Questions Related the Implementation of Evidence-Based Practice

Answer

Questions Related the Implementation of Evidence-Based Practice

#1

Adequate comprehension of the system of healthcare at a local level is significant when planning the implementation of evidence-based practice (EBP) due to three reasons. First, EBP implementation calls for various resources that exist at the local level including adequate funding and human capital (Mallion & Brooke, 2016). Skilled human resources at the local level such as nurses and physicians among other professionals provide the necessary competence and leadership for EPB implementation. Second, the organizational structure associated with the system of healthcare at the local level contributes significantly to successful implementation of EBP (Mallion & Brooke, 2016). Organizational leadership’s willingness to implement EBP promotes the availability of critical resources like training opportunities, adequate human resources, and funding. As such, there is a significant need to comprehend healthcare system’s leadership at the local level, with the aim of establishing its readiness to implement EPB (Mallion & Brooke, 2016). Third, comprehending the healthcare system’s culture at the local level is a significant factor when it comes to the planning for EBP implementation.  Significant cultural factors for consideration at the local level are traditions of local communities and organizational norms or policies that guide the management of human resources. These cultural aspects play a vital role in influencing stakeholder cooperation at a local level during EPB implementation. In relation to this, the factors that will be taken into consideration in my change project are the involvement of local agencies and communities, as a means of enhancing goodwill for cooperation and collaboration. Moreover, the regulations at the local level that govern the health and safety of individuals, as well as the traditions and norms of local communities will be taken into consideration.

#2

Lewin’s (1951) Change Model and Lippitt’s theory are two change theories that can be employed in implementing EBP. Whereas Lewin’s model involves three major stages including unfreezing, moving, and refreezing, Lippitt’s theory incorporates seven stages (Udod & Wagner, 2018). The seven stages of Lippitt’s theory are problem diagnosis, motivation and change capacity assessment, change agent’s resources and motivation assessment, progressive change objective’s selection, selection of change agent’s appropriate role, change maintenance, and the helping relationship termination respectively (Udod & Wagner, 2018). In Lewin’s model, the unfreezing stage is associated with examining the status quo and increasing driving forces for change. This stage corresponds to first three stages of Lippitt’s theory including problem diagnosis, change agent’s resources and motivation assessment, and motivation and change capacity assessment. The moving stage is associated with taking action for change, making changes, and involving people. This stage corresponds to the phases of change maintenance, progressive change objective’s selection, and selection of change agent’s appropriate role in Leppit’s theory (Udod & Wagner, 2018). The refreezing stage is associated with making changes permanent, establishing novel ways of events, and rewarding desired outcomes. This phase aligns with the stage of the helping relationship termination in Lippitt’s theory (Udod & Wagner, 2018). In my view, Lewin’s model is more effective in change implementation than Lippitt’s theory, as it takes into consideration the aspect of coalition or team-building and focuses on the creation of awareness concerning the need for change. My mentor is on record for employing Lewin’s model and realizing significant success in change implementation in terms of effective cooperation of stakeholders and awareness creation. 

#3

Stakeholders play a vital role in ensuring the success of implementing change in healthcare. When it comes to the implementation of my evidence-based project, internal stakeholders such as healthcare practitioners or nurses will play a significant role in the project’s successful implementation by providing their knowledge and skills and providing suitable leadership within the organization, with the aim of allowing for the change (Huntink et al., 2014). As key internal stakeholders, nurses are considered primary care providers who are in charge of converting the evidence into exact practice while providing care to patients (Huntink et al., 2014). To accomplish this goal, nurses will require the support of other healthcare professionals such as pharmacists, anesthesiologists, physiotherapists and physicians among other health specialists, who are directly involved in care provision. Moreover, the support of the organization’s management structure will be needed for successful implementation of my evidence-based project, as it provides the requisite framework and leadership that would promote change adoption.

