NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Walden University NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change                     

Whether one passes or fails an academic assignment such as the Walden University NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change                     

The introduction for the Walden University NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change                     

After the introduction, move into the main part of the NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change Included After Question

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
• Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

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.
• 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.
• Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
• 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 within the Critical Appraisal Tool Worksheet Template (1-3 slides)

A Sample Answer For the Assignment: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change
Title: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Introduction

Health organizations operate with the aim of optimizing outcomes such as safety, quality, and efficiency in addressing the needs of their organizations. Often, health organizations operate in highly dynamic and challenging environments. They experience issues such as competition from other organizations, changing consumer needs and preferences, and emerging health problems. These challenges imply that health organizations must embrace change to respond to their current and emerging needs in their markets.

Change initiatives provide organizations competitive edge over others involved in the same market niche. Healthcare providers, including nurses play a crucial role in the implementation of change initiatives that address organizational needs. They select evidence-based practice interventions to ensure efficiency in the adopted strategies and realization of optimum safety and quality outcomes in service delivery. Therefore, this presentation examines an organizational issue and proposed change to address it.

Organizational Description

The organization I work with is a tertiary hospital. The hospital leads in the region in the provision of specialized and general care to its diverse populations. The hospital has a culture that supports change. First, healthcare providers utilize teamwork in the provision of patient care services. Teamwork aims at ensuring collectivism in the realization of the organizational outcome. The organization also strives to support safety culture. This is achieved by the adoption of evidence-based interventions in the implementation of organizational strategies. Evidence-based strategies optimize outcomes such as safety, quality, and efficiency.

There is also the use of open communication among different stakeholders. Open communication ensures the prioritization of the stakeholder needs, views, and concerns. Open communication has strengthened openness and trust among the organizational employees, hence, enhanced teamwork in the provision of patient care. The organization also recognizes the vital role that rewarding performance plays in contributing to employee productivity. As a result, it undertakes biannual performance appraisals and uses them to reward employees and motivate them to explore additional ways of achieving the desired outcomes. These aspects of the organizational culture make it ready to embrace change.

Description of the Current Problem

The selected nursing problem in my organization is nursing shortage. The hospital currently experiences an acute shortage of nurses, which has affected the provision of patient care services to the patients. Several circumstances surround the issue of nurses shortage in the hospital. One of them is high rate of nurses’ turnover. The rate of nurses leaving their jobs intentionally has risen significantly over the past years. The rise is attributed to organizational issues such as high workload because of the few nurses, burnout, and occupational stressors associated with the challenge of balancing professional and family life demands.

The other factor is unhealthy workplaces. This can be seen from violence targeted at nurses by other nurses and other healthcare providers. Most nurses report experiencing either physical or verbal violence from others, which affect their psychological and physical health, hence, their intention to leave their jobs. The other factor is the low number of nursing students being trained among the American universities. This is attributed to the shortage of faculty staff to train a high number of nurses to address the current shortage. Lastly, more than one million nurses will be retiring in the next decade.

This implies that the problem of nursing shortage will persist if no intervention is embraced (Yahya Muabbar & Zayyan Alsharqi, 2020). The affected stakeholders by the problem include nurses and patients. Nurses suffer from high workload while patients are affected by low quality nursing care being given to them. The risks of implementing change include resistance to change from the adopters, inadequate support from health organizations, and disruption of the existing systems and processes by change.

Change is necessary in the healthcare systems. With the advancement in the operational processes, there is always the need to adjust some of the approaches used in the healthcare. Most organizations often implement changes to ensure efficiency in the healthcare processes and also to increase revenues. With the increased demands of quality in the healthcare delivery, most healthcare institutions are always involved in the continuous change processes to ensure that they meet the ever increasing demands from the clients. Given that healthcare institutions are faced with different challenges that need to be addressed, there is always the need to initiate change processes to address such challenges/problems (Arditi, Nayak, & Damci, 2017).

Different healthcare institutions are associated with different issues that either require changes in people’s behaviors or the processes or approaches in the healthcare system. Some of the challenges may include medication errors, workplace conflicts, inadequate care delivery, high costs of healthcare services, and low nurse to patient ratios. These challenges/issues often require the implementation of appropriate changes in the service delivery to ensure effective operational processes. The purpose of this paper is to examine an issue that may lead to the implementation of change processes in the healthcare system.

Executive Summary of the Issue Impacting Organization/Workplace

One of the main issues affecting my organization/workplace is workplace conflict. In most cases, conflicts among the employees and the management often impact effective operational processes. Usually, workplaces with a lot of issues experience delays in service delivery. Also, the quality of service delivery may go down. With the increasing conflicts within the work environment, people cannot reach consensus on various issues that impact healthcare processes. Workplaces with continuous conflicts often require constant changes to ensure that there is an overall improvement in the operational processes.

