Recommending A Evidence Based Practice Change Essay
Recommending A Evidence Based Practice Change Essay
You are to create an 8- to 9-slide PowerPoint presentation in which you do the following:
Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.Recommending A Evidence Based Practice Change Essay
Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
Be sure to provide APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.
Add a lessons learned section that includes the following:
A summary of the critical appraisal of the peer-reviewed articles you previously submitted
An explanation about what you learned from completing the evaluation table (1 slide)
An explanation about what you learned from completing the levels of evidence table (1 slide)
An explanation about what you learned from completing the outcomes synthesis table (1 slide)
Here are some helpful hints for your Powerpoint projects due this week.
1. Do not make the slides too wordy. Use Bullet points
2. Use Speaker Notes if needed for additional information
3. Select your slide design carefully and make sure information fits on the slide and does not overhang
4. Avoid white font unless on dark background
5. Do not forget a Title slide with the same information as a Title page Recommending A Evidence Based Practice Change Essay
6. Be creative
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research.
Full APA formatted citation of selected articles. Article #1 Article #2 Article #3 Article #4
Lin, S. H., Liao, W. C., Chen, M. Y., & Fan, J. Y. (2014). The impact of shift work on nurses’ job stress, sleep quality, and self‐perceived health status. Journal of nursing management, 22(5), 604-612.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Schiffer, C. A., Mangu, P. B., Wade, J. C., Camp-Sorrell, D., Cope, D. G., El-Rayes, B. F., … & Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 31(10), 1357-1370.
Ghadmgahi, F., Zighaimat, F., Ebadi, A., & Houshmand, A. (2011). Knowledge, attitude, and self-efficacy of nursing staff in hospital infection control. Journal Mil Med, 13(3), 167-172.
Evidence Level *
(I, II, or III)
III I V III
Conceptual Framework
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Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here). **Recommending A Evidence Based Practice Change Essay
None is mentioned
Educational intervention programs for parents of infants born prematurely instigated early in the Neonatal Intensive Care Unit can cut parental stress, depression, and anxiety, improve parent-infant relations, and decrease the length of stay in hospital. None mentioned. None mentioned
Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). A cross-sectional study that included 266 nurses from four Chiayi county district hospitals.
Data was collected using a demographics, stress checklist, work schedule forms, a health status measure, and sleep-quality measure. The collected data were analyzed using Pearson’s r, one way ANOVA, Independent t-test, and hierarchical regression. A randomized control trial study. Study subjects were randomly assigned to receive Creating Opportunities for Parental Empowerment or a comparison intervention program. A systematic search of MEDLINE and the Cochrane library. All articles with evidence-based guidelines on central venous catheters for patients with cancer were included, while those lacking this information excluded. Cross-sectional study, including 135 study subjects.Recommending A Evidence Based Practice Change Essay
Sample/Setting
The number and characteristics of
patients, attrition rate, etc. Two hundred and sixty-six nurses working in Taiwan. There was no attrition of the study participants. Two hundred and sixty families with preterm infants. 61preterm infants were transferred to another hospital. Five articles with evidence-based guideline questions. 135 nurses working in selected Mashhad hospitals
Major Variables Studied
List and define dependent and independent variables. Dependent variables- sleep quality, nurses’ stress, and self-perceived health status. Independent variables were the nurses’ ages and gender. State anxiety, depressive symptoms, stress related to the NICU, quality of parent-infant interaction in the NICU. Independent variables-parental beliefs. Dependent-Catheter type, insertion site, and placement.
Independent-age, sex Dependent-Nosocomial infections control, knowledge, attitude, and self-efficacy.
Independent- Age, sex of nurses.
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Independent t-test, one-way ANOVA, hierarchical regression, Pearson’s r Parental stressor scale
Index of parental behavior-NICU
Parental beliefs scale. Randomized controlled tests with results specific to cancer patients Man-Whitney tests, Chi-square tests.
Data Analysis Statistical or
Qualitative findings Recommending A Evidence Based Practice Change Essay
(You need to enter the actual numbers determined by the statistical tests or qualitative data). 266 nurses reported moderate job stress, poor sleep quality, and average self-perceived health status. Stress-related to NICU-.94-.96. Quality of parent-infant interaction in NICU-.83-.86. Parental beliefs- .90-.93.
None 67.9% nurses have common knowledge, 29.9% had good understanding, and 90.4% had positive attitude, 25.2% average self-efficacy, and 74.8% functional self-efficacy.