External stakeholders for the evidence-based project include suppliers, patients, and financial organizations such as healthcare insurance providers and government among others. The support of external stakeholders is required for successful implementation of the evidence-based project, as they provide the needed resources such as funding, equipment, and infrastructure (Huntink et al., 2014). Other external stakeholders that will play a vital role in the implementation of my evidence-based project are opinion leaders, whose support is significant in influencing perception or opinion of the change within the society and community.  To secure the support of external and internal stakeholders for my evidence-based project, I will employ several approaches including the creation of awareness concerning the project, use of media, and community coalitions. I will create awareness about my evidence-based project by holding seminars, partaking in conferences, and journal forums among other platforms that can enhance interactive engagements.

#4

Emerging technologies in various healthcare fields such as therapeutics and diagnostics have played a significant role in enhancing patient care and care delivery. Apart from improving healthcare outcomes, technology has contributed largely to the reduction of healthcare costs (Smith-Strøm et al., 2018). One of the technologies that would be employed in improving the process of implementing my EBP project and the outcomes of this process is telemedicine. This technology would enhance care monitoring and delivery to surgical patients within unmonitored settings. According to Smith-Strøm et al. (2018), is appropriate during postoperative period, particularly when the patient is subjected to homecare. It is vital to note that the employment of telemedicine in implementing my EBP project is feasible owing to fast internet speed and increased broadband penetration across the country. As such, these factors make telemedicine cost-effective when it comes to monitoring and teaching patients, as well as their caregivers in remote areas. Furthermore, telemedicine can effortlessly be integrated with other medical applications and technologies, thereby allowing a multidisciplinary approach in care delivery for outpatients (Smith-Strøm et al., 2018). Even though telemedicine is a suitable technology for successful implementation of my EBP project, I will not employ this technology due to two reasons. First, telemedicine is vulnerable to frequent technical hitches and interruptions, which in turn could jeopardize care delivery to patients within remote regions that have poor access to the internet. Second, this technology would not be inappropriate for patients with insufficient knowledge regarding the technology and those with reduced functional capabilities, especially those deficiencies that arise due to old or advanced age (Smith-Strøm et al., 2018).

#5

One financial aspect that will be impacted by my evidence-based project is the reduction of healthcare costs arising from wound-related readmissions. Kueny et al. (2015) assert that wound-related readmissions are considered among the major contributors to increased healthcare costs in diabetic patients. According to Kueny et al. (2015), the provision of low cost, high quality care is among the core objectives associated with the nursing practice. As such, the evidence-based project will contribute to the reduction of healthcare cost by limiting the rates of wound-related readmissions for diabetic patients. In relation to the aspect of quality consideration, an EBP project should assist in the promotion of the expected patient health outcomes including promoting quality of life, reducing mortality rate, and limiting hospital readmissions (Kueny et al., 2015). The EBP project will result in improved patient health outcomes by enhancing wound healing, relieving diabetic patients from wound-related pain, preventing wound infection, and eliminating unplanned revascularization. When it comes to the clinical aspect that will be impacted by the EBP project, it is significant to note that the existence of healthcare personnel with relevant knowledge and expertise to facilitate EBP implementation in inpatient and outpatient setting serves as a vital step towards attaining quality care delivery. As such, the EBP project will contribute to the establishment of a multidisciplinary team or skill mix needed for successful adoption of the EBP solution.

