Evidence-Based Practice for Nurses

workload. When input from stakeholders is not solicited, mistrust can develop
among healthcare providers, often putting patients in the middle of the feud-
ing disciplines.

1. Which of the following are ways to engage others in transitioning evidence to practice?
   (Select all that apply.)
   a. Journal club
   b. Collaborating with an APN
   c. Developing care maps
   d. Maintaining status quo


2. Put Kotter’s eight phases of change in order.
   a. Develop a clear vision
   b. Anchor the change
   c. Create a coalition
   d. Empower people to clear obstacles
   e. Establish a sense of urgency
   f. Consolidate and keep moving
   g. Secure short-term wins
   h. Share the vision

TEST YOUR KNOWLEDGE 16-2

How did you do? 1. a, b, c; 2. e, c, a, h, d, g, f, b

16.3 Keeping It Ethical

At the end of this section, you will be able to:

‹ Discuss dilemmas that can be encountered during change

One must compare the benefits of any proposed change to the potential cost
that might be incurred as a result of that change (resulting in a cost-benefit
ratio). Sadly, many individuals in health care think about cost only in terms of
dollars and cents. Although the financial bottom line cannot be ignored, other
kinds of cost must be considered such as time, personnel, patient preferences,
and relationships. If changes are made to practice, process, and policy without
considering other aspects of cost, change may be inadvertently sabotaged.

To illustrate this point, consider how health care has changed to a system
of reimbursement based on a patient’s length of stay (LOS). Suppose a patient

KEY TERM

cost-benefit ratio:

Comparison of

benefits to potential

costs that might

result from change

16.3 Keeping It Ethical 443