Conflicts within the work environment may be caused by poor communication, lack of common understanding among the workforce, as well as the lack of respect among the employees and the management. Close-mindedness, misunderstandings, as well as passive aggressive behaviors are some the other causes of workplace conflicts in my organization. In my organization, the management has been involved in implementing different change processes to address the issue of workplace conflicts. However, the approaches that have been taken often appear ineffective. For instance, the management has tried to transform communication processes to enhance understandings among the employees and the management; however, the approaches that were taken failed to produce effective outcomes.

Description of the Change Being Proposed: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Changes in the organizational culture and policies is essential in addressing the workplace conflicts. Changing an organizational culture is one of the best approaches in ensuring a reduction in workplace conflicts. However, it is one of the challenging processes for the management as there is always the need to transform the mind-set of employees as well as their behaviors. Also, the organization’s culture often consists of interlocking set of roles, goals, values, processes, attitudes, communication policies, as well as assumptions. Changing an organizational culture is often a large scale undertaking that requires the organization of different resources. For instance, the organizational tools that are required in changing the minds will need to be put in place.

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Changing an organizational culture will involve addressing the communication processes and improving the behaviors of people. In other words, the proposed change, which is the transformation of the organizational culture, will address the issues that often lead to conflicts. For example, the change process will create an environment of mutual respect and effective communication. Changes in the organizational culture may also create an environment where there is teamwork.

In most cases, workplaces where people interact and operate together experience less conflicts. The change or transformation of the organizational culture may lead to strong employee relationships, which can lead to less conflicts. Changing an organizational culture may also lead to changes in policies, objectives, mission, and vision, especially if these factors are attached to the cultural practices.

Justification for the Change: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Addressing the cultural change will have significant impact in the organization/workplace. Cultural change will lead to the creation of a positive environment for all the stakeholders, which will lead to increased quality in service delivery and the general patient outcomes. Organizational culture often contributes significantly to the behaviors of the people as well as the interaction processes. Therefore, whenever there is the need to resolve workplace conflict, transforming culture is necessary. Also, organizational culture often determines the value, principles, and ethical behaviours of the people. Therefore, transforming it would mean improvement on individual’s values, ethical behaviors and the development of positive principles which are necessary in resolving conflicts.

Type and Scope of the Proposed Change

Making changes to the organizational culture should incorporate making adjustments to the standards of behaviors of the people. Also, the whole process involves changes in the values and principles that people ought to adhere to. In other words, cultural change should incorporate changes in the workplace values, policies, skill, practices, attire, language, expectations, aesthetics, and tools.

Cultural change should involves overall changes in behaviors. In other words, the organizational culture change should incorporate a shift in behaviors and in the ways things are supposed to be done as well as how employees are expected to behave under different circumstances (Slack & Singh, 2018). The cultural change should also involve the transformation of policies relating to human resource activities.

Stakeholders Impacted By the Change and the Identification Of The Change Management Team: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Some of the stakeholders that will be impacted by the cultural change include employees and the management. In the process of change, employees will be required to transform their behaviours, which may go contrary to the normal behaviors of a person. Also, adjusting to the set standards of behaviors may become very difficult for some people. Given that the management often relates directly to the employees, they may also be impacted by the cultural change (Pitafi, Liu, & Cai, 2018). Other stakeholders that may be impacted by the change include clients/patients that often get engaged directly with the organizational employees.

The change management team will involve the management. For instance, human resource managers will be among the change management team. Also, the chief executive officer, lower level managers, nurse leaders, and some employees, especially nurses, will be part of the change management team. The above professionals understand what it takes to transform the organizational culture.

Plan for Communicating the Proposed Change

There is always the need to communicate proposed changes to ensure that everyone understand the procedures and processes required is necessary. Selecting credible leaders to communicate the change process is necessary in ensuring that every aspect of the change process is well understood and addressed by the stakeholder involved in the whole process. Keeping communication all the way to the end of the whole process is necessary in ensuring that all the stakeholders become aware of the change process (Currie et al., 2017). Delivering accurate messages to the people and ensuring that everyone captures the information being communicated is important. While communicating the processes of change, there is the need to ensure that all the messages delivered are consistent to the end.

Conclusion

Change is necessary in the healthcare systems. With the advancement in the operational processes, there is always the need to adjust some of the approaches used in the healthcare processes. Transforming cultural practices is necessary in ensuring that there are improvements in the quality services delivery and that clients can enjoy effective services offered. Addressing the cultural change will have significant impact in the organization/workplace. Cultural change will lead to the creating of a positive environment for all the stakeholders, this will lead to the quality in service delivery and the general patient outcomes.