#6

Diabetic wound management is considered a suitable EBP solution to addressing the problem of wound-related readmission that result from adverse health outcomes such as poor wound healing, wound infection, persistent wound-related pain, and unplanned revascularization (Holscher et al., 2018). Significant changes have occurred in my EBP project since I envisioned it. By performing a series of assignments related to the implementation of my EBP project, I have managed to envision the success of implementing an EBP solution, as pegged on the embracement of a system approach including a range of factors and players including healthcare system at local level, change theory, stakeholders at local level, role of technology, and the financial, quality, and clinical aspects. The consideration of healthcare at the local level ensures that the necessary resources, leadership and guidance, and cultural requisite needed for successful EBP implementation are accessed (Holscher et al., 2018). Having a change theory is needed for guiding the process of implementing EBP solution, and I selected Lewin’s model over Leppitt’s theory owing to its ability to engage stakeholders and create awareness about the need for change. Stakeholders play a vital role when it comes to successful implementation of EBP solution, as they provide the needed skills, financial resources, and buy-ins. Technology contributes to the ease of implementing an EBP solution and improving project or change outcomes. Aligning an EBP solution to the clinical, financial, and quality aspects ensures that the nursing goals of healthcare cost reduction, improving patient outcomes, and developing a multidisciplinary team for care provision are accomplished. 

#7

 Derman and Jaeger (2018) consider the dissemination of EBP outcomes a targeted circulation or transmission of interventions and information to a given clinical or public health practice audience. Effective dissemination of EBP outcomes is associated with positive involvement of the targeted group, which in turn enhances understanding, awareness, and motivation to implement within the workplace (Derman & Jaeger, 2018). In relation to this, one internal method that I would employ in disseminating the outcomes of my EBP project is the hospital board. Derman and Jaeger (2018) assert that the hospital board comprises health organization’s employees such as physicians and nurses among other professionals involved in delivering patient care. Face-to-face approach will be embraced in disseminating the EBP results to the hospital board, as it facilitates instant feedback and interaction, especially during sessions for questioning. One external method that I would use to disseminate my EBP project results is presenting such outcomes in conferences held by professional organizations such as the American Nurses Association (AMA). This method is preferred, as it would provide a perfect platform to enhance the dissemination of the project outcomes to an enormous audience of nurses. Face-to-face approach would also be embraced in this process, as it encourages discussions and consultations with other nursing practitioners. The significance of reporting the outcomes of my EBP project to the hospital board and conferences held by healthcare professional organizations lies in the fact that it facilitates information and knowledge sharing within the nursing fraternity (Derman & Jaeger, 2018). As a result, decision-making potential among the members involved within the nursing practice is enhanced and patient outcomes promoted. Reporting outcomes to these groups promote constructive criticism of such results, which in turn offers an opportunity for improving them prior to the project’s implementation. Company intranet, face-to-face communication, and emails will be employed in communicating changes to the project to the hospital board. On the other hand, newsletters, emails will be sent to the senior representatives of healthcare professional organizations for any changes to the project.

#8

The evaluation of an evidence-based practice solution or project calls for the determination of the effectiveness of the change. Nonetheless, ensuring that the expected change actually transpired happens to be among the most challenging steps in the process of evidence-based practice implementation (Harris et al., 2015). After the implementation of the practice change, it is significant to ask or inquire whether the anticipated results were accomplished. In relation to my evidence-based practice, the expected patient-related outcomes will be the decline in wound-related readmissions due to better or improved wound healing, decrease in persistent wound-related pain, decline in unplanned revascularization, and reduction in cases of wound infection. Some of the measures that will be embraced in determining the changes in these outcomes or the effectiveness of the EBP project in attaining the desired outcomes are focus on hospital records on wound related readmissions and conducting surveys with diabetic patients who have received wound care and nurse practitioners. Hospital records on wound-related readmissions will enable me to establish the rates or levels of reduction or decrease in wound associated readmissions of diabetic patients. On the other hand, conducting surveys with nurses and diabetic patients will enable me to establish the effectiveness of the EBP solution in attaining the desired results, especially anticipated patient outcomes.

