Abstract

Adverse effects following immunization or AEFIs are adverse reactions that occur following the administration of vaccines. Both the bivalent and quadrivalent HPV vaccines given to girls aged 9-12 years have been shown to produce some of these AEFIs. They include postural orthostatic tachycardia syndrome or POTS which leads to syncope (fainting), and complex regional pain syndrome or CRPS. Because there is no realistic possibility of completely eliminating these AEFIs related to HPV vaccination (as is also the case with other vaccines), there is need to come up with evidence-based measures to contain their severity. This is what this project has proposed in the form of a nurse-led educational intervention to psychologically prepare the girls before they receive the vaccine.  Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example

Keywords: HPV, vaccination, AEFIs, prevention, mitigation.

Evidence-Based Practice Final Paper: Reducing the Impact of Adverse Effects of HPV Vaccination through a Nurse-Led Educational Counseling and Preparation Program

According to Melnyk and Fineout-Overholt (2019), evidence-based practice or EBP is nursing practice that is governed by the application of patient interventions that are efficacious. This efficacy must however be backed by scholarly peer-reviewed scientific evidence derived from solid research. This is what best practice is all about. EBP knowledge is built through the process of clinical inquiry that itself employs the PICOT model. This is the model whereby a proposed solution or intervention (I) is suggested for the population of interest (P) and compared to what is currently being done (C). The expected outcome (O) is stated s well as the timeframe (T) during which the intervention will be implemented and the outcome expected. Including the timeframe is fundamental because the goals of the intervention need to me specific, measurable, attainable, realistic, and time-bound or SMART. In this project, the identified population of interest is that of young girls aged 9-12 years who are supposed to receive routine human papillomavirus (HPV) vaccine. The project and the paper are about implementing a nurse-led evidence-based intervention to mitigate the impact of the adverse effect following immunization (AEFI) of syncope after HPV vaccination.

Section A: Organizational Culture and Readiness for Change Evaluation

Every organization has a culture that is unwritten but that influences the actions of all the persons that work in that organization. Healthcare organizations are no exception. For this reason, there are some organizations that have a culture that is open to change (change-friendly) and others whose culture is hostile to change. The influence for the organizational culture that any organization adopts comes from its top management or directors. This is because these are the policy makers who give direction and determine the strategic plan of the organization. There are definitely both facilitators and barriers for change in any of these organizations, including those that are friendly and welcoming to change. To determine the change preparedness of the organization in this case, the author made use of the Organizational Culture and Readiness for System-Wide Implementation of EBP (OCRSIEP) tool. This is a 5-point Likert-type data collection tool that asks simple straightforward questions on the organizational culture from the viewpoint of the employees. The range of choices for the respondents is from ‘not at all’ to ‘very much’ (Melnyk & Fineout-Overholt, 2019).

Facilitators and Barriers for Change

One of the most important facilitators or enablers to change implementation in this organization is the commitment of the top management to change and quality improvement initiatives. This is evidenced by a formal policy in the organization that allows innovators and other staff with ideas to access the directors with a well-written executive summary through a laid-down procedure. Another facilitator is the general use in the organization of a transformational form of leadership (Choi et al., 2016). From the directors to supervisory management, there is an open-door policy with staff empowered and motivated to air their opinions freely about practices and procedures. Morale is characteristically high in the organization and psychological safety is at its peak (Northouse, 2019). Lastly, the organization’s procedures, policies, and practices are pro-employees. There is no culture of victimization for mistakes but one of consultation and consensus. This is important because it is easy to obtain the buy-in of these employees when implementing a change project.

At the organizational level, there are really no barriers as has been seen above. The barriers to implementation of change in this organization are almost all related to the individual. First, nurses generally have a feeling that EBP change is a time-consuming affair that takes away time from their work schedules. Then there is the deficiency in knowledge related to EBP skills such as the synthesis of evidence and critical appraisal. These are the major barriers that may hinder the effective implementation of this program in the organization. Clinical inquiry can however still be integrated, banking on the overwhelming organizational support for change which includes financing. The strategies for strengthening the organization’s weaker areas would include staff training on EBP change implementation and the incorporation of the implementation elements into the normal work routine. This will prevent it being seen as a time-consuming event.

