NRS 490 Essay Discussions

NRS 490 Essay Discussions

WEEK 1 : EBP Proposal and Nursing Practice

The aim of this essay is to explore the relationship between the research process and evidence based practice. The author of this essay intends to explore and illustrate an understanding of the various types of evidence used within nursing practice. There are barriers to implementing research into practice, the author intends to give explanation to these barriers and detail strategies/organizations that assist to putting research into nurse’s everyday practice. Two journal articles will be critiqued within this essay; the aim of this is to indicate which evidence has been used, to assess the strengths and weaknesses in the research process and to evaluate its usefulness in practice.NRS 490 Essay Discussions

Principles of Evidence Based Practice

Research can be described as a method of investigating a chosen area to illicit new information on the topic or to build on previous knowledge.  In nursing research the aim of this research is to provide clients, their carers and their families with the best possible care in all aspects of their treatment to promote well being (Burns and Grove 2001).

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“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research.” (Sackett et al 1996;72)

Nurses are at the front line of healthcare and have most one to one contact time with clients; therefore it is essential that the foundation of their practice be formed from reliable evidence (Parahoo 2006). Evidence based practice sets out to integrate the best possible evidence, nursing knowledge and patient views into practice. It is vital that nursing staff be knowledgeable of the latest findings in nursing research and are able to access and opt for the most suitable evidence to inform and implement into their practice. (Gerrish 2006) suggest that evidence based practice consists of research, patient experience and clinical expertise.

It is important to address which research findings nurses should consult to inform their clinical practice in order for them to deliver adequate care to their patients.  There are many different types of evidence available to practitioners; Gray Muir (1997) as cited in Gerrish (2006) outlines a hierarchy of evidence and indicates which types are more superior. Placed at the top of the hierarchy are systematic reviews and multiple randomized controlled trials (RCTs). A systematic review is essentially a study done on prior research; this is then deemed as secondary research (Parahoo 2006). The aim of this type of review is to carry out an extensive and thorough search of material already available on this topic. The most fitting material in relation to the topic is chosen, this is then evaluated, the findings are then collaborated and summarized to answer the original question. This process should be performed in a clear manner so that it would be possible for others to carry out this research. In second place on the hierarchy is randomized controlled trials, third; non-randomized controlled trials, fourth; non-experimental studies and fifth; descriptive studies/expert committees. This hierarchy is more suited to quantitative research and is deemed inappropriate if outcomes are not measurable (Gerrish 2006).

There are many organizations that provide information on research and guidance to how it should be implemented into clinical practice. The National Institute for Health and Clinical Excellence (NICE) offer  clinicians guidelines and criteria to follow with the aim of developing nursing care to the benefit of the clients health (NICE). The Cochrane Collaboration supply research material which is available to everyone. Their aim as an organization is to provide health care workers, clients and their carers with information on the most current and reliable evidence used within health care settings.NRS 490 Essay Discussions

There are several different barriers to implementing evidence into clinical practice; Gerrish (2006) suggests that these barriers can be set into four categories; the nature of the evidence, communication of the evidence, knowledge and skill of the nurse and organizational barriers. Barriers with regard to the nature of the evidence may include research questions unsuitable to clinical practice. In relation to communication of evidence the language used in the research may be deemed as inaccessible due to complex terminology. It has been identified that barriers concerning the nurses skill include troubles identifying or appraising evidence and also lack of confidence of the individual in using resources to access the research. Organizational barriers seem to indicate that lack of support from senior staff in providing information and time to implement changes are the main cause for concern.

Parahoo (2006) suggests that there are four main components in the research process. Identification and formulation of the research question is the first stage in the process, this is where the researcher determines what is being researched and a question is created. Previous literature researched in the chosen field may be consulted by the researcher to help define concepts. The final question must be clearly set out. The second stage of the process is the collection of data, in this part of the process several decisions will have to be made before data is collected. The design of the study, methods used within it and sometimes piloting need to be decided upon. The population that will be participating needs to be defined at this point consent may need to be sought from ethical committees. Once these arrangements are in place the data can be collected. The third stage in this process is the analysis of data, at this stage the researcher would analyze, translate and display their findings. It is important to note that before the data was collected the researcher would have decided on how the analysis would be conducted. After analysis the researcher would typically translate findings, examine the limitations and make suggestion as to how to implement into practice. Recommendations may be made for additional research needed. The final stage in research process is the dissemination of findings. An organization that might be responsible for this area would be NICE, the barriers to the implementation of evidence are outlined above.

