Integrating Evidence-Based Practice Nursing Essay
Integrating Evidence-Based Practice Nursing Essay
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Assignment:
Integrating Evidence Based Practice
Write a 1350-1550 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with (4) sources (3 outside source and the textbook) using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in the correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment. Integrating Evidence-Based Practice Nursing Essay
Part 1:
Describe the eight steps to integrating evidence-based practice into the clinical environment. What barriers might you face in implementing a new practice to address your research topic (as identified in Module 1)? Describe strategies that could be used to increase success including overcoming barriers. Integrating Evidence-Based Practice Nursing Essay
Part 2:
Describe six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes.
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Integrating Evidence-Based Practice Nursing Essay. Chapter 11 Leadership Strategies and Evidence-Based Practice Competencies to Sustain a Culture and Environment That Supports Best Practice Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Influencing EBP Implementation Studies have found that resistance to accepting EBP is declining; however, factors that still influence EBP implementation include: • Beliefs and attitudes about EBP • Knowledge about EBP • Organizational commitment to EBP • Organizational support for EBP • An organizational culture responsive to change • Support of EBP ideas/initiatives Copyright © 2015 Wolters Kluwer • All Rights Reserved Interventions Vital to Consistent Implementation of EBP • EBP education combined with active repetitive skills building • EBP mentorship and support • A culture and an environment that supports EBP • Leaders and managers who support and role model EBP • Strategies that overcome system barriers to EBP Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Research studies over the last two decades have found that some barriers to EBP have changed in their importance while others remain. Select all of the barriers that still have impact on building and sustaining an environment favorable to EBP: a. Organizational support and commitment b. Resistance to EBP implementation c. Attitude about the importance of EBP d. Knowledge about EBP processes Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer a, b, and d Rationale: Over the last decade, studies have shown that attitude toward the importance of EBP to clinical practice has improved; however, barriers such as organizational support and commitment, resistance to EBP implementation on site, and sound knowledge about the EBP process continue to be barriers to its implementation. Copyright © 2015 Wolters Kluwer • All Rights Reserved Nursing Organizations That Incorporate EBP Into Their Standards and/or Expectations of Leadership • • • American Nurses Association (ANA) ANA Scope and Standards of Practice for the Nurse Administrator (2010) The American Organization of Nurse Executives (AONE) AONE Nurse Executive Competencies The American Nurses Credentialing Center (ANCC) Magnet Recognition Program Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories for Contemporary Nursing and Healthcare Leadership • • • • Focus on the relationship between the leader and the follower Leader creates an environment where individuals are supported and recognized for their work Workers feel inspired and empowered to innovate and change Leadership theories include: o Innovation leadership o Transformational leadership o Servant leadership o Authentic leadership Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Innovative Leader Leadership that creates the context in which innovation occurs and sustains Competencies of the innovative leader: • • • •Integrating Evidence-Based Practice Nursing Essay
Focuses on the essence of the innovation Possesses knowledge and experience in concepts and processes of innovation Possesses an understanding of their own personal strengths and limitations Demonstrates effective collaboration based on listening, encouraging feedback, openness, and conflict resolution Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Innovative Leader—(cont.) Competencies of the innovative leader—(cont.): • • • • Manages considerable amounts of data and information and quickly evaluates the evidence, its value, and potential outcomes Collects related information/evidence when gaps are identified in the information or evidence Evaluates new technology from the perspective of enhancing the organization rather than purely as a new technology Coaches others in the principles of innovation, adult learning, and change Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Transformational Leader • • Leader is the one who provides a vision and motive and is an inspiration to others Four dimensions of transformational leadership: o Idealized influence: Role models with a focus on doing things right rather than ensuring that others do the right things Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Transformational Leader—(cont.) • Four dimensions of transformational leadership— (cont.): o o o Inspirational motivation: Articulates a clear vision that inspires and motivates others to accomplish great achievements Intellectual stimulation: Encourages innovation and creativity by empowering others to explore new ways of doing things and approaching