Findings and Recommendations
General findings and recommendations of the research The nurses displayed moderate job stress, poor quality of sleep, and sensible self-perceived health regardless of the amount of shift work they did.Recommending A Evidence Based Practice Change Essay
Hospital managers should make sure more healthy work shifts scheduling to improve clinical performance and individual health status of nurses to improve the quality of care. A reproducible theory-based intervention with parents of preterm babies in NICU results in less parental stress, more positive familial interactions in the NICU, less anxiety, and depressive symptoms after hospitalization and a decreased LOS for preterm. It is essential to encourage mothers with preterm infants to embrace NICU. Femoral catheterization should be avoided, well-trained providers should place CVC. A clinical care CVC bundle to be used. Heparin-impregnated and antimicrobial-impregnated CVCs to be used. No significant relationship between knowledge and self-efficacy. No correlation between attitude and efficacy. Significant relation between knowledge and sex.
Recommendations- training of nurses to increase their knowledge and attitude.
Appraisal and Study Quality Recommending A Evidence Based Practice Change Essay
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice? The article is essential in providing an insight into the significance of work shifts in healthcare facilities.
Strengths- the methods and design of study were useful.
No limitations. The research is worth practicing by nurses to improve the health of parents with preterm infants.
Strengths-the study methods and design were appropriate.
Limitations-infants transferred before the end of the study period. The quality of the study is sound. However, the literature had a small number of patients with heterogeneity in trial design, types of catheter, placement techniques, and evaluation methods. Also, there were changes in clinical practices. The study is worth because the information therein is an eye-opener to nursing professionals regarding nosocomial infections.
Strengths-the study design and methods were appropriate.
Limitations- un-answered questionnaires.Recommending A Evidence Based Practice Change Essay
Key findings
Job stress inversely related to sleep quality, sleep quality directly related to self-perceived health status. Parental beliefs and roles significantly correlated with a shorter NICU length of stay. Less maternal depression, less stress, and anxiety in the NICU. Mothers and fathers in COPE program recorded positive interactions with their infants. The overall quality of evidence regarding catheter use in cancer patients was good. Nurses lack appropriate knowledge regarding control of nosocomial infections.Recommending A Evidence Based Practice Change Essay
Outcomes
Moderate job stress, poor sleep quality, and average self-perceived health status. Infants’ shorter days of stay in NICU. The evidence-based guideline on central venous catheters for cancer patients was established. Nurses lack appropriate knowledge regarding nosocomial infections.
General Notes/Comments Giving healthcare workers shift at work is critical for their productivity and health. The article was full of relevant information. The article gave precise information concerning catheter use on cancer patients, a crucial area of study. Knowledge regarding nosocomial infections is fundamental, and the article explains precisely why nurses should acquire this knowledge.
*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide
• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
• Level II
Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
• Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis.
• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence Recommending A Evidence Based Practice Change Essay
**Note on Conceptual Framework
• The following information is from Walden’s academic guides, which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework
• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study are unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
• Theoretical and conceptual frameworks provide evidence of academic standards and procedures. They also explain why the study is pertinent and how the researcher expects to fill the literature gap.Recommending A Evidence Based Practice Change Essay
• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
The best practice arising from the four research articles’ critical appraisal was the article discussing the impacts of a work shift to quality of care in nursing practice (Lin, 2014). This is because a prolonged work schedule of nurses is a common thing, very little is recognized regarding how such extended hours influence the care patients to get or the nurses’ well-being (Stimpfel, 2013). Even though there are schedules for nurses, the tangible shifts are unpredictable due to fluxes in patient wants and unexpected staffing modifications. Because of this, nurses are forced to work overtime past the scheduled length of shift.
Once long shifts are merged with overtime, shifts, which revolve between day and night responsibility, and the following shifts, nurses face the risk of stress and exhaustion, which as a result, may compromise the patients’ care (Stimpfel, 2012). Regardless of the guidelines on the length of shifts and the collective working hours for resident doctors and other people in other organizations, national work hour guidelines for registered nurses are lacking. Nurses have always reported being coerced about working overtime.Recommending A Evidence Based Practice Change Essay
Following the fact that nurses are facing a lot of challenges regarding the prolonged shifts, it is a significant area of study that aims to improve patient care and because there is limited research regarding this area of study. Therefore, it is vital to study the impacts the working shifts have on the work outcome of nurses and patient care.
Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills. As stated by McSherry, Simmons & Pearce (2002); “Nurses are responsible for the care they provide for their patient.…show more content…
(Polit & Beck, 2010). As nursing is person-centred and relies on a multidisciplinary team approach it has to take into account the care setting, patient predilections, clinical judgement and best available evidence. (Holland & Rees, 2010). The key steps involved in evidence based practice come from a thirst for knowledge that once ignited makes the next step to asking a well worded clinical question easier. A well formulated question improves patient outcomes and supports the implementation of change. One such method looks at foreground and background questions. A background question is usually a basic knowledge question and is usually answered by a textbook. Foreground questions are usually specific and once answered can help in clinical changes. An acronym useful for formulating a well worded question is PICOT. ( Stillwell, Fineout-Overholt, Melnyk, Williamson, 2010). Recommending A Evidence Based Practice Change Essay“PICOT is an acronym for the elements of the clinical question: patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), time it takes for the intervention to achieve the outcome(s) (T).” (Stillwell et al., 2010, p. 59). When a question has been identified the best study design can be chosen. For a prognosis question, a good quality cohort study would be used. For a non-compliance question, a qualitative study would be appropriate and for the effectiveness of treatment a systematic
Nurses and other healthcare professionals have developed several evidence-based practice (EBP) models that aid in the implementation of EBP. These models serve as organizing guides that integrate the most current research to create best patient care practices. In addition to helping nurses integrate credible evidence into practice, EBP models help assure complete implementation of EBP projects and optimize the use of nurses’ time and healthcare resources. No single EBP model can meet the needs of every organization and every patient situation. Therefore, we are providing model definitions, essential steps, salient points, and information resources for the models to help readers identify the EBP model that best fits their current, specific EBP needs.
Model Definition Essential Steps Salient Points to Consider
Iowa Model of EBP (Titler et al., 2001). The Iowa Model focuses on the entire healthcare system (e.g., patient, practitioner, infrastructure) to implement and guide practice decisions based on best available research and evidence.
Identify either a “problem-focused trigger” or “knowledge-focused trigger” that will generate the need for a practice change.Recommending A Evidence Based Practice Change Essay
Determine whether the “trigger” is a healthcare organization priority.
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Reflect a team’s topic of interest and include interested stakeholders. The team will search, appraise, and synthesize literature related to the topic.
Evaluate the availability and merit (e.g., level of evidence, quality of evidence) of evidence. If evidence availability and merit are lacking, conduct research.
If credible and reliable evidence is available, pilot the practice change.
Appraise pilot for level of success. If pilot is successful, disseminate findings within the organization and implement recommended change into practice.Recommending A Evidence Based Practice Change Essay
Recommended for use at organizational systems level
Uses pragmatic problem-solving approach to EBP implementation
Detailed flowchart (see Chapter 11) guides decision-making process
Clearly identified decision points and feedback loops throughout the model
Emphasizes necessity of pilot project before initiating system-wide project
Designed for interprofessional collaboration
Has sustained test of time
Stetler Model (Ciliska et al., 2011; Stetler, 2001). The Stetler Model enables practitioners to assess how research findings and other pertinent evidence are implemented in clinical practice. The model examines how to use evidence to create change that fosters patient-centered care. Steps in this model are referred to as phases.Recommending A Evidence Based Practice Change Essay
Phase I. Preparation: Identify a priority need. Identify the purpose of the EBP project, context in which the project will occur, and relevant sources of evidence.
Phase II. Validation: Assess sources of evidence for level and overall quality. Determine whether source has merit and goodness of fit and whether to accept or reject the evidence in relation to project purpose.
Phase III. Comparative Evaluation/Decision Making: Evidence findings are logically summarized and similarities and differences among sources of evidence are evaluated. Determine whether it is acceptable and feasible to apply summation of findings to practice.
Phase IV. Translation/Application: Develop the “how to’s” for implementation of summarized findings. Identify practice implications that justify application of findings for change.
Phase V. Evaluation: Identify expected outcomes of the project and determine whether the goals of EBP were successfully achieved. Recommending A Evidence Based Practice Change Essay
Designed to encourage critical thinking about the integration of research findings
Promotes use of best evidence as an ongoing practice
Helps lessen errors in critical decision-making activity
Allows for categorization of evidence as external (e.g., research) or internal (e.g., organization outcome data)
Emphasizes use by single practitioner but may include groups of practitioners or other stakeholders
Ottawa Model of Research Use (Graham & Logan, 2004 Graham et al., 2006). The Ottawa Model is an interactive model that depicts research as a dynamic process of interconnected decisions made and actions taken by stakeholders. The model is composed of three phases: (a) Assess barriers and supports. (b) Monitor intervention and extent of use. (c) Evaluate outcomes. Subsumed under the three phases are six designated primary elements that must be considered when integrating research into practice:
Assess barriers and supports:Recommending A Evidence Based Practice Change Essay
Evidence-based innovation: Clearly identify what the innovation is and what the implementation will involve.
Potential adopters: Identify potential adopters with characteristics that could influence the adoption of the innovation (see Rogers’ Change Theory in Chapter 7).
The practice environment: Identify leaders, formal and informal, who can inspire change. Assess environment for needed resources.
Monitor intervention and extent of use:
Implementation of intervention strategies: Select appropriate strategies to increase awareness of implementation and provide necessary education and training for conducting the implementation.Recommending A Evidence Based Practice Change Essay
Adoption of innovation: Determine the extent of adoption of implementation.
