NR 505 Discussion Future Use of Evidence-Based Practice
NR 505 Discussion Future Use of Evidence-Based Practice
NR 505 Discussion Future Use of Evidence-Based Practice
I work in the emergency room and during my shifts I come across at least one person whose chief complain is related to chronic pain. For the most part, the primary care providers provide them with some sort of analgesic in order to manage their pain. We definitely have our regulars who come in at least once a week demanding morphine or dilaudid. PCP’s have a constant pressure to maintain high patient satisfaction scores and feel the need to negotiate the plan of care with these patients. However, many are reluctant to order or prescribe opioids or controlled substances even though because they don’t see it as appropriate to chronic pain management. Nonetheless, if these patients don’t get the drugs they seek, one knows they will be unsatisfied with their care. As mentioned by Henson and Jeffrey (2016), pilot studies can provide a better insight of the developing research, they assess sample size, data collection and clarify many questions before the implementation process. Pilot studies tend to foretell what one must expect from the actual study, therefore providing one with the opportunity to alter and adjust one’s methods. Implementing a pilot study in the ER will be challenging for me. For the most part the ER consist of pharmacological intervention and in this fast phase setting it would be difficult to implement nonpharmacological interventions. Currently, in my ER we divide our patients in two sections. One section is for our acute patients whom need to be seen by a PCP as soon as possible or whom will require numerous resources such as blood draw, xray, radiology, etc. The other section is our “fast track”, this portion of the ER sees nonemergent cases or those whom will require one to two resources such as those whom need small sutures or medication refill. Many time, some of the patients whom are complaining of chronic pain will go to the fast track section, medication will be provided, and they will be discharged. Given this setting is less acute and patients are more stable, I believe I could integrate nonpharmacological teaching and interventions. Nonetheless, in order to intergrade a pilot study, one must take many things into consideration.
Deisi Henson, A., & Jeffrey, C. (2016). Turning a clinical question into nursing research: the benefits of a pilot study. Renal Society of Australasia Journal, 12(3),99-105.
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Thank you for the great post as always. I have enjoyed reading your posts this class as you always provide great insight on the discussions. I also work in the emergency setting and see many of the same issues as you. We have a similar set up in our ER including a fast track area. It works well moving non-acute patients quickly. I like your idea regarding implementing non-pharmacological interventions for patients with chronic pain. Last week, there were discussion posts explaining the value of physical therapy for those with chronic pain. This is one of my favorite interventions to discuss with patients with chronic pain as it has the capacity to alleviate pain as well as provide overall health benefits. The pressure on providers to prescribe narcotic pain medications is a huge issue and very unfortunate. I can see why many feel pressured to give out medications for fear of being negatively criticized. We have had many discussions in our ER regarding this issue and found that through working together as a group and being consistent, our level of pain medication disbursement has gone down significantly. It began with our medical director speaking to all physicians on our new goal and continued with nursing managers and staff providing constant education to the public that things were changing and why they were changing. Overtime, we saw many patients who frequented our ER seeking pain medications for chronic issues had less visits thus lowering our overall disbursements of narcotics. Thank you again and good luck in your studies!
. In this current state of healthcare, it is sad to see the realization that doctors are basically being blackmailed to receive good patient satisfaction scores. This is the issue with pay for performance in my opinion. Because every area in the US is not like another. In one ER they may have more resources or patient population, which if they receive a couple of negative scores, it does not hurt their reimbursement. Now, look to the converse of this situation. You work in a rural community ER and people are coming in for chronic pain or drug seeking behavior, you refuse their request for meds, then your facility receives a bad review. So, your performance is lower; therefore, you do no receive reimbursement as readily. I do believe there are people out there with chronic pain, but resources for the ER should not be used for refilling chronic pain or pain seeking behaviors. Sadly, drug seekers are very manipulative and realize what they are doing and the impact they play. Chronic pain patients are different, but as well, they know when their prescriptions are due to be filled. coming to the ER for a refill is in my humble opinion ridiculous. This would totally make me as a PCP or nurse have huge issues with this practice.
Like James has noted, I too have enjoyed reading your posts and perspective throughout our course. Your topic, like many others in our current healthcare environment, is so multifaceted and complex. Patients seeking pain management options in the ED is the result, in my opinion, of an overall fail of their health management. I continuously hear our senior leaders talk about primary care and primary prevention; as well as care across the continuum. As I read your post, I stop and think about how the many opportunities we have at every point of care a patient may receive.