#9

My evidence-based project will focus on diabetic wound management to address wound-related readmissions in hospitals. () emphasize the collection of dependent and independent variables when it comes to the evaluation of EBP outcomes. The dependent variables that I would gather for evaluating my EBP project are healthcare costs associated with wound-related readmissions and patient outcomes, particularly the factors that result in wound-related readmissions such as poor wound healing, unplanned revascularization, wound infection, and persistent wound-related pain. On the other hand, the dependent variable that will be gathered for the evaluation of the EBP project’s success is DM wound management. These independent variables are significant because they are directly associated with the provision of quality care to diabetic patients and rely on effective wound management. As such, by gathering data on these patient outcomes I will manage to establish whether the EBP project is effective in addressing wound-related readmission. Moreover, gathering data on changes on healthcare costs related to wound care provision to diabetic patients will contribute significantly to the establishment of the effectiveness of my EBP project. Gathering data associated with DM wound management is vital, as it serves as the independent variable that influences patient outcomes and healthcare costs associated with wound-related readmissions. 

#10

EBP is supposed to influence clinical decision-making process. However, the interpretation of research always presents problems to some clinicians (Ranganathan et al., 2015). The significance of clinical interpretation of study on treatment outcomes lies in the fact that it impacts critical clinical-decision-making including efficacy and patient safety. Not all EBP projects lead to statistically significant outcomes. Nonetheless, from a clinical viewpoint, the absence or presence of statistically significant difference is considered to be of limited consideration or value. Page (2014) argues that a non-significant result does not automatically denote that the treatment was clinically ineffective, as small sizes of samples and measurement variability can impact statistical outcomes. Ranganathan et al. (2015) define clinical significance as the magnitude of the exact treatment effect or treatment effect size that will establish whether trial results have a likelihood of impacting present nursing practice.

There exists a substantial difference between clinical significance and statistical significance. Clinical significance of outcomes is dependent on the implications of such results on the existing effect-size of practice-treatment, as one of the factors that drive decisions associated with treatment. On the other hand, statistical significance is largely reliant on the sample size of the study. Even in situations where large sample sizes exist, even small effects of treatment can seem statistically significant (Ranganathan et al., 2015). As such, it can be noted that whereas statistical significance specifies the study results’ reliability, clinical significance mirrors the impact of research outcomes on clinical practice. In evidence-based study practice, the determination of statistical significance must be done prior to the establishment of clinical significance. Nevertheless, clinical significance is often subjective assessment and cannot be determined by a single experiential assessment or test. To accomplish positive results in my EBP project using clinical significance, I would ensure that the outcomes are statistically significant. My view is informed by the notion that most statistically significant outcomes always possess clinical significance.  

#11

Nurse practitioners are increasingly being required or asked to engage in professional presentations within formal and informal situations or settings such as poster presentations, conferences, case reports, ward-based teaching, and job interviews (Foulkes, 2015). In relation to this, I have certain personal strengths and weakness when it comes to the delivery of professional presentations. One of my strengths in delivering professional presentations is the use of hooks in engaging the audience. However, I can still build on this strength by embracing certain strategies including use of real life experiences, humor, and analogies. Real-life experiences enables the present to delivery key information in a memorable manner. According to Foulkes (2015), humor serves as a robust ally in getting the information across. The most successful or effective conveyance of humor is achieved using fewest possible words and in a personalized. While using humor, the present should avoid off limit humors such as gratuitous insults, slapstick, sarcasm, and put-downs, as well as humor that contradicts the presenter’s philosophy or personality. One of my weaknesses when it comes to delivering professional presentations is nervousness. To address this weakness, I will embrace measures such as pre-speech warm up, a night-prior routine, practice, and preparation. Working on my presentation skills presents several benefits. By sharpening these skills, I can manage to share expertise and knowledge, as well as communicate clearly within several workplace scenarios. Moreover, these skills can contribute significantly to my advancement along my career ladder. 