The results of the OCRSIEP survey showed that there were higher total scores. Thus means that the organization is ready for change through EBP implementation. The rationale for the survey category scores that were significantly high is that staff in this organization have high job satisfaction levels and therefore have a high opinion of the organization.      Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example

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Section B: Proposed/ Problem Statement and Literature Review

The refined PICOT elements in this project are as follows:

Table: The PICOT elements for the mitigation of the impact of AEFIs such as syncope related to HPV vaccination

From this, the final PICOT statement is therefore as follows: “In young girls aged 9-12 years and due for HPV vaccination (P), does a nurse-led educational counseling preparation program in the period before receiving vaccination (I) compared to the usual brief reassurance before vaccination (C) succeed in reducing the few HPV vaccination AEFIs such as syncope and helping recipients to cope (O) in a span of six months (T)?”

Proposal/ Problem Statement

There are two types of the HPV vaccine that have been approved for administration to girls between the age of 9 and 12 years. The first is the bivalent HPV vaccine that targets the most infectious and virulent HPV strains 16 and 18. The other one is the quadrivalent HPV vaccine that targets not only the HPV strains 16 and 18, but also 6 and 11. By the year 2013, it was evident that many countries had already implemented some sort of HPV vaccination program. However, there soon emerged anecdotal reports that some of the girls who received the vaccination went on to experience some unwanted AEFIs. These were later determined to include postural orthostatic tachycardia syndrome or POTS which leads to syncope (fainting), and complex regional pain syndrome or CRPS (Chandler et al., 2017). The problem is therefore how to mitigate the effects of these AEFIs if and when they occur. This is because it is not possible to completely prevent these AEFIs as they also depend on the physical condition of the recipient and medications taken.

Literature Review

            In Australia, for instance, about 9 million doses of the HPV vaccine have been administered in ten years between 2007 and 2017. This is according to the NHPVR or National HPV Vaccination Program Register for Australia. The wide coverage was achieved by instituting a school-based program for the HPV vaccination. Because of the risk of AEFIs in any vaccination program, the government made it mandatory to report the occurrence of any adverse effects that happened after administration of the HPV vaccines (Phillips et al., 2020). Due to the surveillance program undertaken in the ten years in Australia and the mandatory reporting policy, concrete figures were able to be collected about the incidence of these HPV vaccination AEFIs. Out of all the quadrivalent HPV vaccine doses administered between 2007 and 2017, there were a total of 4,556 cases of adverse events reported. Syncope or fainting was the most reported AEFI affecting about 70% of the recipients (Phillips et al., 2020).

In a catch-up program for girls aged 3-15 years and reported by Ward et al. (2019) in Denmark, there were significant reports of adverse events attributed to the administration of the HPV vaccines. There were a total of 963 reports of adverse events from 960 females. Out of these, the most reported adverse events were fainting or syncope and fatigue (Ward et al., 2019). Harper and DeMars (2017) also report adverse events occurring after administration of HPV vaccines. They used data from the SAEFVIC model which is an enhanced Victorian surveillance system for AEFIs. The data collected in two years showed that 29% of the adverse events were associated with the quadrivalent HPV vaccine. Of 94 cases reported, 63 were of syncope alone while the remaining 31 events had syncope and an associated seizure (Harper & DeMars, 2017). All the females were aged between 8 and 26 years.

It is inevitable that some of the studies reviewed above had significant limitations. Some of these were related to small sample sizes that robbed them of reliability, others had weak sampling methods making them lack internal validity, and yet others had methodological drawbacks that made their findings more or less unreliable. With the problem statement and the literature review of the issue as outlined above, the next step is to reveal the proposed solution according to the PICOT statement. This is what the discussion in the section below entails.

Section C: The Proposed Solution

According to Love (2017), enhanced nursing communication with patients or clients who are about to receive the HPV vaccine results in better patient outcomes. By extrapolation, this would include the occurrence of less AEFIs and better coping with the few that would occur. Liu et al. (2016) concur and state that the actual position is that the total number of confirmed adverse events linked to the HPV vaccines is actually statistically low. They opine that the vaccines are therefore safe for use and the rates of adverse effects compare favorably to any other vaccines in the market. The solution proposed for this project is therefore a nurse-led and facilitated program of teaching the girls and their mothers at least a week before they receive the HPV vaccine. This teaching with involve psychoeducation and counseling to prepare them psychologically. They will be told that the likelihood of an AEFI is low, but that when it occurs it also subsides just as quickly as it came. This means the effect is transient and not permanent. This psychological preparation is expected to reduce psychosomatic expression and anxiety, which in itself may lead to fainting.