References

Arditi, D., Nayak, S., & Damci, A. (2017). Effect of organizational culture on delay in construction. International journal of project management, 35(2), 136-147. /https://doi.org/abs/pii/S0263786316303052

Currie, D., Gormley, T., Roche, B., & Teague, P. (2017). The management of workplace conflict: Contrasting pathways in the HRM literature. International Journal of Management Reviews, 19(4), 492-509. https://doi.org/10.1111/ijmr.12107

Pitafi, A. H., Liu, H., & Cai, Z. (2018). Investigating the relationship between workplace conflict and employee agility: The role of enterprise social media. Telematics and Informatics, 35(8), 2157-2172. https://doi.org/10.1016/j.tele.2018.08.001

Slack, N. J., & Singh, G. (2018). Diagnosis of organizational culture in public sector undertakings undergoing reforms. Public Organization Review, 18(3), 361-380.: https://doi/org/10.1007/s11115-017-0383-5

I enjoyed reading your post this week! I liked your statement about EBP analysis creating sustainable interventions to improve the care of the patients and that utilizing a variety of decision aids can improve and support patient preferences while assessing patients and developing their expected outcomes. I agree completely. EBP implementation and the use of decision aids allow the patients to be included more in their care. EBP allows medical professionals to educate the patients and use practices that are proven to be beneficial. Clinical expertise is important when educating and providing care for our patients.

Clinical practitioners should be continuing education throughout their time practicing. If clinical practitioners are not continuing to develop skills and enhance their knowledge base, organizations cannot be successful and provide the necessary care that patients require (Melnyk & Fineout-Overholt, 2018). EBP utilization can foster better relationships between providers and patients, as well as allow for intelligent essential conversations that are centered around the patient (Melnyk and Fineout-Overholt, 2018).

By using EBP and decision aids, healthcare professionals can enhance the shared decision-making (SDM) process. When patients feel like they are included and in charge of their healthcare, they feel more in control regarding the outcomes, which can improve the quality of care provided. For example, more than 60% of providers using a decision aid for SDM with screening options for Colorectal Cancer (CRC) patients stated that the care provided was enhanced by the decision aid in conjunction with their regular methods used while enhancing the knowledge of patients, helping patients decipher which treatment option was best for them, enhancing the drive of the patient to be assessed all while saving time (Schroy et al., 2014).

SDM is proven to enhance care on both ends of the spectrum. Providers can provide more accurate information based on the needs of the patient and allow them to be the leader of their healthcare team. Providing the best care for our patients is of the utmost importance. Patients rely on the providers and nurses to provide them with the best options and treatments regarding their care. Teaming up with the patients in making these essential decisions will all-around enhance the outcomes of the care provided.

A Sample Answer For 2 the Assignment: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change
Title: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

References

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide

to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal

cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. https://doi.org/10.1111/j.1369-7625.2011.00730.x

Health care organizations should constantly evaluate their performance and intervene appropriately as situations necessitate. One of the highly recommended interventions is evidence-based practice change. Organizations adopt positive change based on current, relevant, and high-level evidence to solve clinical problems through such changes. The purpose of this presentation is to recommend an evidence-based practice change for addressing workplace incivility. It starts with an overview of the organization before describing the problem, the idea for change, and the plan for knowledge transfer. Other vital sections include an analysis of the measurable outcomes and lessons learned.

The success of an evidence-based change project depends on the organizational policies, attitude towards change, and culture, among other factors. The organization is primarily a general health care facility dealing with inpatient and outpatient services. It is highly centralized, with each department dealing with specific functions. Regarding culture, the organization is primarily an adhocracy.

Lepore et al. (2018) defined an adhocracy as a culture where the management supports individual initiatives instead of prescribed rules. Readiness for change can be determined by assessing the organization’s approach to change. It is right to deduce that the organization is highly ready for change since it embraces change. Previous change-driven projects have been a massive success, and the management commits resources to support innovation.

The current problem is workplace incivility. According to Shi et al. (2018), workplace incivility includes rude and discourteous behavior towards colleagues. An uncivil workplace is detrimental to patient care and nurses’ productivity since it hampers workplace relationships and nurses’ wellbeing. It is a leading cause of discomfort and nurse turnover (Shi et al., 2018). Workplace incivility is among the issues that nurse leadership cannot ignore in health care settings.

It adversely affects the nursing staff, patients due to low-quality care and the organization due to reduced performance. Stakeholders involved in change-facilitation and/or affected by the problem include the management as change promoters, patients, the nursing staff, nurse leaders, and human resources experts (for awareness programs). The most significant risks include a change in the workplace culture and resistance.