There are some patients that do not have chronic health care needs, do not see a primary care provider for a health condition, and are the ones seeking medications like you described above. I agree with James’s thoughts; and your response as to how difficult a pilot would be in the ED regarding the expectations around pay for performance with this patient population. It is unrealistic to achieve high patient satisfaction scores in an ED with this population when the expectation and regulations on the clinicians and providers is to NOT prescribe narcotics. The narcotics are what the patient came to the ED for; another issue that we have all identified. I feel that until there is a true collaborative effort with all points of care patients may touch across their healthcare journey; and a solid plan to connect these patients with the additional care they may need post ED visit to address their pain, and in most cases their drug dependency, we will continue to see these opportunities and struggle to meet the goals that are set for us (pay for performance, customer satisfaction, and throughput to name a few).
Like James has noted, I too have enjoyed reading your posts and perspective throughout our course. Your topic, like many others in our current healthcare environment, is so multifaceted and complex. Patients seeking pain management options in the ED is the result, in my opinion, of an overall fail of their health management. I continuously hear our senior leaders talk about primary care and primary prevention; as well as care across the continuum. As I read your post, I stop and think about how the many opportunities we have at every point of care a patient may receive.
There are some patients that do not have chronic health care needs, do not see a primary care provider for a health condition, and are the ones seeking medications like you described above. I agree with James’s thoughts; and your response as to how difficult a pilot would be in the ED regarding the expectations around pay for performance with this patient population. It is unrealistic to achieve high patient satisfaction scores in an ED with this population when the expectation and regulations on the clinicians and providers is to NOT prescribe narcotics. The narcotics are what the patient came to the ED for; another issue that we have all identified. I feel that until there is a true collaborative effort with all points of care patients may touch across their healthcare journey; and a solid plan to connect these patients with the additional care they may need post ED visit to address their pain, and in most cases their drug dependency, we will continue to see these opportunities and struggle to meet the goals that are set for us (pay for performance, customer satisfaction, and throughput to name a few).
Like James has noted, I too have enjoyed reading your posts and perspective throughout our course. Your topic, like many others in our current healthcare environment, is so multifaceted and complex. Patients seeking pain management options in the ED is the result, in my opinion, of an overall fail of their health management. I continuously hear our senior leaders talk about primary care and primary prevention; as well as care across the continuum. As I read your post, I stop and think about how the many opportunities we have at every point of care a patient may receive.
There are some patients that do not have chronic health care needs, do not see a primary care provider for a health condition, and are the ones seeking medications like you described above. I agree with James’s thoughts; and your response as to how difficult a pilot would be in the ED regarding the expectations around pay for performance with this patient population. It is unrealistic to achieve high patient satisfaction scores in an ED with this population when the expectation and regulations on the clinicians and providers is to NOT prescribe narcotics. The narcotics are what the patient came to the ED for; another issue that we have all identified. I feel that until there is a true collaborative effort with all points of care patients may touch across their healthcare journey; and a solid plan to connect these patients with the additional care they may need post ED visit to address their pain, and in most cases their drug dependency, we will continue to see these opportunities and struggle to meet the goals that are set for us (pay for performance, customer satisfaction, and throughput to name a few).
I appreciate your post and definitely agree that fostering a culture of research and inquiry is needed in the clinical setting and provides the framework for the utilization of evidenced based practice. Krau (2014) discusses the importance of evidenced based practice as it provides a stronger foundation on which to make clinical decisions. As future nurse practitioners, we can be role models and encourage the use of research, evidenced based practice, and inquiry to improve the way healthcare is delivered. So many areas within healthcare have insufficient data or research to determine best practice and could benefit from leaders taking the initiative to better understand how a treatment method or education could be better provided or delivered. Krau (2014) encourages nurses to retain their perspective on patient care and look at research and modalities that have the best interest of the patient and instill a caring nature as the foundation behind the research. As leaders and role models we can influence the culture around us to continue to seek and discover best practice and alternative ways to improve quality care and the lives of the patients we serve.
Krau, S. D. (2014). The utilization of evidenced-based practice in nursing: some important considerations. The Nursing Clinics of North America, 49(4), xi-xii. doi:10.1016/j.cnur.2014.09.002
As a family nurse practitioner (FNP), utilizing evidenced based practice and working on continued research will be vital to the continued success of my clinical setting. As a leader, I can be a role model and advocate for ensuring the clinical practice is focusing on improved outcomes and best practice based on current data. Implementing evidenced based practice starts with changing the culture and mind set of the environment and establishing foundational guidelines that foster research and improving the lives and safety of patients and their families. Alam (2016) discusses the importance of support from management and leaders and encouraging consistent feedback from members of the team on what they are seeing in the clinical setting and areas that need to be improved. As a leader and a FNP, I will seek to encourage further research on best practice and encourage teamwork and feedback on implementing new ideas and interventions that will improve patient care.
