Response # 1 To Deana
Creating a Culture of Evidence-Based Practice
Evidence-based practice (EBP) is frequently cited as a goal for healthcare organizations; however, the practical processes and resources for achieving EBP may not be readily apparent, available, or successful (Aitken, Hackwood, Crouch, Clayton, West, Carney & Jack, 2011). The organization I work for uses evidence-based practice to attain excellence and the highest level of quality care. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research (Barnsteiner, Reeded, Palma, Preston & Walton, 2010). We currently have many EBPs policies in place. A particular practice that stands out is Fall Prevention.Falls and fall injuries in hospitals are the most frequently reported adverse event among adults in the inpatient setting (Quigley & White, 2013).
My organization has achieved Magnet Recognition, meaning it is recognized for quality patient care, nursing excellence and innovations in professional nursing practice. The culture of the facility is very open and embraces EBPs. The implementation of shared governance to support such practice is widely encouraged at my facility. That includes nurses that are magnet champions who are on the EBP committees. A healthcare culture focused on excellence, and world-class patient care requires that nursing research and EBP integrate into the professional practice model and nursing care delivery (Aitken et al. 2011).
In the hospital setting, falls continue to be the number one adverse event with approximately 3-20% of inpatients falling at least once during their hospitalization (Quigley & White, 2013). Using gate belts with each patient transfer, bed alarms for high fall risk patients, and toileting patients often are some of the fall prevention EBPs used in my facility. A healthcare acquired condition (HAC) is a complication or comorbidity (CC) or major complication or comorbidity (MCC) that occurs as a consequence of hospitalization and is high volume and/or high cost, and be reasonably preventable using evidence-based guidelines (Quigley & White, 2013). With the support of healthcare providers and proper education of the staff, successful implementation of the EBP model for fall prevention is effective.
Disseminating the Findings
According to Polit & Beck (2012) good research communication depends on providing information that can be understood, so researchers should think about the audience they are hoping to reach. To disseminate information about EBP findings, I could use written material like poster boards or prepare a PowerPoint presentation. Major advantages of conference presentations are that they typically can be done soon after study completion, and offer opportunities for dialog among people interested in the same topic (2012). I also need to keep in mind the target audience to make sure the information provided is understood.
Strategies for strengthening the culture of EBP within an organization should begin with awareness and go through an integration phase. According to Cullen & Adams (2012) strategies for implementing the process include creating awareness and interest, building knowledge and commitment, promoting action and adoption, and pursuing integration and sustainability to promote application by nursing and team leaders. Nurses have the responsibility to further the use of EBP to provide quality care. The IOM proposes that use of EBP could provide greater consistency of patient care, using the most up-to-date and best research to obtain optimal outcomes, resulting in standardized care that is more cost-effective, equitable, and of higher quality (Estrada, 2009).
In conclusion, the use of EBP in nursing care is important to provide quality patient care, nursing excellence and innovations in professional nursing practice. Creating a culture of acceptance of EBP policies is vital for improving the delivery of health care and is key to providing information that can be understood. Building knowledge and commitment provides an essential foundation for promoting action and adoption of the EBP change (Cullen & Adams, 2012).
Aitken, L. M., Hackwood, B, Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process.Australian Critical Care, 24(4), 244–254.
Barnsteiner, J. H., Reeder, V. C., Palma, W. H., Preston, A. M., & Walton, M. K. (2010). Promoting evidence-based practice and translational research. Nursing Administration Quarterly, 34(3), 217–225.
Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222–230.