Section D: Roger’s Diffusion of Innovations (DOI) Model of Implementing Change and Its Relevance to this Project

Roger’s Diffusion of Innovations theory states that different categories of employees exist within the organization. There are those who are considered as the innovators who come up with change ideas. They are only 2.5% of the employees. Then there are the early adopters who are 13.5% of the employees. They are the easiest to convince and adopt the change recommendations immediately. These are followed by the early majority representing 34% of the employees. These need a trusted colleague to convince them to adopt the change. Then there is the late majority who are stubborn sceptics representing another 34% of the employees. They are made to adopt change by pressure from the leadership and effective leadership. Lastly, there are the laggards (16%) who are the most obstinate of all the employees. They are the last to adopt change after everybody else has done so (Dearing & Cox, 2018; Pashaeypoor et al., 2016). The stages of the model are as follows:

1. Knowledge

At this first phase, the nurses are educated on the presence of the data showing presence of AEFIs related to HPV vaccination and how to mitigate their impact.

1. Persuasion

This phase deals with obtaining the buy-in of the nurses by convincing them that the change proposal needs to be implemented by them.

• Decision

At this point, the decision is made to go ahead with the project after being certain that it has a chance of success.

1. Implementation

The project is implemented at this stage. The vaccinating nurses lead the intervention for the period of six months and document successes and failures.

1. Confirmation

This is where the confirmation is made to incorporate the intervention permanently into the organization’s policies and procedures. This is after it has shown success in mitigating the impact of HPV AEFIs.

Section E: Implementation Plan

Setting and Access to Potential Subjects

The setting for the implementation of this project will be the well-woman clinic at the healthcare facility of the organization of interest. The nurse involved will be the same nurses who normally administer vaccination to the women and girls at the clinic. As to the matter of access to the participants, these will be the same clients coming to the facility of their own volition to get vaccinated against the HPV vaccine. They will however have to fill a consent form to be able to participate in the one week educational program voluntarily before being injected.    Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example

Timeline for Implementation

The timeline for the intervention will be six months, a period sufficient enough to allow the demonstration of the efficacy of the intervention as envisaged. During this period, the educating and vaccinating nurses will keep a record of the events and progress as this is the data that will ultimately be used to perform program evaluation. The exact timeline is in the Appendix section.

Resources Required

Like any project, there are resources that will be required. These will be human, material, and fiscal. The human resources that will be needed are more nurses to help with the teaching, sensitization, counseling, and general preparation for receiving the HPV vaccine. These must be registered nurses, preferably baccalaureate nurses who understand research, leadership, and evidence-based practice. Materials will include flip charts, overhead projectors, and pamphlets. Fiscal resources will be some amount of money that will go towards footing the FTE bill of the extra nurses needed.

Method, Instruments, and Process of Delivering Intervention

The method of delivery will be presentations aided by visual aids for faster and better comprehension. The instruments used will include flip charts and overhead projectors as well as handouts. The nurses delivering the educational intervention will first need to be trained and appraised themselves first on HPV AEFIs, the problem identified, and the potential solution.

Data Collection Plan, Management of Barriers, and Feasibility

Data collection will be by means of vaccination records, patient records (biographical data), and records of any adverse reactions immediately after receiving the HPV vaccine. Barriers will be managed by first training the nurses and making them comfortable with the project. They will then not see it as a time-consuming venture. The way the project has been planned and arranged, its achievement is very feasible as it only requires nonpharmacologic measures that are behavioral in nature.

Section F: Evaluation Plan

Rationale for Methods of Collection, Validity, Reliability, and Applicability

The rationale for the methods used to collect data is that the data will be collected in real-time. Therefore, the best strategy will be to document the events as they happen. The ways in which the outcome measures evaluate the extent to which the objectives have been achieved is that if the rate of AEFIs is shown to be reduced in a statistically significant way, then the project will have succeeded. The outcomes will be evaluated ad measured based on the evidence through analysis of the patient and vaccination data documented by the nurses. The validity of the data will be assured as the clients come to the facility n a random fashion. Since the data collection will happen without intrinsic bias, the results of the findings will definitely be reliable and generalizable to the wider population. If the outcomes do not yield positive results, the strategy that will be adopted will be to review the PICOT statement and propose a different solution using a different approach. The implications to practice are that if the project is successful, the intervention used in this project will become part and parcel of EBP. As for future research, there will be need to find out if there are possible pharmacotherapeutic interventions that may mitigate the severity of AEFIs related to the administration of the HPV vaccines.