The evidence-based practice (EBP) approach recommends solving a clinical problem by integrating scientific evidence into clinical practice. As already mentioned, the problem of interest is workplace incivility. After generating evidence, it is crucial to appraise it to get the most relevant evidence for a clinical problem. Policy interventions and incivility awareness emerged as the most practical interventions for addressing workplace incivility.

Such interventions include zero-tolerance policies, a culture of reporting, and education programs on workplace incivility. Cognitive rehearsal can also be integrated into the intervention programs to ensure that nurses are adequately prepared to identify and cope with workplace incivility. The objective is to reduce workplace incivility in the facility within six months.

EBP change projects would not be fruitful if the proposed changes are not implemented and knowledge shared. An effective way of knowledge creation is to continue searching and appraising evidence to ensure that changes are based on scientific evidence. Consultative forums and nursing education programs would also be effective in sharing knowledge and generating new ideas. The best way to adopt and implement changes is to share the EBP results with the management to facilitate appropriate practice changes. Dissemination is vital for ensuring that the EBP results reach a wider nursing audience. A policy brief and posting the results on the organization’s education would ensure that information reaches all the organization’s members. Other strategies can be chosen later to share knowledge externally.

The primary objective of the EBP change project is to reduce workplace incivility. It will lead to better health outcomes, achieved through EBP and shared decision-making (Hoffman et al., 2014). As a result, a combination of incivility awareness programs and policy interventions will promote a more civil workplace in six months. Shi et al. (2018) found workplace incivility a leading cause of anxiety and burnout. The proposed changes will address this problem and others stemming from workplace incivility, like reduced esteem and negative perception of the nursing profession. Reducing workplace incivility is also expected to improve the nurses’ wellbeing and confidence. Doing so will reduce medication errors and improve patient satisfaction since patients will be served better.

Research appraisal is a rigorous process which involves systematically evaluating research evidence to determine its relevance and value (Melnyk & Fineout-Overholt, 2018). After the appraisal, four articles were found relevant to workplace incivility prevention. Shi et al. (2018) recommended the importance of informed and resilient nurses to cope with workplace incivility. Armstrong (2018) recommended the need for improving nurses’ ability to recognize and manage workplace incivility, justifying awareness programs. also advised health care managers to improve nurses’ skills. The last article emphasized the need for awareness. According to Kile et al. (2019), awareness programs should be intensified in health care settings to reduce workplace incivility.

The evaluation analyzes articles about workplace incivility from multiple dimensions. It is tedious to analyze articles from multiple dimensions including research methodology, sample size, design, and outcomes. Also, research evidence should be sourced from credible sources with high-level evidence. Systematic reviews are highly reliable since they comprehensively select, analyze, and appraise evidence from multiple data sources. Also, reading the entire article can be time-consuming when searching for evidence. Therefore, it is crucial to rely on the abstract as the guide. Other vital observations include the importance of searching via keywords and in-depth understanding of research databases and the type of articles found in each.

It is crucial to conclude the presentation by summarizing the key findings. One of the major findings is that EBP change promotes positive change in health care by proposing evidence-based interventions for addressing clinical problems. Workplace incivility can be addressed using the same approach where research is sourced from current and relevant evidence. Suitable interventions for addressing workplace incivility include policy changes to promote a new workplace culture and increased awareness on workplace incivility to enable nurses identify and cope with the problem. It is also crucial to share EBP results with other health care providers and the larger nursing profession hence the need for dissemination

A Sample Answer For 3 the Assignment: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change
Title: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966 Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106 Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186 Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709 Lepore, L., Metallo, C., Schiavone, F., & Landriani, L. (2018). Cultural orientations and information systems success in public and private hospitals: preliminary evidences from Italy. BMC Health Services Research, 18(1), 1-13. https://doi.org/10.1186/s12913-018-3349-6 Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer. Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461

The evolution of technology allows patients to have more access to information resulting in well-informed, educated patients. While it is great that patients are taking the initiative to play active roles in their healthcare, it comes with challenges. Working in labor and delivery, I have had many experiences with patient involvement in treatment and healthcare decisions. One reoccurring experience that patient involvement helps aid in best practice and incorporates them in healthcare decision-making is birth plans.