Fostering a culture that utilizes evidenced based practice within the clinical setting and throughout an organization comes from communication and leadership. For example, after completing this course, I feel my outlook on research and evidenced based practice has deepened significantly and I find my self looking to see what current research says about clinical situations I may be faced with. I recently attended a learning session with corporate leaders presenting a slideshow presentation outlining current data and how clinical outcomes improve when best practice is utilized. I left the meeting excited and inspired to encourage my fellow team members on the utilization of new research and immediately changed certain areas of my own practice based on the presentation. Levin and Chang (2014) encourage clinicians to focus on the PICOT and search for the best evidence available and continue to foster a spirit of inquiry among co- workers.
Assisting reluctant co-works with the utilization of evidenced based practice is something I am very familiar with and have found success by getting to the root of the reluctancy to implement change. Many times, team members have fear or anxiety about implementing a new system and other times they may just enjoy being a pessimist. Helping team members understand how and why a new method needs to be implemented could help reduce anxiety and provide a better understanding to the benefits of the applied intervention. Levin (2014) encourages leaders to engage team members in the action of the research, review, and implementation of the data to encourage excitement and application of the information.
Alam, A. Y. (2016). Implementing evidenced based patient safety practices. JPMA. The Journal of The Pakistan Medical Association, 66(6), 637-638.
Levin, R. F., & Chang, A. (2014). Tactics for Teaching Evidenced-Based Practice: Determining the Level of Evidence of a Study. Worldviews on Evidence-Based Nursing,11(1), 75-78. doi:10.1111/wvn.12023
Role modeling is an essential characteristic of a leader, and evidence based practice is fundamental in nursing practice. Using systematic approaches to problem solving based on best nursing practices as well as my own nursing experience as a nurse to achieve patient-centered care would be the best example of EBP advanced degree nursing.
The way I would foster an organizational culture that promotes EBP would be by demonstrating strategic leadership.Strategic Leadership is the ability to influence others to voluntarily make decisions that enhance the prospects for an organizations long-term success while maintaining long-term financial stability. There are five keys to the process of strategic leadership. Competence is the first concept. Competence is when knowledge or skill have been mastered that demonstrate the ability to meet needs in a distinct area. The second step in strategic leadership is the development of a vision for the company. vision is the ideal of what the organization or situation should look like at a specific point in the future. Effectively communicating the vision to the appropriate internal group is the next step in the strategic process. Finally one must serve others to make the vision a reality. “When in the act of service and sacrifice for others, one builds influence. After influence is built, one earns the right to be called leader. The paradox is that by being selfless and serving others, the leader enhances self.” (Strand, 2014) Communication is the last step in the process, but it is also the glue that keeps the vision intact. communication must be effective in order to promote the idea with stakeholders.
Addressing a staff member that does not like change: “Planned change in nursing practice is necessary for a wide range of reasons, but it can be challenging to implement. Understanding and using a change theory framework can help managers or other change agents to increase the likelihood of success” (Mitchell, 2013). That is what I would implement to assist with the challenge of an employee resistant to change. A change model details and breaks down a process so that the principals may be applied by strategic leaders. There are several key elements of a model for change which include; strategic orientation, knowledge of which system level change occurs, the use of champion, mobilization of knowledge, and transformation. Many change models have been developed over time to provide structure in approach. Some examples of models for change are; The Plan-Do-Study-Act model, Lippitt’s Change Theory, and Lewin’s Change Model. It is up to the leader to select the most appropriate model based on the specific circumstances of the work environment. In utilizing any of the models for change, effective leaders approach mobilizing the change process with these ideas in mind: Be an example, have the mind of a teacher, challenge “the old way” of thinking, engage participants, build a strong team, measure outcomes, know how to take action, hold yourself accountable. Proper communication is an essential component of every phase of the change process and almost all researchers cite it as fundamental to effective application (Mitchell 2013). Once change has been initiated, leadership must ensure the change is accepted and implemented. In order to sustain the results the leader should be present for support, monitor what must be sustained, and make the change unavoidable. Choosing the change theory that best fits the situation can Simplify the process for change agents and help stakeholders to be more receptive to the change.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management,20(1), 32-37. doi:10.7748/nm2013.04.20.1.32.e1013
Strand, R. (2014, January 14). Strategic Leadership of Corporate Sustainability. Retrieved March 30, 2018, from https://doi.org/10.1007/s10551-013-2017-3