Conclusion

The clinical problem of AEFIs among young girls receiving both the bivalent and quadrivalent HPV vaccine is a significant one. Several studies ascertain the fact that there are indeed confirmed cases of adverse events attributable to these vaccines. The question is that can therefore be done to mitigate their impact, since t is not possible to eliminate them completely. This project has provided an evidence-based answer by proposing a nurse-led educational intervention to counsel, inform, and prepare the girls psychologically before getting the vaccine.

Appendix I

Consent to Participate in the Nurse-Led Educational Intervention Before HPV Vaccination

As a client being given vaccination in this institution, you are asked to participate in this exercise that will be conducted by our nurses. You will be educated and counselled for one week prior to receiving the vaccine. Your participation in the program is entirely voluntary. You are free to choose whether or not you would like to participate or not. Even after starting, you can voluntarily withdraw from the program and request to get the vaccination and go.

The aim of the exercise is to mitigate the impact of vaccination side effects.

I understand what this exercise is all about and its intentions. I have been answered to my satisfaction and I voluntarily agree to take part in this trial. The institution has given me a copy of this form.      Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example

Appendix III

Likert Questionnaire for Evaluation

1. Was the educational intervention before inoculation helpful in terms of coping?
2. Were you still fearful of the unknown with regard to the outcome of the HPV vaccination after getting the health education?
3. Did you experience anything unusual after getting the HPV vaccination?

Appendix IV

The Types of Resources Required

1. Human

• More baccalaureate RN nurses (more full-time equivalents or FTEs)

2. Material

• Flip charts
• Overhead projectors
• Pamphlets

3. Fiscal

• The extra remuneration required for the extra FTEs

Appendix V

Conceptual Framework

The conceptual framework represents the main concepts of the project on which it is based.

Part 1:
In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.
Section A: Organizational Culture and Readiness Assessment
It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness.
1. Develop an analysis of 250 words from the results of the survey, addressing your organization’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization’s weaker areas.
2. Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
3. Submit a summary of your results. The actual survey results do not need to be included.
Section B: Proposal/Problem Statement and Literature Review
In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:
1. Refine your PICOT into a proposal or problem statement.
2. Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.
General Guidelines:
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
PICOT
Human Papillomavirus
Human papillomavirus (HPV) accounts for nearly 70% of cancers in the cervix worldwide (Harper & Demars, 2017). More than 200 known types of HPV have 35-40 types of being responsible for anogenital diseases. Fifteen of these are high-risk types and are related to cancer (Kose & Karabuk, 2020). Low-risk HPV types cause 90% of anogenital warts. The Human Papillomavirus (HPV) vaccine has been made available to adolescent girls and women since 2006. The first dose is administered to girls between 11-12 years and a follow-up vaccination between 13-26. The purpose of this paper is to evaluate if syncope was one of the adverse experience when women received a bivalent vaccine in comparison to quadrivalent a vaccine.
Population Health Research and PICOT Statement
PICOT; P – Patient/Problem, I – Intervention, C – Comparison, O – Outcome, T – Time.

Are women who received HPV vaccination likely experience syncope as an adverse effect when

received as a bivalent vaccine compared with the quadrivalent vaccine in one clinic visit?

P- women who received the vaccine

I – causes syncope when received as HPV bivalent vaccine

C- compared with HPV quadrivalent vaccine

O- Evaluate the increased occurrence of adverse effects like syncope of different types of the

HPV vaccine.