Birthing plans set expectations and standards of care couples expect during the laboring process (Hidalgo-Lopezosa et al., 2021). According to a study by Hidalgo-Lopezosa et al. (2021), birth plans in southern Spain resulted in fewer interventions and more natural birthing processes. While the utilization of birth plans creates a clear picture of how the patient wants their delivery to go, they can be challenging, especially when they are unwilling to deviate from the plan. When I first started working labor and delivery, the first bout of knowledge my preceptor shared with me is never to trust a pregnant woman. While she did not mean this figuratively, the patient’s status can rapidly progress or decline. This instability can create a need for evidence-based innovations the couple is unwilling to try or had not discussed when developing their plan.

De Campos Silva and Lopes (2020) concluded the need for couples to discuss their birth plans with their physician or midwife to ensure all possibilities are deliberated, and each party has a clear understanding of desires and possible outcomes. Initiating these conversations before delivery would help reduce the challenges healthcare providers at my organization face when handed a birth plan, especially when the plan does not align with unit policies and the American College of Obstetricians and Gynecologist recommendations. The biggest challenge I have faced is a delivery that resulted in a limp unresponsive newborn.

The mother’s demand for the newborn to be placed in kangaroo care impeded proper intervention outlined by the Neonatal Newborn Resuscitation Program. After much explanation, the mother allowed the newborn to be placed in the warmer, where the newborn was intubated and flown to a tertiary hospital. The newborn was diagnosed with a diaphragmatic hernia which prevented proper lung growth. The diaphragmatic hernia could have been diagnosed with ultrasound; however, the mother refused. While the patient had the right to create a birth plan, I feel frequent in-depth conversations with a physician or midwife could have helped this situation.

Patients have the right and should want to be active participates in their healthcare decisions. They should research and become educated but also value the expertise of their physician and other healthcare providers. Without the collaboration of patients and healthcare providers, evidence-based practice is nonexistent (Melnyk and Fineout-Overholt, 2019).  Both must work together and use best practices to aid their decisions to improve health.  

A Sample Answer For 4 the Assignment: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change
Title: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

References

de Campos Silva, T. M., & Lopes, M. I. (2020). The couple’s expectations for the birth

plan. Revista de Enfermagem Referência, 2, 1–7. https://doi-org.ezp.waldenulibrary.org/10.12707/RIV19095

Hidalgo-Lopezosa, P., Cubero-Luna, A. M., Jiménez-Ruz, A., Hidalgo-Maestre, M., Rodríguez-

Borrego, M. A., & López-Soto, P. J. (2021). Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study. International Journal of Environmental Research and Public Health, 18(2). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020456

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

A Sample Answer For 4 the Assignment: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change
Title: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Introduction

Nurses play an important role in providing care that addresses the needs of their populations. They ensure that they adopt interventions that prioritize outcomes such as safety, quality, and efficiency in their practice. Often, nurses encounter issues such as the rise in neonatal abstinence syndrome that should be managed by utilizing evidence-based interventions. Neonatal abstinence syndrome affects most of the infants that abuse drugs. There exists a mix of evidence on the treatments that should be used in optimizing outcomes in infants affected by NAS. The mix of evidence affects the therapy that healthcare providers adopt to enhance recovery outcomes. A similar problem exists in the practice site. As a result, it is the focus of this presentation.

Organizational Description, Culture, and Readiness for Change

My organization is a hospital. It is a tertiary hospital that provides both specialized and general care. It is also a medical training center in the region. The hospital is well known in the region for the provision of high quality, safe, and efficient care to the diverse populations. It is considered a home to specialized care because of its large number of specialists that address the different needs of the population. The hospital has a positive culture. First, healthcare providers utilize interprofessional collaboration to ensure that it provides care that meets the prioritized an actual need of their populations. The hospital also supports open communication between and among different stakeholders.

Open communication is used to ensure that the desired culture of patient safety is created and supported. Through open communication, healthcare providers play a proactive role in expressing their views about how to achieve the desired patient outcomes in the care process. The hospital also encourages its staff to explore different evidence-based interventions that can be used to enhance care outcomes. The leadership also supports the use of best practices in the firm. For example, it supports healthcare providers that implement evidence-based practice projects that improve care outcomes (Mathieson et al., 2019; Moran et al., 2023). Therefore, based on the above, the organization is ready to implement change.

Current Problem, Scope, Stakeholders, and Risks of Change Implementation

The current problem in the practice site is that the number of infants admitted due to neonatal abstinence syndrome has risen significantly. Despite this rise, there is a confusion on the treatment that should be adopted to improve outcomes among this population. In some infants, the physicians often prescribe morphine for treatment while others adopt methadone. The confusion in the appropriate treatment modality that should be used for NAS increases the risk of poor outcomes among these neonates.