#12

Two potential hindrances that may deter EBP change proposal from continue to realize same desired outcomes 6 months to a year from now are absence or shortage of knowledge and skills on DM wound management. In relation to the shortage or absence of skills and knowledge about DM wound management, the existing nurse practitioners may be relocated from the hospital or face issues such as job termination, thereby creating a skill or knowledge gap in DM wound management. The skill or knowledge gap may arise from the fact that the skilled personnel may be replaced by new practitioners who lack adequate knowledge about DM wound management. Another key barrier that can impede the sustainment of the desired EBP outcomes is the shortage of nurses or lack of human resources (Khammarnia et al., 2015). The movement of nurses to other organizations or termination of employment in the future can lead to the shortage of personnel, who can effectively and adequate attend to diabetic patients with wounds. Certain measures will be embraced to address these two barriers. When it comes to addressing skill or knowledge gap on DM wound management, a training program will be implemented within the organization and made compulsory to all practitioners including new recruits. Such an undertaking will ensure the continuation of the existing knowledge and skills on DM wound management within the organization, as argued by Khammarnia et al. (2015). When it comes to addressing the shortage of nurses in the future, I will liaise with the human resources to ensure that a favorable work environment that enhances job satisfaction is created for practitioners to limit job termination and relocation to other organizations. Besides, I will encourage the human resources to embrace an active personnel recruitment program so that constant supply of employees can be maintained. 

#13

 Dissemination of EBP and research, such as presenting results at a conference or writing an article for a journal, is an important part of professional practice. Identify one professional journal and one nursing or health care conference where you might present your project. Discuss why each of your choices is the best option for you to disseminate your new knowledge

One professional journal that I can employ in presenting my project is the American Journal of Nursing (AJN). On the other hand, one nursing conference where I can present my EBP project is the World Nursing and Healthcare Conference. The AJN is a peer-reviewed journal with a well-develop history. By disseminating my EBP project using this journal, the project will undergo an initial editorial review aimed at ensuring that it meets the anticipated standards of style and quality, and that its contents fits within the scope of the journal, as suggested by Curtis et al. (2017). This goal will be accomplished with the help of peer reviewers, who possess the expertise needed to offer an unbiased evaluation of quality and significance of the EBP project’s outcomes when it comes to effective management of wounds in diabetic patients. The World Nursing and Healthcare Conference is a global nursing convention. As such, presenting the outcomes of my EBP project is such a conference will ensure that findings are disseminated quickly and to a large or global audience owing to the existence of a short lag time between the completion of the EBP project and the presentation at the conference, as argued by Edwards (2015). It is also vital to note that the World Nursing and Healthcare Conference is always attended by leaders within the field, who have a higher likelihood of being early adopters of the EBP findings into practice. Moreover, such a conference will enhance my interaction with other global practitioners and stimulate detailed discussions about my project’s outcomes and quick reception of feedback.

#14

Evidence-based practice is a significant component of the practice of a BSN-prepared registered nurse as contributes significantly to showing the importance of research, other side of nursing, and novel ways that nurses can employ in standing up for their patients ().Two ways of continuing to integrate evidence into my practice area and promote it within the work setting are creating a learning environment by developing and delivering training interventions like EBP journal clubs and holding regular inter-professional and inter-wards’ discussion meetings. Some of the obstacles that could impede this plan are resistance and lack of adequate inter-professional collaboration. Moss et al. (2016) define inter-professional collaboration as the collective engagement of different professional healthcare practitioners working with caregivers, patients, families, and communities to take into consideration and communicate one another’s unique view in providing the highest care quality. Resistance in the organization could present significant problems to the establishment of a culture of learning within the organization, whereas insufficient inter-professional collaboration could jeopardize the holding of inter-professional meetings. To minimize the issue of resistance, I will focus on engaging all stakeholders, especially nurse practitioners and other healthcare professionals within the organization in evidence integration. Besides, I will seek the support of hospital administration in terms of helping me to establish a culture that backs EBP. When it comes to minimizing insufficient inter-professional collaboration, I will focus on the creation of robust, collaborative inter-professional teams that can enable members to adopt patient care protocols and policies that are patient-centered and team-based, as suggested by Moss et al. (2016). In addition, I will use technology to encourage collaboration by forming WhatsApp and Facebook group for various professionals.