T- in one clinic visit

Population Demographics

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There are currently two HPV Vaccines available; a bivalent vaccine and a quadrivalent vaccine. The bivalent vaccine targets HPV type 16 and 18, which are the common culprits for most cervical cancers globally, while the quadrivalent vaccine targets HPV 16 and 18 and HPV 6 and 11. Both vaccines are preventive and should be administered to young women before an HPV infection.
By 2013, most countries worldwide had already successfully developed national HPV vaccination policies in their respective countries. Women who received these vaccines started to raise concerns about the adverse effects of the vaccination. Some of these concerns included complex regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS) (Chandler et al.,2016).
Australia’s population is estimated to be 25 million, with more than 9 million doses of HPV vaccine administered for ten years between 2007 and 2017(Phillips et al.,2020). It is according to Australia’s National HPV Vaccination Program Register (NHPVR). Through the school-based vaccination program, the majority of the doses were administered to the population. It is mandatory for healthcare providers to report any occurrence of an adverse effect (AE) via state and territory vaccine safety surveillance mechanisms. For 4vHPV (quadrivalent HPV) doses administered between April 2007 and December 2017, 4556 AE were reported, but only 4551 were used for analysis. 70% of the total AE reports analyzed were from women. The analysis results showed syncope being the most reported adverse events of special interest (AESI) amongst the female.
HPV vaccination catch-up program for girls aged between 13–15 years since October 2008 (Ward et al.,2019). HPV vaccination was included as part of the national childhood program for girls aged 12 in January 2009. In August 2017, Statens Serum Institute received reports indicating serious AE after HPV vaccination. 976 individuals reported a total of 979 unique but serious AE reports. Duplicate reports were removed from the data set as well as reports from children below 5 years and the ones from males. The final dataset comprised of only 963 reports from 960 females. Analysis of these AEs showed that fatigue and syncope were the most reported AE among females after HPV vaccination.
A study on the Adverse Events Following Immunization reported to the Adverse Events Following Immunization (AEFI) was conducted (Mauro et al.,2019). The National AEFI surveillance system receives mandatory AE reports from the private and public health centers. The reports are classified as either severe or non-severe. Data used in this study was obtained from the AEFI databases. Only those that were properly submitted in terms of having sufficient information was used. Information collected from the reports included: demographic information, vaccination date, dose number, concomitant vaccines, signs, and symptoms, provided healthcare, diagnosis, and case severity. After conducting a series of analyses on the most frequently reported AE, syncope was the most frequently reported event.
SAEFVIC model is an enhanced Victorian surveillance system for advance events following immunization that was established in April 2007 (Harper and Demars, 2017). Therapeutic Goods Administration (TGA) forwarded some unidentified reports it had received to SAEFVIC for investigation. Forwarded reports from 1 May 2007 to 30 April 2009 were selected for analysis and review. 29% of the collected data between the two-year period were found to be those of the 4vHPV (Quadrivalent) vaccine. Out of 29%, 192 reports were cases involving seizures and syncope. 51% of the 192 patients had received the 4vHPV vaccine. All patients were females between the ages of 8-26. There were 94 Syncope cases out of which 63 cases purely involved syncope alone, and the remaining 31 cases had an associated seizure
From the above cases, it is clear that HPV vaccinations are useful in the fight against cancer, but it still has undesirable side effects. “Some of these effects are serious in nature and overlap with symptoms reported in cases from the recent safety signals of postural orthostatic tachycardia syndrome, complex regional pain syndrome, and chronic fatigue syndrome.” Syncope, from the results of the above cases, seems to be a common event accompanying HPV vaccinations. This study aims to describe the likelihood of women who receive HPV vaccines to experience syncope as an adverse effect when received as a bivalent vaccine compared with the quadrivalent vaccine in one clinic visit. Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example
Potential Solutions
Kuntz et al. (2019) note that the Centers for Disease Control (CDC) and Prevention encourage adolescents to receive several vaccinations to protect them from preventable diseases through vaccinations. Although safe and effective, it is essential to acknowledge that vaccines’ administration may cause undesired effects. Bivalent HPV vaccine and Quadrivalent HPV vaccine have been proven to cause syncopic episodes at least one time per 1000 doses administered.
Most surveillance systems that collect AE reports are passive. It makes it challenging to capture credible data needed to determine syncope’s correct occurrence after HPV vaccinations. There is little information on the causal relationship between the HPV vaccines and syncope. It may be attributed to the fact that it is an uphill task to get correct data on syncopal episodes after vaccines. Therefore, the surveillance systems should be upgraded into active ones to help deal with the issue of data quality.
Eliminating syncope after an HPV vaccination may not be possible since various factors such as underlying conditions and Trypanophobia may trigger the episodes. Instead, measures may be taken to manage the situation by preventing the affected patient from sustaining any injury in the process.