problems using the EBP process Individualized consideration: Supports and encourages others by offering reward and recognition for unique contributions Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Servant Leader • • Leadership based on the essential elements of trust, empathy, caring, and a focus on others Foundational characteristics that are central to servant leadership: o o o Intent and careful listening to others Seeking to understand and empathize with those they lead Healing relationships by helping others to solve problems and conflicts, thus supporting and promoting personal growth in others Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Servant Leader— (cont.) • Foundational characteristics that are central to servant leadership—(cont.): o o o o Self-awareness that allows a better understanding of issues surrounding ethics, power, and values Ability to build consensus among others and a reliance on persuasion rather than power to influence Seeing beyond the “day-to-day” and focusing on long-term goals Learning from the past to understand the present consequences of decisions Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Servant Leader— (cont.) • Foundational characteristics that are central to servant leadership—(cont.): o o o Belief that serving the needs of others is an obligation Commitment to the personal, professional, and spiritual growth and development of each individual Desire to develop a true community among businesses served Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Authentic Leader • • A composite of other leadership types; these leaders are confident, hopeful, optimistic, resilient, transparent, self-aware, and possess high moral character. Integrating Evidence-Based Practice Nursing Essay
Integrating Evidence-Based Practice Nursing Essay. They assure that their communication is transparent and comprehended as intended. Leadership based on four central behaviors: o Balanced processing: Ability to objectively analyze data to formulate decisions while soliciting views that may challenge ideas without being selfprotective Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Theories: Authentic Leader—(cont.) • Leadership based on four central behaviors—(cont.): o o o Internalized moral perspective: Role models high standards of moral and ethical conduct Relational transparency: Presents genuine self to followers and shares their values, emotions, and goals in a transparent manner that encourages others to be forthcoming with their ideas and opinions Self-awareness: Assesses their strengths and weaknesses to come to a better understanding of their own unique talents, beliefs, and desires in order to enhance their leadership effectiveness Copyright © 2015 Wolters Kluwer • All Rights Reserved Question There are four leadership theories that have been identified as congruent with initiating and sustaining evidence-based practice. Match the hallmark characteristics with the theory to which they belong. a. Innovative __ Doing things right rather than ensuring leader that others do the right things b. Transfor__ Based on the essential elements of trust, mational leader empathy, caring, and a focus on others c. Servant __ Presents genuine self to followers and leader shares their values, emotions, and goals in a transparent manner d. Authentic __ Evaluates new technology from the leader perspective of enhancing the organization rather than purely “to be first” Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer In order: b, c, d, a Rationale: Although there are some commonalities among characteristics described in leadership theories, each of the theories has at least one distinctive trait, as identified in previous PowerPoint slides and in the textbook. Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment Strategy EBP education and skills building Activities • Develop EBP content and skill-building programs targeted at clinicians in various levels of practice including staff, managers, and directors • Include EBP content and EBP competencies in orientation and residency programs designed for new hires Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.) Strategy Operational budgets for EBP resources Library services support Activities • Purchase computers dedicated for EBP work • Allot/budget time for EBP project work • Access to library with adequate clinical databases and journals available • Support from librarians knowledgeable in EBP steps and processes Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.) Strategy Activities Job descriptions • Write or revise job descriptions with and EBP competencies/expectations performance articulated evaluation tools • Write or revise performance appraisal tools with EBP outcomes/deliverables articulated Clinical ladder • Write or rewrite clinical ladder requirements application with progressive EBP requirements at each level Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.) Strategy Activities Organizational •Integrating Evidence-Based Practice Nursing Essay