Evaluate outcomes:
Evaluate the impact of innovation on patients, practitioners, stakeholders, and healthcare organization.
Patients are central to the model’s process and their health outcomes are the primary focus.
The model focuses on the unit-level environment instead of the entire healthcare organization.
The prescriptive aim of the model is to assess, monitor, and evaluate.
Promoting Action on Research Implementation in Health Services (PARiHS) Framework (Rycroft-Malone, 2004). The PARiHS Framework provides a method to implement research into practice by exploring the interactions among three key elements: (a) evidence, (b) context, and (c) facilitation.
Evidence: Search for and identify the best available evidence from research, clinician experience, patient values, organization data, and information.Recommending A Evidence Based Practice Change Essay
Context: This is the local environment where the practice change will occur. Adoption of practice change is dependent on contextual features such as organizational culture and level of acceptance, leadership investment, and evaluation of desired outcomes.
Facilitation: Organizational participants use their knowledge and skills to foster implementation of practice change.
Explicitly uses facilitation as a factor impacting integration of research findings into practice
Does not address generation of new knowledge
Focus is on unit settings more than system-wide environment
Codified (e.g., research data) and noncodified (e.g., practitioner experience) sources of evidence used
ACE (Academic Center for Evidence-Based Practice) Star Model of Knowledge Transformation© (Kring, 2008; Stevens, 2004). As a framework, the ACE Star Model aids in systematically integrating best evidence into practice. The model has five major stages that depict forms of knowledge in relative sequence. Research moves through the cycles to combine with other forms of knowledge before integration into practice occurs. Five Stages:
Discovery: This stage involves searching for new knowledge found in traditional quantitative and qualitative methodologies.Recommending A Evidence Based Practice Change Essay
Evidence Summary: The primary task is to synthesize the body of research knowledge into a meaningful statement of evidence for a given topic. This is a knowledge-generating stage, which occurs simultaneously with new findings that may arise from the synthesis.
Translation: The aim of translation is to provide clinicians with a practice document (e.g., clinical practice guideline) derived from the synthesis and summation of research findings.
Integration: Practitioner and healthcare organization practices are changed through formal and informal channels.
Evaluation: An array of EBP outcomes are evaluated on impact, quality, and satisfaction.
Focus on promoting use of EBP for direct care nurses
Includes use of qualitative evidence
Primary goal of model is knowledge transformation
Does not incorporate nonresearch evidence (patient values, practitioner’s experience)
Identifies factors that impact adoption of innovation
Advancing Research and Clinical Practice Through Close Collaboration (ARCC) (Melnyk & Fineout-Overholt, 2015).
Assess the healthcare organization for readiness for change and implantation of EBP project.
Identify potential and actual barriers to and facilitators of EBP project.
Identify EBP champions to work with direct care nurses or specific clinical units.
Implement evidence into practice.Recommending A Evidence Based Practice Change Essay
Evaluate EBP outcomes.
Promotes use of EBP among advanced practice nurses and direct care nurses
Identifies a network of stakeholders who are supportive of the EBP project
Cognitive behavioral theory underpinnings
Emphasis on healthcare organizational readiness and identification of facilities and barriers
Encompasses research, patient values, and clinical expertise as evidence.
Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) (Newhouse, Dearholt, Poe, Pugh, & White, 2007). The JHNEBP Model applies a problem-solving approach to clinical decision making. The model is designed to meet the EBP needs of direct care nurses using an uncomplicated three-step process referred to as PET: (a) Practice Question, (b) Evidence, and (c) Translation.
Practice Question: Using a team approach, the EBP question is identified.Recommending A Evidence Based Practice Change Essay
Evidence: The team searches, appraises, rates the strength of evidence, describes quality of evidence, and makes a practice recommendation on the strength of evidence.
Translation: In this stage, feasibility is determined, an action plan is created, and change is implemented and evaluated. Findings are presented to the healthcare organization and broader nursing community.
Emphasizes individual use
Well-developed tool kit that provides nurses with guide for question development, evidence-rating scale, and appraisal guide for various forms of evidence
Knowledge-to-Action (KTA) Process Framework (Graham et al., 2006). The KTA is a model of knowledge creation and knowledge integration. Phases:
Identify problems that need to be addressed and begin searching for evidence and research about the identified problem.
Adapt the knowledge use to a local context.
Identify barriers to use of knowledge.Recommending A Evidence Based Practice Change Essay
Select, adapt, and implement interventions.
Monitor the use of implanted knowledge.
Evaluate outcomes related to knowledge use.
Sustain appropriate knowledge use.
Adapts well for use with individuals, teams, and healthcare organizations
Is grounded in planned action theory, which makes the model adaptable to a variety of settings
Breaks knowledge-to-action process into manageable sections.Recommending A Evidence Based Practice Change Essay