is higher in the morning and lower at night. However, these wearable devices can detect consistent increased blood pressure readings that can place a patient at an increased risk of stroke, cerebral hemorrhage, and other organ damage. (Kario, 2020). Oscillometric measurement of blood pressure using wrist-cuff devices have been proven to cause less discomfort for patients than transitional blood pressure cuffs. One area where remote blood pressure monitoring has been shown to be significantly useful is in pregnant women. Hypertension in pregnant women can result in preeclampsia. Over 40 million women are affected by preeclampsia each year. Preeclampsia, also known as toxemia, and causes strain on organs such as the liver and kidneys not working appropriately. Preeclampsia can lead to premature births in babies. Therefore, closer monitoring of maternal blood pressure readings can allow for appropriate prevention and treatment which can reduce maternal morbidity, mortality, and premature births (Ganapathy, Grewal, & Castleman, 2016). Remote blood pressure monitors can send readings to an “app” on their phone and to the physician. The results allow for the physician to monitor trends in blood pressure readings. The advantages of remote blood pressure monitoring include the fact that patients can take control over their own health, medical knowledge is not necessary because interpretation of results are easy to understand, and compliance can be monitored (Ganapathy et al., 2016). Innovations in Fall Prevention Wearable sensors have been helpful in determining mobility patterns in elderly patients. Elderly patients are more susceptible to falls that can result in hip fractures, brain injuries, and even death. Wearable sensors can be worn around wrist, ankle, or waist. These sensors can assess a patient’s ability to move around obstacles and is helpful in implementing interventions and exercise routines for preventing falls. Data can be sent from smartphone applications to

RESEARCH PROJECT 9 physicians that will provide information to the physician that will allow them to prescribe the appropriate exercise regimen for that patient. Remote monitoring devices can also detect when a patient has fallen to prevent them from lying on the floor for long periods of time with no one to help get them up (Lord & Close, 2018). It is estimated that one-thirds of patients above 65 years old experience a fall each year and it can cost approximately $14,000 to treat each patient admitted for falls (Lord & Close, 2018). Palarum LLC® developed PUP (“Patient is Up!”) socks. These socks use real time using sensors on the bottom that determine weight distribution and mobility patterns. The nursing staff is provided with a SmartBadge that connects to the socks and provides alert to the three closest caregivers to alert them that a patient that is at higher risk for falls is up unattended. Once someone has attended to the patient, the SmartBadge alarm deactivates. Palarum collects real time data that can monitor falls and initiative appropriate programs for fall prevention (“Palarum SmartSocks”). Heart Failure The standard analysis of patient status in patients with heart failure is typically in the hospital setting, outpatient office, and implantable cardiac devices. However, wearable devices can provide real time data in heart failure patients. These can be worn as watches, clothing, and cutaneous devices that allows for the transmission of data to the physician. These wearable devices allow for the analysis of current treatments and eligibility for future treatments.

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RESEARCH PROJECT 10 Figure 1 . Utilization of wearable devices in heart failure patients. From Devore et al, 2020, https://doi.org/10.1016/j.jchf.2019.08.008 Figure 1 above describe the progression and application of wearable devices in heart failure patients. It can range from monitoring weight loss in patients with obesity in Stage A HF. Wearable devices in Stage B HF patients can assess the progression of valvular disease and their increased risk for developing heart failure. In Stage C, this incorporates continuous heart rate monitoring and assists in providing appropriate therapies for patients with heart failure. Lastly, wearable devices with Stage D HF can monitor blood oxygenation levels and speed settings of left ventricular devices (DeVore, Wosik, & Hernandez, 2019). An example of wearable technology includes smartwatches, such as an iWatch, that can detect irregular heart rhythms using photoplethysmography. Photoplethysmography utilizes a light source and a photodetector at the cutaneous level to determine changes in blood circulation. Although this data isn’t always accurate, Apple did advance its program to be able to alert a patient with detection in irregular rhythms such as rapid atrial fibrillation and bradycardia. The