Write or revise organizational and mission, vision, departmental mission, vision, and and values values statements with EBP language statements integrated throughout EBP mentors • Structure EBP mentors/champions aligned within centrally within the organization to the promote, support, and sustain a unified organization message and vision of EBP • Designate a dedicated, knowledgeable EBP leader to oversee EBP activities and create and inspire the EBP culture Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.) Strategy EBP mentor positions Activities • Create specific job descriptions for designated EBP mentors (include robust knowledge and skills in EBP, motivation, and change theory) • Align EBP mentors centrally in the organization Manager and • Write/revise leadership job descriptions leader to reflect clear EBP expectations accountability • Write/revise performance appraisal tools with required EBP outcomes/deliverables Copyright © 2015 Wolters Kluwer • All Rights Reserved Evidence-Based Practice Competencies for Practicing Registered Nurses • • • • • Questions clinical practices for the purpose of improving the quality of care Describes clinical problems using internal (organizationgenerated) evidence Participates in the formulation of clinical questions using PICOT format Searches for external (research) evidence to answer focused clinical questions Participates in critical appraisal of pre-appraised evidence Copyright © 2015 Wolters Kluwer • All Rights Reserved Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.) • • • • Participates in the critical appraisal of published research studies to determine their strength and applicability to clinical practice Participates in the evaluation and synthesis of a body of evidence gathered to determine its strength and applicability to clinical practice Collects practice data systematically as internal evidence for clinical decision making Integrates evidence gathered from external and internal sources in order to plan evidence-based practice changes Copyright © 2015 Wolters Kluwer • All Rights Reserved Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.) • • • • Implements practice changes based on evidence and clinical expertise and patient preferences to improve care processes and patient outcomes Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups, and populations to determine best practices Disseminates best practices supported by evidence to improve quality of care and patient outcomes Participates in strategies to sustain an evidence-based practice culture Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Is the following statement true or false? Evidence-based practice competencies as identified by Melnyk, Gallagher-Ford, Long, and Fineout-Overholt (2014) are basically the same for both the practicing registered nurse (RN) and the advanced practice nurse (APN). Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer False Rationale: Integrating Evidence-Based Practice Nursing Essay
Integrating Evidence-Based Practice Nursing Essay. Although several of the competencies as described by Melnyk et al. (2014) are built on the practicing registered nurse competencies, several of them, such as leading interdisciplinary teams in applying synthesized evidence, are exclusive to the APN role. Copyright © 2015 Wolters Kluwer • All Rights Reserved Chapter 10 The Role of Outcomes and Quality Improvement in Enhancing and Evaluating Practice Changes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Evidence-Based Quality Improvement (EBQI) and Outcomes Management (OM) • • EBQI: Systematic and continuous actions that lead to improvement in health services and the health status or health outcomes of targeted patient groups (U.S. Department of Health and Human Services, 2011) OM: “Technology of patient experience designed to help patients, payers, and providers make rational medical care-related choices based on better insight into the effect of these choices on patient life” (Ellwood, 1988, p. 1549) Copyright © 2015 Wolters Kluwer • All Rights Reserved Basic Principles Supporting Outcomes Management • • • • Emphasizing practice standards that providers can use to select interventions Measuring patient functional status, well-being, and disease-specific clinical outcomes Pooling outcome data on a massive scale Analyzing and disseminating outcomes, in relation to the interventions used, to appropriate decision makers and stakeholders (Ellwood, 1988) Copyright © 2015 Wolters Kluwer • All Rights Reserved Health Outcomes Institute’s Outcomes Management Model First model to provide steps to guide measurement of the impact of new interventions on improving healthcare outcomes First two phases of the model: 1. Define clinical problem, including structure/process contributors and descriptive and confounding variables; identify desired outcomes and related measures; build database; measure baseline 2. Compare appraised evidence with traditional practice; engage stakeholders; negotiate adoption of new practice; develop methods to support new practice; adopt new standard Copyright © 2015 Wolters Kluwer • All Rights Reserved Health Outcomes Institute’s Outcomes Management Model—(cont.) Last two phases of the model: 3. Educate all stakeholders; assure that role models and resources are available for troubleshooting processes; monitor reliability and stability of measures and refine as needed; finalize the refined process and measurement methods; begin data collection 4. Close first data collection cycle; analyze results and disseminate to stakeholders; identify opportunities for further improvement (return to phase 2 to begin refinement of improvement) Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Is the following statement true or false? The Health Outcomes Institute’s Outcomes Management Model provides a four-step process for the critical appraisal of evidence. Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer False Rationale: The Health Outcomes Institute’s Outcomes Management Model delineates a process that can be used to guide measurement of the impact of new interventions on improving healthcare outcomes. It does not provide a specific process for critical appraisal of the literature. Copyright © 2015 Wolters Kluwer • All Rights Reserved Sources of Internal Data for EBQI Internal Data Resources Quality management department Finance department Type/Source of Data Incident reports, patient satisfaction scores, data collected for regulatory or accreditation bodies Charges for tests, medications, equipment, or supplies; patient days; readmission rates; patient demographics; patient diagnosis coding (MS-DRG, ICD-9/10) Human resources Staff turnover and education levels; hours by pay/labor category; contract labor use; provider skill mix; staffing ratios Copyright © 2015 Wolters Kluwer • Integrating Evidence-Based Practice Nursing Essay
All Rights Reserved Sources of Internal Data for EBQI—(cont.) Internal Data Resources Clinical systems Type/Source of Data Will vary with system—at minimum typically diagnostic test results and pharmacy data Administration Patient complaints Electronic Patient-level information captured through health record documentation of clinical care Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Which of the following two sources would be the most likely to house the data needed to measure patient outcomes related to a proposed change in the nursing skills mix at a hospital? a. Finance and administration b. Human resources and the quality management department c. Clinical systems and the electronic health record d. Administration and the quality management department Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer b. Human resources and the quality management department Rationale: The human resource department is a key source of data related to nursing skills mix and the quality management department collects data on patient outcomes through incident reports, patient satisfaction scores, and data collected for regulatory or accreditation bodies. Administration data are usually limited to patient complaints, and financial data are related to charges, such as for tests, medications, equipment, or supplies. Finally, clinical systems address lab results and pharmacy orders, while the electronic health record is based on clinical documentation, from which aggregate outcomes are hard to derive. Copyright © 2015 Wolters Kluwer • All Rights Reserved When Existing Data Sources Are Unavailable Measurement instruments that are developed must be evaluated as to whether they are valid and reliable • Validity: Is the instrument actually measuring what it is supposed to measure? • Content validity: The minimum demonstration of validity needed; often reflected through a panel of experts reviewing the instrument Copyright © 2015 Wolters Kluwer • All Rights Reserved When Existing Data Sources Are Unavailable—(cont.) Reliability: Does the instrument measure the construct consistently every time it is used? • Cronbach’s alpha: A Cronbach’s alpha of .80 or greater usually indicates that an instrument should perform reliably each time that it is used Copyright © 2015 Wolters Kluwer • All Rights Reserved Levels of Data Measurement Level of Characteristics Measurement Nominal Data sorted into categories; any numbers assigned to categories used only for labeling Ordinal Data can be ranked in order, but the absolute difference between each level is not equal Copyright © 2015 Wolters Kluwer • All Rights Reserved Example Gender, presence or absence of a quality (e.g., disease) Likert scales Levels of Data Measurement—(cont.) Level of Characteristics Measurement Interval Numeric data with equal and consistent mathematical values separating each discrete measurement point, however, lacks an absolute zero Ratio Same data characteristics as interval-level data, but also has an absolute zero value Copyright © 2015 Wolters Kluwer • All Rights Reserved Example Fahrenheit temperature scale Kelvin temperature scale Reporting to Key Stakeholders •Integrating Evidence-Based Practice Nursing Essay
• All parties involved with the process of practice change should have an opportunity to understand the results achieved Two methods of presenting data in an understandable way are: o Scorecards o Dashboards Copyright © 2015 Wolters Kluwer • All Rights Reserved Reporting to Key Stakeholders: Scorecards Copyright © 2015 Wolters Kluwer • All Rights Reserved Reporting to Key Stakeholders: Dashboards Copyright © 2015 Wolters Kluwer • All Rights Reserved Why Would Quality Projects Need IRB Approval? • HIPAA regulations require IRB approval of all studies involving personal health information (PHI) • If it is possible that knowledge might be shared outside of the specific quality improvement initiative and institution (e.g., publication or presentation of strategies used and resultant outcomes), then IRB approval is required prior to initiation of the project Copyright © 2015 Wolters Kluwer • All Rights Reserved Question A rating scale asks patients to rate their nausea by describing it as “no nausea,” “slight nausea,” “significant nausea,” or “severe nausea.” What is the highest level of data measurement that this scale provides? a. Nominal b. Ordinal c. Interval d. Ratio Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer b. Ordinal Rationale: In Likert-type scales, data can be ranked in order, but the absolute difference