There are many ethical issues involved in the research process; the author of this essay intends to discuss some of these implications. Beneficence is an important ethical issue, it is essential that the study should be of the benefit of its participants and in the best interests of the overall public. Confidentiality is another ethical issue within the research process, any information gathered should be respected. Consultation to the participant’s wishes should be sought throughout the process and care must be taken by the researcher when publishing results so not to unintentionally expose the identity or information of its participants.NRS 490 Essay Discussions

conclusion

The author of this essay has explored the relationship between evidence and the clinical setting. Research, evidence based practice and the research process was considered. Barriers to implementing evidence based practice and the strategies/organizations used to avoid these barriers were discussed. Critiques of two research articles are included in this essay; these critiques aim to illustrate the author’s understanding of the research process and knowledge of the various types of research and the methods used.

WEEK 2 : Solution to Evidence-Based Nursing Practice

Evidence-based practices have been associated with improved patient outcomes in the clinical setting. In most cases, such clinical interventions usually reduce the rate of medication errors and provide long-term solutions. This essay evaluates how the consistent use of condoms can be a proper way of overcoming the cases of sexually transmitted infections and unwanted pregnancy among students due to unprotected sex.

Clinical Issue

The higher cases of unprotected sex among teenagers and young adults have been on a rise in high schools and colleges where they have got the freedom that they were seeking. Furthermore, “Health Promotion and Maintenance” is one of the NCLEX category, which has a subsection known as the “High-Risk Behavior” (NCSBN, 2017). Hence, the clinical issue highlighted is classified as one of the high-risk tendencies that are associated with younger people. The subcategory that the medical providers should identify the inappropriate activities that the patients are undertaking and raise awareness about the concerns associated with such issues. From that point, they can have programs that can transform the behaviors of the population and help them in avoiding such elements to overcome their infections.NRS 490 Essay Discussions
Importance
A discussion of the high-risk behaviors can help the nurses in identifying how certain infections are caused. As a result, they can suggest the evidence-based practices that can address the problem and provide long-term solutions. In the process, the patients will remain healthy and avoid the risk factors that can increase their chances of contracting some serious infections. The high school and college students will also understand the danger associated with having multiple sexual partners. The knowledge can enhance their awareness of such situations and how they should avoid the issues that might undermine their health.
On the other hand, the failure to comply with such requirements can place the well-being of the patient population at risk. For instance, unprotected sex will result in higher cases of sexually transmitted infections (STIs) and pregnancy among young adults (Ashenhurst, Wilhite, Harden, & Fromme, 2017). As a result, such negative effects can interfere with their education because the ladies might be forced to abandon school so that they can take care of their new-born babies. They can also spend more time in the medical institutions and funds as they are seeking treatment for the STIs that they have acquired.
The healthcare system will keep getting more cases of infections and ladies with unwanted pregnancy seeking…

WEEK 3 : Methods for Evaluating Evidence
The fifth step of the process, outcome evaluation, attempts to interpret the results and evaluate the outcomes of the applied evidence (intervention).  Outcome measures may be psycho social (quality of life, improved patient perception of care, reduction in depressive and anxiety symptoms), physiologic (improved health, reduced complications), or functional improvement.  Evaluation of the process and the results may occur through peer assessment, audit, or even self reflection.  Depending on the type of outcomes achieved, it may be possible to compare the outcomes of a study with similar outcomes on a local, regional, national, or international level.NRS 490 Essay Discussions

The Iowa Model for Evidence-Based Practice to Promote Quality Care has been revised to better address sustainability of EBP, inter professional change implementation, and patient-eccentric care for clinicians at all levels of practice, guiding them through a team-based, multi phase process. The path initiates with a clinical “trigger” that identifies a clinical problem and includes decision points with evaluative feedback loops when recommending and implementing practice change. The model phases are inter professional team formation; evidence review, critique, and synthesis; change implementation through piloting; ongoing evaluation; and outcomes dissemination.

The Advancing Research and Clinical Practice Through Close Collaboration Model is for building resources and training mentors who play a central role in facilitating and sustaining EBP at the point-of-care and throughout the organization. The model has seven steps: cultivating a spirit of inquiry; asking a PICOT-formatted clinical question; collecting, critically appraising, and integrating the best evidence with clinical expertise and patient preferences; and evaluating and disseminating practice change outcomes.

The Johns Hopkins Nursing Evidence-Based Practice Model is clinician-focused, allowing rapid and appropriate application of current research and best practices. It simplifies the EBP process and cultivates a culture of care based on evidence. It has three overall steps: practice question, evidence, and translation. Its directive tools are intended for practicing clinicians working individually or in a group to address clinical inquiries.