Over time, it has become evident that the practice site needs to develop a guideline that will be used for addressing the practice issue. Therefore, the scope of the presentation is the implementation of an evidence-based treatment that will standardize the treatment of NAS. The proposal is a change in itself. As a result, the implementers should be aware of the risks associated with the implementation of change. One of them is resistance from the healthcare providers. Resistance to change will minimize the translation of the evidence-based intervention in nursing practice. The other risk is the lack of competencies among the healthcare providers on translation of evidence into clinical use.

Evidence-Based Idea

The proposed intervention to enhance outcomes in infants diagnosed with NAS is the use of methadone as compared to the current practice of morphine use in treatment. A review conducted in this project showed that methadone is associated with enhanced outcomes in NAS as compared to morphine. For example, in the research by Davis et al., (2018) the use of methadone for infants born with NAS was associated with a reduction in the length of hospital stay and median length of hospital stay. It also the length of treatment because of NAS. A reduction in hospital stay has additional benefits that include cost reduction in healthcare and improved outcomes among the affected populations. Similar findings on the effectiveness of methadone have been replicated in the study by Tolia et al., (2018) where it led to a shorter length of hospital stay as compared to morphine treatment alone. The intervention should be implemented incrementally with the close monitoring of outcomes.

Plan for Knowledge Transfer

Several strategies will be explored to facilitate knowledge transfer. One of them will be coaching. Selected nurse practitioners will act as coaches and mentors to the staff in the implementation process. They will provide the staff the guidance they need for them to successfully implement the change. The mentorship and coaching will aim at ensuring sustainability in the use of methadone in NAS and monitoring its effectiveness, safety, and efficacy. The other approach to knowledge transfer will be training. Nursing and medical staff in the pediatric care units will be trained on the use of methadone for NAS.

The training will aim at ensuring they have the competencies needed in ensuring the safe and consistent use of the interventions. There will also be active staff participation in the change initiative. Active participation will aim at ensuring that the staff is empowered to use the interventions. It will also ensure staff ownership of the interventions for their sustainable use in the firm. Feedback will also be obtained from the staff to inform any changes that are made in the process of implementing the change (Zanchetta et al., 2022).

Disseminating Results

            I will use three strategies to disseminate results to my audiences. The first one will be presenting the project findings in nursing conferences. Different nursing organizations have conferences where nurses share their knowledge on the different ways of improving practice. conferences will be effective for the change since I will reach a wider audience of specialists who may benefit from the project. The second strategy will be developing practice guideline and protocol to be used in the hospital in NAS management.

The protocol will be incorporated into the existing policies to ensure its sustained use to improve care outcomes. The last strategy would be publishing an article. I will publish an article about the project with a reputable nursing organization. The article will reach the global audience and encourage their use of the bundle to improve the population’s outcomes (Zanchetta et al., 2022).

Measurable Outcomes

Several measures will be used to assess the effectiveness of the change. One of them will be length of hospital stay. Length of hospital stay among neonates started on methadone will be compared with those of morphine. A reduction in length of hospital stay will translate into the effectiveness of the intervention. The other outcome measure will be the cost of care. The total costs incurred in caring infants started on morphine and methadone will be compared. The intervention will be considered effective should the assessment show it having lower costs as compared to morphine use.

The other outcome measure would be the need for other therapies among neonates started on methadone. A comparison with those of morphine will be made to determine the true impact of the change. The last outcome measure would be the experiences of the healthcare providers with the change. This will include conducting surveys and administering questionnaires to determine their experiences in using the change and impact on care outcomes.

Lessons Learnt

I learnt from the selected studies that treatment of neonatal abstinence syndrome (NAS) is a challenge in nursing end medical practice. However, the reviewed studies demonstrate some potential for the use of methadone in treating NAS. For example, the use of methadone for infants born with NAS was associated with a reduction in the length of hospital stay and median length of hospital stay.

The benefits were incomparable to the use of other treatments such as morphine for the disorder. The studies had the limitation of using small sample sizes in their investigations. Therefore, future studies should utilize large samples with randomization to provide accurate insights about the true effect of methadone. Nurses should also be competent in determining the quality of evidence in different resources.

I enjoyed reading your post this week! I liked your statement about EBP analysis creating sustainable interventions to improve the care of the patients and that utilizing a variety of decision aids can improve and support patient preferences while assessing patients and developing their expected outcomes. I agree completely. EBP implementation and the use of decision aids allow the patients to be included more in their care. EBP allows medical professionals to educate the patients and use practices that are proven to be beneficial.

Clinical expertise is important when educating and providing care for our patients. Clinical practitioners should be continuing education throughout their time practicing. If clinical practitioners are not continuing to develop skills and enhance their knowledge base, organizations cannot be successful and provide the necessary care that patients require (Melnyk & Fineout-Overholt, 2018). EBP utilization can foster better relationships between providers and patients, as well as allow for intelligent essential conversations that are centered around the patient (Melnyk and Fineout-Overholt, 2018).