between each level is not equal. It is not possible to calculate a mean or a standard deviation. Copyright © 2015 Wolters Kluwer • All Rights Reserved Chapter 9 Implementing Evidence in Clinical Settings Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Essential Elements Needed to Create an EBP Environment (With permission from Hockenberry, M., Walden, M., Brown, T., & Barrera, P. (2007). Creating an evidence-based environment: One hospital’s journey. Journal of Nursing Care Quality, 22(3), 223.) Copyright © 2015 Wolters Kluwer • All Rights Reserved Why Create an EBP Clinical Environment? • • • Regulatory initiatives and insurance-mandated outcomes National Strategy for Quality Improvement in Healthcare’s “triple aim” Magnet Recognition Program’s expectations that the nursing culture promotes superior performance through EBP Copyright © 2015 Wolters Kluwer • All Rights Reserved Essential Objectives for an EBP Vision Objectives Develop a mental framework Establish a motivating image for change Create specific goals Gain administrative support Establish a leadership team Involve experts and EBP mentors in clinical practice Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies for an EBP Vision Objectives Strategies Develop a mental framework • Develop a written summary of what you want to accomplish • Brainstorm with colleagues regarding the environment you want to create • Use creativity to capture attention of the clinical staff • Take advantage of real clinical scenarios to stress the need for changes in practice • Focus on short-term, attainable goals • Establish only two or three goals at a time Establish a motivating image for change Create specific goals Copyright © 2015 Wolters Kluwer • All Rights Reserved Strategies for an EBP Vision—(cont.) Objectives Strategies Gain administrative support • Create a presentation that reflects the need for transforming the culture into an EBP environment • Seek administration support for the project to be identified as an organizational priority • Identify key personnel with a passion for EBP • Conduct small focus group meetings Establish a leadership team Involve experts • Identify clinical experts and EBP mentors and mentors in •Integrating Evidence-Based Practice Nursing Essay
Engage clinical expert support clinical practice Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Is the following statement true or false? Implementation of EBP is the responsibility of graduateprepared nurses and members of the nursing leadership. Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer False Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines. Copyright © 2015 Wolters Kluwer • All Rights Reserved Common Barriers to Implementing Evidence-Based Practice Barriers Inadequate knowledge and skills Weak beliefs about the value of EBP Poor attitudes toward EBP Rationale The best evidence-based policies are of no value when staff lack knowledge of how to implement them in practice Poor dissemination of the relationship between evidence-based practice and patient outcomes can result in weaker belief in the effectiveness and efficacy of EBP Negative attitudes about clinical research can make it difficult for staff to become engaged in EBP Copyright © 2015 Wolters Kluwer • All Rights Reserved Common Barriers to Implementing Evidence-Based Practice—(cont.) Barriers Lack of EBP mentors Rationale Findings from research have indicated that a lack of EBP mentors in the environment also can be a barrier to implementing EBP by point-of-care staff Lack of support by Knowledge, attitudes, and beliefs of leaders and mid-level and upper-level administrators clinicians and their perceived roles in communicating support for this change affect lower-level support Copyright © 2015 Wolters Kluwer • All Rights Reserved Common Barriers to Implementing Evidence-Based Practice—(cont.) Barriers Economic restrictions Rationale Lack of consideration that one type of cost may be readily offset with savings in time (i.e., workload), satisfaction, or the additional expense of patient complications Copyright © 2015 Wolters Kluwer • All Rights Reserved Objectives and Related Strategies to Develop Staff Engagement in EBP Objective Strategies Engage staff and • Engage stakeholders to identify stakeholders in educational content and strategies assessing and to learn about the practice change eliminating • Seek information from staff about barriers their attitudes toward the affected practice • Involve influential staff and leaders in conducting discussions with colleagues Copyright © 2015 Wolters Kluwer • All Rights Reserved Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.) Objective Prioritize clinical issues Strategies • Select clinical issues of direct interest and responsibility of clinician stakeholders • Choose issues with solid empiric evidence to begin an organizational area’s EBP endeavors Copyright © 2015 Wolters Kluwer • All Rights Reserved Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.) Objective Evaluate the infrastructure Strategies • Determine the individuals and committees who have decision-making authority • Gain administrative support for adequate time and personnel for the initiative • Enlist experts to lead EBP initiatives • Ensure access to databases, search engines, and full-text articles Copyright © 2015 Wolters Kluwer • All Rights Reserved Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.) Objective Develop experts in the evidencebased process Strategies •Integrating Evidence-Based Practice Nursing Essay
