list four variables which impact the adoption of evidence-based practice (EBP) across health systems
PLEASE RESPOND TO EACH 6 DISCUSSIONS SEPERATELLY Peer Response must be substantive by bringing information to the discussion or further enhance the discussion. Each Peer Response must have a minimum of ONE reference with citations (the best is a peer-reviewed article). Word count is greater than 75 words or at least 5 sentences in length. Statements like “I agree” or “great post” does not count for the words or sentences.
Participation #1 Taenzer et al. (2017) list four variables which impact the adoption of evidence-based practice (EBP) across health systems: the external environment, the organization, features of change to be implemented, and the implementation process itself. Additionally, one factor which inhibits adoption of EBP is the absence of proven outcomes (Taenzer et al., 2017).
Given this information, it is important to tailor the dissemination of my capstone change project to reflect the known hurdles to implementation. Internally, my urine testing algorithm is easily printed and placed at all nurse stations throughout the hospital. Additionally, a health stream module and “huddle topic” will be developed to educate all nurses across the facility. Externally, this new protocol will be proposed to division leaders and implemented across other HCA divisions throughout the United States and Europe once outcomes on the local level have been obtained. Beyond this, I have no plans to disseminate information further.
Communication strategies differ for dissemination of information between internal and externally to divisions across the HCA family. Internally, Giomuso et al. (2014) suggest creating unit based “champions” comprised of nurses from all skill levels and across all areas of nursing. These nurses serve as “consultants” of-sorts to other nurses within each unit to provide further information and to answer questions.
One internal method for the dissemination of my evidence based changed proposal would include the environmental service department to discuss the process in implementing UV lighting in their normal sanitation regime. I would have to propose this to administration and have approved by the board. A strong argument that this new intervention would be fiscally beneficially for the facility would need to include past pilot programs that developed this new intervention and how it had save their facility money and also saved lives.
An external method of the dissemination of my evidence based changed proposal would include the Greater New York Hospital Association and their collaboration team on how to reduce C-diff in a hospital setting. Including this outside stakeholder would justify the cost of the new equiptment and training that will be needed for the staff in the environmental services department.
Communication strategies for the internal method for the dissemination of my evidence based changed propoasl would teach in a way that the staff could clearly understand and relate to. Normally a fifth grade level is what is recommended. When communicating with the Greater New York hospital association my presentation would need to be much more professional and use of appropriate medical terms and verbage would be required.
There is no external source I can think of for my change proposal. If anything is to change then it must be done with the hospital board itself. This is something that doesn’t fit the normal practice to prevent HAPI’s. However, if I was to think of an external source I would say the The American Wound Care Association. They are the for most association in best practices. It would take quite some time to see how the intervention will benefit before submitting the results. The best way to submit the plan to both would be through a presentation of what, how long and the correlations of both 2 hour and 4 hour rotation, along with the reduction of HAPI’s and the nurses responses to how it helped them and the money saved by the hospitals
Dissemination of findings and information on the evidence-based change proposal is a critical stage. This can be done internally by sharing the findings with board members. Multiple platforms and strategies exist that facilitates this internal method. The researchers may directly hold meetings with board members and release the findings. Additionally, the findings can be communicated through the organization websites, hold conferences, by use of social media as well as brochures just among the members (Harris et al., 2018). On the other hand, external method for this evidence-based approach involves communicating the results to individuals or groups outside the organization.
The project will utilize publishing of papers alongside presentations to communicate the findings. Particularly, the evidence-based change project will do presentations at national conferences and meetings of professional associations. It is important to report research findings to the above bodies to make sure its impact is felt socially, politically and economically. Moreover, dissemination of reports to internal and external bodies also helps to ensure the information has reached the target audience. As a result the change proposal can effectively be addressed. Notably, there are multiple ways to communicate change strategies. For the project, this can be done through exploiting various channels, communicating to the write audience either via written or verbal communication as well as listening and answering questions from the audience as a way of responding to feedback (Dang et al., 2021). In addition to that, the project also can utilize use of visuals during the presentations
One way my preceptor and I have determined to evaluate effectiveness of the implemented change project is to track metrics within the facility against previous like-time periods. Retrospectively, we can easily determine the number of urine cultures per 1000 patient days and urinary culture positivity rate. Both of these metrics can easily be obtained through chart audits and laboratory reports within the facility. In order to count “patient days” the Centers for Disease Control and Prevention (CDC) guides facilities to count the number of patients occupying beds at the same time each day (CDC, n.d.). At my facility, charge nurses of each inpatient unit perform this count at midnight each day.
Evidence Based Practice is very easy to measure and can be measured in multiple ways. It is simple, you implement a new policy and you evaluate it’s effectiveness once it is completed. Evidenither ce based practice standards are then either implemented as new policy and procedure or they are disregarded as they may have noted that the new intervention may have created another problem inadvertatly. Sometimes the pilot is successful in reducing health care costs and creating better patient outcomes but an additional issue may have been noted to arise and depending on the severity of the problem the pilot program may not become a new policy. For instance, I worked with a home health care agency and we did a pilot program with telehealth with the developmentally disabled who reside in group homes. When the nurse came to ghe group home and all the other residents saw how the patient was able to talk on an ipad with the doctor they all decided it was very cool. There was only myself and another nurse who were doing the telehealth calls. It was costing the agency a $100 a visit to pay us, not including travel. Although the ER visists were reduced, the home visits increased almost double what the average ER visits were prior to the pilot program. Even with more visits the cost was still reduced compared to the ER visists, but their was not enough staff to continue the program. This is a perfect example of a pilot program still being successful but could not be implemented because another problem was created becasue of it.
More recently, nursing theory has evolved to help us define complex phenomena and design sophisticated multimethod studies to guide nursing practice. Examples include practices for increased mobility (Henderson, 1956) and the use of complementary therapies to manage pain and anxiety (Antal& Kresevic, 2004).With a vast amount of scientific knowledge now contained in journals, textbooks, and cyberpace,it is not appropriate to rationalize nursing interventions based on tradition