RESEARCH PROJECT 11 future of wearable devices in heart failure patients will be able to determine fluids levels in the lungs through a wearable vest (DeVore, Wosik, & Hernandez, 2019). Wireless Capsule Endoscopies Wireless capsule endoscopies were developed in 2000 and have only continued to grow in popularity. Wireless capsules have been helpful in transitioning from the traditional form of endoscopies that can be painful and place the patient at risk for having to intestinal walls. Utilizing these small capsules allow for no pain, no sedation and no air insufflation that is common after a traditional endoscopy procedure. This method works by having a patient swallows a tiny pill-shaped capsule that allows for the physician to capture images through the gastrointestinal tract. These wireless capsules contain a camera, light, and a radio frequency transmitter that allow for real time analysis. It takes about eight hours for the capsule to travel throughout the gastrointestinal tract and the capsule can capture anywhere between 50,000- 80,000 images. These images can allow for the diagnosis of bleeding, lesions, tumors, ulcers, and other diseases of the gastrointestinal tract such as Ulcerative Colitis. The advantages of wireless capsule endoscopies are that it is relatively inexpensive, non-invasive, and is an out-patient procedure that allows for the patient to continue to do their daily activities versus the traditional method having to undergo sedation (Pogorelov et al., 2019). Application of Changes in Healthcare Innovations Effective change intitaitves require the nurse leader to understand the process and tools involved that will allow for improved patient outcomes. The areas of healthcare innovation discussed in this paper are just some of the areas that a leader can focus their attention and gain knowledge on the tools and processes to implement change within the healthcare environment. These advances in technology can not only facilitate the shortage of nurses and other ancillary

RESEARCH PROJECT 12 staff members but can also facilitate patient comfort, communication between providers, and improved patient outcomes. It is essential that the nurse leaders understand change theories that will allow the leader to implement, manage and assess the change initiative (Wagner, 2018). Conclusion Healthcare technology continues to advance to improve patient outcomes and provide more efficient communication between physicians and patients. Application of new innovations in healthcare technology can lead to significant changes when providing patient care. Many of these technological advances allow the physician to assess the patients current clinical condition and provide the appropriate treatment plan. Nursing leaders play a vital role in implementing change within an organization. Change theories help leaders understand what to expect in the process of implementing change. There is often resistance to change, therefore, it is imperative that nurse leaders have a clear understanding of change theories to facilitate changes in healthcare technology and their application to patient care.

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RESEARCH PROJECT 13 References Boyce, E. (2020). Knowledge is power? how continuous blood glucose monitoring systems are changing the management of type 1 diabetes mellitus.(continuing nursing education)(Disease/Disorder overview). Pediatric Nursing, 46 (4), 179-195. Dearing, J. W., & Cox, J. G. (2018). Diffusion of innovations theory, principles, and practice. Health Affairs, 37 (2), 183-190. https://doi.org/10.1377/hlthaff.2017.1104 DeVore, A. D., Wosik, J., & Hernandez, A. F. (2019). The future of wearables in Heart Failure patients. JACC. Heart Failure, 7 (11), 922-932. https://doi.org/10.1016/j.jchf.2019.08.008 Ganapathy, R., Grewal, A., & Castleman, J.S. (2016). Remote monitoring of blood pressure to reduce the risk of preeclampsia related complications with an innovative use of mobile technology. Pregnancy Hypertension, 6(4), 263-265. https://doi.org/10.10116.j.preghy.2016.04.005 Kario, K. (2020). Management of hypertension in the digital era: Small wearable monitoring devices for remote blood pressure monitoring. Hypertension (Dallas, Tex. 1979), 76 (3), 640-650. https://doi.org/10.1161/HYPERTENSIONAHA.120.14742 Lord, S. R., & Close, J. C. T. (2018). New horizons in falls prevention. Age and Ageing, 47 (4), 492-498. https://doi.org/10.1093/ageing/afy059 Masterson Creber, R. M., Hickey, K. T., & Maurer, M. S. (2016). Gerontechnologies for older patients with heart failure: What is the role of smartphones, tablets, and remote monitoring devices in improving symptom monitoring and self-care management? Current Cardiovascular Risk Reports, 10 (10), 1-8 . https://doi.org/10.1007/s12170-016- 0511-8 “Palarum Smart Sock.” Palarum, palarum.org/index.html.

RESEARCH PROJECT 14 Pogorelov, K., Suman, S., Azmadi Hussin, F., Saeed Malik, A., Ostroukhova, O., Riegler, M., Halvorsen, P., Hooi Ho, S., & Goh, K. (2019). Bleeding detection in wireless capsule endoscopy videos — color versus texture features. Journal of Applied Clinical Medical Physics, 20 (8), 141-154. https://doi.org/10.1002/acm2.12662 Raihan, N., & Coguburn, M. (2021). Stages of change theory. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK556005/ Shirey, M. (2013). Lewin’s theory of planned change as a strategic resource. JONA 43 (2), 69-72. Retrieved from https://topwritershelp.com/wp-content/uploads/2020/09/Strategic- Leadership-Article.pdf Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21 (1) Wagner, J. (Ed.). (2018). Leadership and Influencing Change in Nursing. Regina, SK: URPress. Retrieved from: https://ourspace.uregina.ca/handle/1

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