Utilize leaders within the organization or form an academic partnership to provide expertise in research, EBP design, and evaluation • Provide formal classes and/or smallgroup sessions on finding and evaluating evidence • Mentor staff in critically appraising research studies and formulating practice recommendations Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Which of these strategies below is the most effective strategy for engaging care providers in a proposed EBP change? a. Disseminating the evidence that underlies the proposed change b. Reminding staff of their obligation to provide optimal care c. Bringing in EBP experts to speak to staff members d. Creating dissatisfaction with current practice and outcomes Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer d. Creating dissatisfaction with current practice and outcomes Rationale: If care providers are not satisfied with the status quo, then they will be open to evidence-based change. Other strategies, such as bringing in outsiders to teach, disseminating research findings, and telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change. Copyright © 2015 Wolters Kluwer • All Rights Reserved Integration of EBP into the Clinical Environment Objective Establish formal implementation teams Build excitement Strategies • Enlist APNs and other expert staff as clinical team leaders • Create discomfort with the status quo • Enlist local opinion leaders who can attest to the need for practice change • Bring in outside speakers who have the potential to connect and inspire key stakeholders Copyright © 2015 Wolters Kluwer • All Rights Reserved Integration of EBP into the Clinical Environment—(cont.) Objective Disseminate evidence Strategies • Utilize multifaceted strategies to overcome knowledge deficits, skill deficits, and skepticism • Promote experience sharing to emphasize the need for change and positive outcomes of change • Provide time to assimilate new practices Copyright © 2015 Wolters Kluwer • All Rights Reserved Integration of EBP into the Clinical Environment—(cont.) Objective Strategies Develop • Anticipate tools and processes that the staff clinical will need to transform practice tools • Revise patient care documentation records • Ensure easy access to clinical resources • Integrate alerts and reminders into workflow processes at the point of care • Repeatedly expose the staff to evidencebased information Copyright © 2015 Wolters Kluwer • All Rights Reserved Integration of EBP into the Clinical Environment—(cont.) Objective Pilot test Preserve energy sources Strategies •Choose pilot sites with consideration to unit leadership strength, patient population diversity, acuity, and geographic location •Address the root causes of problems •Decide to adopt, adapt, or abandon at the end of the pilot test •Engage support personnel •Implement smaller, more manageable projects •Anticipate setbacks and have patience and persistence Copyright © 2015 Wolters Kluwer • All Rights Reserved Integration of EBP into the Clinical Environment—(cont.) Objective Allow enough time Celebrate success Strategies •Develop incremental project steps •Establish a timeline •Integrating Evidence-Based Practice Nursing Essay
Integrating Evidence-Based Practice Nursing Essay. Acknowledge the staff instrumental in process •Ensure recognition by supervisors and administration Copyright © 2015 Wolters Kluwer • All Rights Reserved Evaluating Outcomes of EBP Change Area of Examples Evaluation Outcomes Measures of death, disability, iatrogenic effects of treatment, health behaviors, economic impact of therapy, and illness management Quality care Success of symptom management such as improvement pain, fatigue, nausea and vomiting, sleep disturbance, and depression PatientPatient perception of healthcare providers’ centered effective communication, consideration of quality care cultural and religious beliefs, respect, empathy, and caring attitude Copyright © 2015 Wolters Kluwer • All Rights Reserved Evaluating Outcomes of EBP Change— (cont.) Area of Evaluation Efficiency of processes Environmental changes Professional expertise Examples Timeliness of procedures, medication administration, diagnostic tests, transfer, and discharge Unit/department resource (equipment, supplies, and personnel) availability Knowledge and competency of staff Copyright © 2015 Wolters Kluwer • All Rights Reserved Question When considering the six areas of EBP evaluation of the clinical environment, which of the following is considered an outcome measure? a. Number of times that heart failure patients are discharged within the case management time parameter b. Incidence of pressure ulcers c. Number of discharged patients who are satisfied with their pain management d. Average turnaround time needed for repair of inoperative intravenous pumps Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer c. Incidence of pressure ulcers Rationale: Incidence of pressure ulcers is an iatrogenic effect of hospitalization. The number of times that heart failure patients are discharged within the case management time parameter is an example of the efficiency of processes. The number of discharged patients who are satisfied with their pain management is an example of patient-centered quality. The average turnaround time needed for repair of inoperative intravenous pumps is a measure of the availability of resources. Copyright © 2015 Wolters Kluwer • All Rights Reserved