Estrada, N. (2009). Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting. Worldviews on Evidence-Based Nursing, 6(4), 200–209
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins
Quigley, P., White, S., (May 31, 2013) "Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations" OJIN: The Online Journal of Issues in Nursing, 18(2). DOI:10.3912/OJIN
Response # 2 to Yvette
Organization’s Use of EBP
Currently in the primary care setting there is little use of evidence-based practice (EBP). Management does not encourage the use of EBP due to the limited procedures we perform daily. On the other floors in the inpatient side there is use of EBP. In our practice area there is lack of EBP mentors. The practical process and resources for implementing EBP is not readily available or successful in our clinic (Aiken et al., 2011). There is a team in place hospital wide to research and implement EBP throughout the units. The only problem with this is they meet after clinic hours. This makes it difficult for most of our staff to stay for these meetings. Another challenge in the current area of practice is nursing leadership is unprepared for the challenge of implementing EBP (Cullen & Adams, 2012). The organizational culture in terms of EBP is not a positive one. When nursing leaders bring up new methods of delivering care, other nurses quickly shut this down. These new methods of delivering care are seen as adding to the workload. Nursing leaders are quickly discouraged and drop the issue, thus not implementing EBP at all. Leaders often times would rather not “rock the boat” and continue with old practices even though they may not be cost-effective or as safe as the EBP suggests.
In order to disseminate EBP findings I would suggest implementing the Watkins & Marsick conceptual framework describing the seven dimensions of the learning organization. The seven dimensions of learning include:
…(1) create continuous learning opportunities, (2) promote inquiry and dialogue, (3) encourage collaboration and team learning, (4) establish systems to capture and share learning, (5) empower people toward a collective vision, (6) connect the organization to its environment, and (7) use leaders who model and support learning at the individual, team, and organizational levels. (Estrada, 2009, pp.203).
This conceptual framework outlines a great method of incorporating EBP into the clinical setting I work in. Creating new opportunities for other employees to learn while encouraging collaboration and team building is a great method to incorporate EBP. In our unit we need to feel we are part of a team. By connecting the organization to change in positive delivery of care for the patients, the employees will feel they have made a contribution to patient outcomes.
Strengthening the Culture of EBP
A strategy for strengthening the EBP culture in our unit would be to create awareness and interest through continuing education programs, staff meetings, EBP workgroups, and nursing rounds. Relevant current clinical issues should be topics to be discussed during EBP workgroups (Aitken et al., 2011). Time should be set aside to allow for EBP to take place. Nursing leadership should be mentors in leading EBP discussions and promoting positive change in the delivery of patient care. Approaching research as a way of growing academically will encourage employees to partake in improving delivery of patient care through updated cost-effective, safe procedures. Research was intended to promote rational processes for clinical decision-making stressing the importance of integrating the latest findings (Satterfield et al., 2009).
Nursing leaders deal with numerous challenges to include staffing issues, employee satisfaction, safety and quality patient care outcomes (Estrada, 2009). There needs to be an emphasis on collaborative delivery of EBP. Empowering staff to learn should be an option for those who want to be part of organizational change (Fineout-Overholt, Williamson, Kent, & Hutchinson, 2010). Providing previous practice changes in other facilities and the impact it has made to their delivery of care could also encourage employees participate in research.
In summary, delivery of care should be done with the use of EBP. A positive organizational culture should be promoted to ensure the safest, latest, and optimal health care delivery. Nursing leaders should be mentors in facilitating change. Promotion of EBP leads to educated decision making changes in a clinical setting.
Aitken, L. M., Hackwood, B, Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011).
Creating an environment to implement and sustain evidence based practice: A
developmental process.Australian Critical Care, 24(4), 244–254.
Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based
practice. Journal of Nursing Administration, 42(4), 222–230.
Estrada, N. (2009). Exploring perceptions of a learning organization by RNs and relationship to
EBP beliefs and implementation in the acute care setting. Worldviews on Evidence-Based
Nursing, 6(4), 200–209.
Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010). Teaching EBP:
Strategies for achieving sustainable organizational change toward evidence-based
practice.Worldviews on Evidence-Based Nursing, 7(1), 51–53.
Satterfield, J. M., Spring, B., Brownson, R. C., Mullen, E. J., Newhouse, R. P., Walker, B. B., &
Whitlock, E. P. (2009). Toward a transdisciplinary model of evidence-based practice. The
Milbank Quarterly, 87(2), 368–390.
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