By using EBP and decision aids, healthcare professionals can enhance the shared decision-making (SDM) process. When patients feel like they are included and in charge of their healthcare, they feel more in control regarding the outcomes, which can improve the quality of care provided. For example, more than 60% of providers using a decision aid for SDM with screening options for Colorectal Cancer (CRC) patients stated that the care provided was enhanced by the decision aid in conjunction with their regular methods used while enhancing the knowledge of patients, helping patients decipher which treatment option was best for them, enhancing the drive of the patient to be assessed all while saving time (Schroy et al., 2014).

SDM is proven to enhance care on both ends of the spectrum. Providers can provide more accurate information based on the needs of the patient and allow them to be the leader of their healthcare team. Providing the best care for our patients is of the utmost importance. Patients rely on the providers and nurses to provide them with the best options and treatments regarding their care. Teaming up with the patients in making these essential decisions will all-around enhance the outcomes of the care provided.

INTRODUCTION

Health organizations operate with the aim of optimizing outcomes such as safety, quality, and efficiency in addressing the needs of their organizations. Often, health organizations operate in highly dynamic and challenging environments. They experience issues such as competition from other organizations, changing consumer needs and preferences, and emerging health problems. These challenges imply that health organizations must embrace change to respond to their current and emerging needs in their markets.

Change initiatives provide organizations competitive edge over others involved in the same market niche. Healthcare providers, including nurses play a crucial role in the implementation of change initiatives that address organizational needs. They select evidence-based practice interventions to ensure efficiency in the adopted strategies and realization of optimum safety and quality outcomes in service delivery. Therefore, this presentation examines an organizational issue and proposed change to address it.

ORGANIZATIONAL DESCRIPTION

The organization I work with is a tertiary hospital. The hospital leads in the region in the provision of specialized and general care to its diverse populations. The hospital has a culture that supports change. First, healthcare providers utilize teamwork in the provision of patient care services. Teamwork aims at ensuring collectivism in the realization of the organizational outcome. The organization also strives to support safety culture. This is achieved by the adoption of evidence-based interventions in the implementation of organizational strategies. Evidence-based strategies optimize outcomes such as safety, quality, and efficiency. There is also the use of open communication among different stakeholders.

Open communication ensures the prioritization of the stakeholder needs, views, and concerns. Open communication has strengthened openness and trust among the organizational employees, hence, enhanced teamwork in the provision of patient care. The organization also recognizes the vital role that rewarding performance plays in contributing to employee productivity. As a result, it undertakes biannual performance appraisals and uses them to reward employees and motivate them to explore additional ways of achieving the desired outcomes. These aspects of the organizational culture make it ready to embrace change.

DESCRIPTION OF THE CURRENT PROBLEM

The selected nursing problem in my organization is nursing shortage. The hospital currently experiences an acute shortage of nurses, which has affected the provision of patient care services to the patients. Several circumstances surround the issue of nurses shortage in the hospital. One of them is high rate of nurses’ turnover. The rate of nurses leaving their jobs intentionally has risen significantly over the past years. The rise is attributed to organizational issues such as high workload because of the few nurses, burnout, and occupational stressors associated with the challenge of balancing professional and family life demands. The other factor is unhealthy workplaces.

This can be seen from violence targeted at nurses by other nurses and other healthcare providers. Most nurses report experiencing either physical or verbal violence from others, which affect their psychological and physical health, hence, their intention to leave their jobs. The other factor is the low number of nursing students being trained among the American universities. This is attributed to the shortage of faculty staff to train a high number of nurses to address the current shortage. Lastly, more than one million nurses will be retiring in the next decade. This implies that the problem of nursing shortage will persist if no intervention is embraced (Yahya Muabbar & Zayyan Alsharqi, 2020). The affected stakeholders by the problem include nurses and patients. Nurses suffer from high workload while patients are affected by low quality nursing care being given to them. The risks of implementing change include resistance to change from the adopters, inadequate support from health organizations, and disruption of the existing systems and processes by change.

It is unfortunate when parents do not understand their child’s diagnosis. It makes me very sad especially in the world of Mental Health. The situation you describe is something I experience often at the pediatric hospital in which I work. I have found parents often struggle to understand what their child is going through and I often wonder if their personal grief hinders their ability to process the situation fully.  Ultimately, the nurse in the situation you described should make advocating for the patient the first priority. Taking the time to continue to educate parents and help them understand is all we can do.

