1642. Influencing Multiple Systems Through Evidence-Based Change As an advance practice nurse, your work is informed by many factors beyond your direct reach, and your influence extends beyond the immediate context in which you labor. Likewise, the changes you propose as a nurse leader are influenced by multiple systems and, in turn, can have an impact on many different groups. One of the ways to distinguish yourself as a leader is to be knowledgeable about these spheres of influence and to promote awareness of the potential effects that may result from a change. Indeed, with the fluid and persistently evolving nature of change, it is essential that you stay abreast of latest developments that may affect the practice environment. This is especially critical for maintaining or adapting a change once it has been implemented. As discussed in Weeks 8 and 9, you may need to make adjustments based on evaluation of outcomes; in addition, you must also be prepared for adjustments based on developments within or outside your targeted environment. To prepare: What are some possible adjustments that you might need to make based on the evaluation of outcomes? Consider insights from the Discussion in Weeks 8 and 9. Consider the evidence-based change you are proposing for your practicum setting: What other systems or components of a system are within the sphere of influence of this change? How could evolving issues internal to the setting, such as budget, staffing shortage, regulations or external to it, such as supply, funding, national priorities, and disasters, affect the implementationand ultimately the sustainabilityof such a change? How might your proposed change, in turn, affect policy or practice at other levels beyond your initial focus? By tomorrow Wednesday 5/1/19 2pm (America/New York time), write a minimum of 550 words essay in APA format with at least 3 references (see list or required readings below). Include the level one headers as numbered below: Post a cohesive response that addresses the following: 1) Describe at least three evolving issues that are internal or external to your practicum setting that could affect the implementation and sustainability of your proposed change. 2) From what systems level do those issues originate (e.g., organizational, local, state, national, global) and what other systems are then involved in response to that factor? 3) How might your proposed change, in turn, lead to shifts at other levels beyond your initial focus? Required Readings White, K. M., & Dudley-Brown, S.(2016). Translation of evidence into nursing and health care practice. (2nd edition) New York, NY: Springer Publishing Company. Review Chapter 11 “Information Technology: A Foundation and Enabler for Translation Review Chapter 15 “Best Practices in Translation: Challenges and Barriers in Translation Braithwaite, J., Westbrook, M., Nugus, P., Greenfield, D., Travaglia, J., Runciman, W., & … Westbrook, J. (2013). Continuing differences between health professions’ attitudes: the saga of accomplishing systems-wide interprofessionalism. International Journal for Quality in Health Care, 25(1), 8-15. doi: 10.1093/intqhc/mzs071 Hoyle, C., & Johnson, G. (2015). Building skills in organizational and systems change. Nurse Practitioner, 40(4), 15-23. doi: 10.1097/01.NPR.0000461948.38539. fc Jeungok, C., & Zucker, D. M. (2013). Self-assessment of nursing informatics competencies for Doctor of Nursing practice students. Journal of Professional Nursing, 29(6), 381-387. doi: 10.1016/j.profnurs.2012.05.014 Toussaint, J. S. (2015). The Framework for a Whole-System Transformation. Journal Of Healthcare Management, 60(6), 386-389.