References
Harper, D. M., & DeMars, L. R. (2017). HPV vaccines–a review of the first decade. Gynecologic oncology, 146(1), 196-204. https://doi.org/10.1016/j.ygyno.2017.04.004
Kose, M. F., & Karabuk, E. (2020). HPV Vaccines: Myths and Facts. In Human Papillomavirus. IntechOpen. https://doi.org/10.5772/intechopen.90442
Phillips, A., Hickie, M., Totterdell, J., Brotherton, J., Dey, A., Hill, R., … & Macartney, K. (2020). Adverse events following HPV vaccination: 11 years of surveillance in Australia. Vaccine, 38(38), 6038-6046. https://doi.org/10.1016/j.vaccine.2020.06.039
Ward, D., Thorsen, N. M., Frisch, M., Valentiner-Branth, P., Mølbak, K., & Hviid, A. (2019). A cluster analysis of serious adverse event reports after human papillomavirus (HPV) vaccination in Danish girls and young women, September 2009 to August 2017. Eurosurveillance, 24(19), 1800380. https://doi.org/10.2807/1560-7917.es.2019.24.19.1800380
Mauro, A. B., Fernandes, E. G., Miyaji, K. T., Arantes, B. A., Valente, M. G., Sato, H. K., & Sartori, A. M. C. (2019). Adverse events following Quadrivalent HPV vaccination reported in Sao Paulo State, Brazil, in the first three years after introducing the vaccine for routine immunization (March 2014 to December 2016). Revista do Instituto de Medicina Tropical de São Paulo, 61. https://doi.org/10.1590/s1678-9946201961043
Kuntz, J. L., Firemark, A., Schneider, J., Henninger, M., Bok, K., & Naleway, A. (2019). Development of an Intervention to Reduce Pain and Prevent Syncope Related to Adolescent Vaccination. The Permanente Journal, 23. https://doi.org/10.1016/j.vaccine.2018.05.070

Part 2:
Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:
1. Identify the selected model or theoretical framework and discuss its relevance to your project.
2. Discuss each of the stages in the change model/framework.
3. Describe how you would apply each stage in your proposed implementation.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Part 3:
In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:
1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion
Part 4:

In 500-750 words, develop an evaluation plan to be included in your final evidence-based practice project. Provide the following criteria in the evaluation, making sure it is comprehensive and concise:
1. Describe the rationale for the methods used in collecting the outcome data.
2. Describe the ways in which the outcome measures evaluate the extent to which the project objectives are achieved.
3. Describe how the outcomes will be measured and evaluated based on the evidence. Address validity, reliability, and applicability.
4. Describe strategies to take if outcomes do not provide positive results.
5. Describe implications for practice and future research.
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Throughout this course, you have developed a formal, evidence-based practice proposal.
The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals must be submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed (3,500 and 5,000 words). The cover sheet, abstract, references pages, and appendices are not included in the word count.
Section headings for each section component are required. Evaluation of the proposal in all sections will be based upon the extent to which the depth of content reflects graduate-level critical thinking skills.
This project contains seven formal sections:
1. Section A: Organizational Culture and Readiness Assessment
2. Section B: Proposal/Problem Statement and Literature Review
3. Section C: Solution Description
4. Section D: Change Model
5. Section E: Implementation Plan
6. Section F: Evaluation of Process
Each section (A-F) will be submitted as a separate assignment in Topics 1-6 so your instructor can provide feedback (refer to applicable topics for complete descriptions of each section).
The final paper submission in Topic 7 will consist of the completed project (with revisions to all sections), title page, abstract, compiled references list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms, as previously assigned in individual section assignments.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Part 2:

Write a paper of 500-750 words for your proposed evidence-based practice project solution. Address the following criteria:

1. Proposed Solution:(a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, if it may be too costly, or if there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your problem statement before continuing.
2. Organization Culture:Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
3. Expected Outcomes:Explain the expected outcomes of the project. The outcomes should flow from the problem statement.
4. Method to Achieve Outcomes:Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations that may need to be addressed.
5. Outcome Impact:Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, or professional expertise.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.  Reducing the Impact of HPV Vaccination through Educational Counseling Essay Example