Dr. Haine-Schlagel and Dr. Walsh (2015) reviewed 23 studies and determined that parental involvement showed a significant clinical outcome improvement in mental health care for Children and Families. I don’t think anyone is surprised to hear that. We all need our family support whether we are dealing with physical health problems or a mental health problem. I think this situation is made even more difficult the fact that the patient was potentially not completely mentally present due to their illness thus making it nearly impossible for them to participate in their plan of care.

Obviously, the situation has passed but I wanted to do a little bit of research and see if I could find a resource for parents that are struggling to understand PTSD in children. Found an article by Dr. Tull that has some excellent information.  I think sometimes, especially in a moment of crisis, parents cannot comprehend the information being shared with them. A handout or printed information sheet that they can take home and review when the crisis has passed might be a helpful resource for the future.  My hope is to be a provider that engages families and encourages them to be involved in the treatment plan and care of their child because I believe it is vital for positive outcomes. 

HEALTHCARE ORGANIZATION

Description:

•HealthPros, my healthcare organization stands as a renowned healthcare institution, widely recognized for its commitment to delivering exceptional patient care. With a steadfast dedication to excellence, the organization operates as a beacon of quality healthcare services in the community it serves. Its reputation is built on a foundation of medical expertise, advanced technologies, and compassionate patient-centered care.

Organizational Culture and Readiness:

•HealthPros fosters a culture deeply rooted in evidence-based practices and continuous improvement. The institution prioritizes the integration of the latest research findings and best practices into its healthcare delivery model. This commitment to evidence-based approaches reflects the organization’s dedication to providing the highest standard of care to its patients.

Main Post

In today’s healthcare environment, it is crucial to involve patients in their care and treatment decisions. However, involving patients in decision making can present challenges, as the illness and treatment can become complex. According to Hoffman (2014), shared decision making is a crucial aspect of providing patient-centered care. This means that healthcare providers need to work with patients to make informed decisions that are aligned with their preferences and values. Additionally, decision aids can be valuable tools to help patients make informed decisions, especially when it comes to complex treatment decisions.

For the sake of this discussion, I will call my patient John. John was diagnosed with a heart condition that required surgery. The surgeon proposed an invasive procedure that had potential complications, including a longer recovery time. However, John was reluctant to undergo surgery and expressed his preference for a less invasive treatment option. The surgeon did not fully consider John’s preference and instead recommended the invasive procedure. John ultimately agreed to the procedure but was unhappy with the outcome and the extended recovery period.

Impact of incorporating or not incorporating patient preferences, social determinants of health, and values:

The lack of incorporation of John’s preferences impacted the outcome of his treatment plan negatively. It caused John to be unhappy with the extended recovery period and affected his satisfaction with the treatment plan. If John’s preference was considered, he might have opted for a less invasive procedure that would have reduced his recovery time and helped him return to his daily activities faster.

Social determinants of health, such as economic stability, access to healthcare, and neighborhood, were not considered during the treatment plan. These factors could have influenced John’s decision, and the surgeon could have recommended a less invasive procedure that would have cost less and required less recovery time (Academic Guides: Social Determinants of Health, 2023).

Value of the patient decision aid selected and how it might contribute to effective decision making:

By utilizing a decision aid, healthcare providers can support patients in making informed decisions that are aligned with their preferences and values. According to Melnyk and Fineout-Overholt (2018), this approach can help promote patient satisfaction, reduce healthcare costs, and improve health outcomes.  

The patient decision aid selected is the “Coronary artery disease (CAD): Should I have angioplasty or bypass surgery?” This decision aid provides clear and unbiased information about the advantages and disadvantages of both procedures, including the risks and benefits. It enables patients to make an informed decision about their treatment options, based on their preferences, values, and social determinants of health. It can contribute to effective decision making by involving patients in the decision-making process, reducing the potential for miscommunication, and improving satisfaction with the treatment plan.

How this decision aid inventory might be used in professional practice or personal life:

As a nurse I would use this decision aid inventory in my practice to educate patients and involve them in the decision-making process, ultimately leading to better outcomes. Healthcare professionals can use the decision aid to provide unbiased information to patients and involve them in treatment decisions, reducing the potential for miscommunication and improving satisfaction with the treatment plan. In personal life, this decision aid inventory can be used by individuals to educate themselves about health conditions and treatment options, empowering them to make informed decisions about their health.

References

Academic guides: Social determinants of health: Social determinants of health. Social Determinants of Health – Social Determinants of Health – Academic Guides at Walden University. (n.d.). Retrieved May 7, 2023, from https://academicguides.waldenu.edu/Library/sdoh

Links to an external site.

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision makingLinks to an external site.. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statementLinks to an external site.. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Links to an external site.

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