The Promoting Action on Research Implementation in Health Services (PARIHS) Framework has been revised into the integrated or i-PARIHS framework. The framework refers to evidence-based change as practice innovation. It contends the core elements of successful implementation of practice innovation is dependent on the type of evidence available, context of the care setting, and how the process is facilitated. The framework emphasizes the importance of taking into consideration the perspectives of all recipients of the intended change.

Although these are just a few models for translating evidence into practice, each outlines and promotes the need for a systematic approach to evidence-based change. Each addresses the sustainability of EBP through organizational culture change, stakeholder engagement, comprehensive literature review and appraisal, barrier identification, impact evaluation, and outcomes dissemination. Regardless of the preferred model, the EBP process should tell the story of how a problem was recognized, addressed, and improved, and that story should be shared.NRS 490 Essay Discussions

WEEK 4 : EBP Implementation

While evidence-based practice is regarded “as the gold standard in patient care,” Luciano and colleagues note that research shows that hospitals and clinics can take about 17 years to adopt a practice after the release of the first systematic evidence showing it helps patients.

According to Luciano and colleagues, a big part of the challenge is adapting the practices to fit a clinic’s environment.

“Leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context,” they write. “Attempting to simply ‘plug in’ a new practice to a different hospital or clinic often conflicts with existing practices. … But deviating from the evidence-base can weaken the effectiveness of the practice and lessen the benefits.”

The 4 keys to implementing evidence-based practices

With these challenges in mind, Luciano and her colleagues conducted research on organizational change and identified four approaches leaders can use to implement evidence-based practices at their organization “while staying close to the foundational evidence.” Specifically, Luciano and colleagues urge leaders to:

1. Understand the data. While some evidence-based practices and treatments are applicable to multiple clinical contexts, in other instances, the data behind an evidence-based practice may not translate to your organization. “What if the evidence-base is constructed from different patient populations, hospitals with different structures or cultures, or countries with different regulatory environments and payment structures,” Luciano and colleagues write.

   In those situations, leaders need to adapt the evidence-based practices to fit their organization. And that requires understanding the data, Luciano and colleagues write.

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   For example, Luciano and colleagues recommend that leaders look at the data and consider “what is similar, what is different, and why those might matter.” They add, “Leaders should also consider whether existing data is sufficient to support implementing a new practice … or if additional data should be collected to verify the efficacy.”NRS 490 Essay Discussions

   Even after the practice is implemented, leaders should continue the data collection process so they can reassess and make modifications as needed, according to Luciano and colleagues.

3. Consider your resources. Similarly, every organization has different resources at their disposal, making it likely that leaders will need to modify evidence-based practices to fit the resources that are available to them, Luciano and colleagues write.According to Luciano and colleagues, adapting a method based on resources can shift providers’ reactions from “we don’t have the resources to do that” to “how can we apply these practices with the resources we do have?”

   For instance, while hospitals that don’t have “sophisticated [EHRs] may not be able to implement electronic patient smart order sets,” they could “still attain similar improvements in care coordination by using paper checklists,” Luciano and colleagues write.

4. Establish patient-centered goals. When implementing a new evidence-based practice, health care leaders need to identify goals based on patient-centered outcomes, according to the Luciano and colleagues. “The goal of implementing an evidenced-based practice should not be the implementation itself,” they write.”For example, many hospitals have the goal of reducing inpatient length of stay. If the change leaders focus just on the inpatient length of stay itself, they may create a program that rushes the patient out of the hospital before they are ready,” Luciano and colleagues write. “If instead the goal is to optimize recovery … the focus shifts to the patient experience, and reduction in inpatient length of stay is simply the residue of a provider and patient-friendly program.”
5. Identify your preferences. Finally, leaders should note that health care providers’ personal preferences often determine whether an organization will adopt a new practice, according to Luciano and colleagues.”Preferences driven by subjective, idiosyncratic reasoning inhibit adopting new approaches that can attain better health outcomes, reduce expenses, and decrease errors,” Luciano and colleagues write.NRS 490 Essay Discussions

   For example, one health system that adopted a standardized set of tools found that physicians preferred the tools they’d been trained on, even though evidence showed the old tools were more costly and had no impact on patient outcomes.

Technology is integral to successful implementation in many projects, through either support or integration or both. Name at least one technology that you might or will need to work with that will improve the implementation process and the outcomes of your EBP project.