1. Identify a patient or community group that contributes to or is involved in the principal behavior you are attempting to improve with your intervention.
One of the community players that contributes the night time vitals in low risk patients is the ordering physician.
2. Using any of the individual explanatory theories in “Theory at a Glance”, develop an explanatory model for the target behavior (above) that you will be attempting to influence with your intervention. This can be an extension/based on expected findings (or previously published literature) from your answers to Homework #3. Figures are always very useful... keep it simple.
Since my project deals with changing behavior in the provider, I felt the theory planned behavior best fit. While I don’t have answers or inklings of every component of the theory, a survey of the group would help assess these aspects and, as discussed in class, we may think we know what is going on but actually don’t so it will be useful to have input from the ordering physician group on developing an explanatory model for the target behavior.
Theory Planned Behavior Attitudes:
Beliefs – There may be two camps of belief: it is important for hospitalized patients to sleep vs hospitalized patients are here to get all the care they can and send them out.
Evaluation of Behavioral Outcomes – decreased night time vitals in low risk patients may mean they sleep better and will feel/heal better.
Subjective Norm:
Normative beliefs – (practice norm) current practice norms is to stay with ad lib orders with vitals performed per protocol on that particular floor
Motivation – it is easy to order for the vitals to be avoided in the evening but if they’re done anyway because the night shift nursing aide continues to check it, it will take a lot of effort on the provider’s part to do more to have the order actually be followed.
Perceived control:
Control beliefs – depends on whether they feel they have control on whether a patient receives nighttime vitals; if they feel that the nursing aides are going to do it anyway, then there is no point in “fighting the system”
Perceived power (self-efficacy) –
3. Identify how one or more of your specific interventions will target one or more of these key factors contributing to the behavior of interest.
(Methods discussed in class that are relevant target strategies: Attitudes: increase exposure to pro-behavior attitudes with education. Subjective norm: social marketing to ‘naturalize’ desired behavior. Perceived behavioral control and self-efficacy: ID behaviors within control, then train and guide, goal setting, reinforce, demonstrate skills.)
One of my interventions will need to be to address these factors through education of the group, but I think it will also require the development of a risk assessment tool for the provider to potentially feel comfortable calling a patient low risk where the patient is felt safe without night time vitals.
4. Create a framework that draws upon a socio-ecological framework to orient your target behavior within a larger context. ie, what are some of broader, external forces that influence the individual behavior of interest...see Figure 2 of “Theory at a Glance.”
Using Figure 2’s model, we can evaluate the target behavior within the socio-ecological framework.
Social and Economic policies: Hospital policy can encourage/mandate change in behavior
Institutions: Will decide how to best implement the intervention of interest and getting buy-in from the providers to use it.
Neighborhoods and communities: I think of this as the patients and the patient’s community (family members, etc.) can influence the provider behavior by asking not to have sleep interrupted in the evening
Living conditions: not applicable
Social relationships: colleague buy-in will encourage within the community of providers to change behavior
Individual risk factors: patient load, whether they are tired themselves