NRS 493 What is the main issue for your organization in addressing a solution to evidence-based nursing practice?
NRS 493 What is the main issue for your organization in addressing a solution to evidence-based nursing practice?
NRS 493 What is the main issue for your organization in addressing a solution to evidence-based nursing practice?
The main issue for my organization in addressing a solution to evidence-based nursing practice is the lack of nurses within the hospital to carry out evidence-based practice because qualitative care is lost because there isn’t enough nurses to carry out this task. Evidence based practice is extremely open and supportive of change which is important because of the constantly revolving nature of healthcare and disease. It can be defined as the application of research and new knowledge into daily patient care (Wilson & Austria, 2021). This is also the acceptance of abandoning old models and practices to better fit the general population and patients of diverse backgrounds who don’t fit into the mold of the “average patient.” Evidence based practice is the collaboration of researched evidenced, clinical experience, and preferences of the patients in order to provide treatment so that patient outcomes would improve patient outcomes (“Why is evidence-based practice in nursing so important?,” 2018). Evidence based practice is incorporated everyday into the nursing field in a process similar to the scientific method. This starts with the nurses formulating a question to find a solution to a problem, gathering data and evidence about the patient’s condition, medical and family history, analyzing the evidence to find a correlation or link to different disease and identify a pattern, then applying the information found into practice. Evidence based practice aids nurses in making decisions about their patients’ healthcare and treatment not just based on their own opinion but backed by research and the opinion of the patient. This also allows for nurses to be able to evaluate the risks and benefits of certain preventive methods, treatments, and preventive plans which all contribute to the overall decrease in demand for healthcare resources because patients will be diagnosed and treated correctly without delegating excessive personnel and resources trying to treat the wrong condition which lengthens a patients stay in the hospital, decreases patient outcomes, and decreases the effectiveness and quality of healthcare given by an organization. The first step in resolving this issue is acknowledging that there is an issue affecting evidence based practice within the organization. I believe the next step is asking the staff and personnel including doctors, technicians, nurses etc about what issues each unit faces and cross checking to see which of the issues are most commonly being brought up so that those issues can be solved first. Then it is necessary that the management team of the organization to formulate and brainstorm the correct and most reasonable approach to solving the issue whether that be in the form of having a job fair to increase the amount of nurses or decrease the budget and admission of patients so that the organization only does and takes what they already have resources for.
Wilson, B., & Austria, M.-J. (2021). What is evidence-based practice? What is Evidence-Based Practice? Retrieved April 24, 2022, from https://accelerate.uofuhealth.utah.edu/improvement/what-is-evidence-based-practice
Why is evidence-based practice in nursing so important? Eastern Illinois University. (2018, April 21). Retrieved April 21, 2022, from https://learnonline.eiu.edu/programs/rn-to-bsn/evidence-based-practice-important/
Evidence-based practice (EBP) is the act of making decisions about patient care that draws on an understanding of the best currently available evidence on the topic. EBP includes the integration of the best available evidence, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making.
The EBP encompasses more than just applying the best available evidence, many of the concerns and barriers to using evidence-based practice revolve around finding and applying research. In addition, the health personnel’s scope of practice, level of education, knowledge, previous experience with a patient, and competence are very pertinent to help carry out the evidence-based practice. Using clinical decision-making and judgment is very important. The patient cannot be left out when it comes to evidence-based practice. Considering the patient’s spiritual, cultural, and psychosocial needs to provide best practice services (American Physical Therapy Association, 2020).
The main issue for my organization in addressing a solution to evidence-based nursing practice is nurses’ reluctance to change (Mahmoud & Abdelrasol, 2019). In the hospital where I worked, the hospital developed new policies of care based on the new findings by researchers in the healthcare delivery system. I have the privilege to precept new hires on my unit and always I notice differences in how these new hires are trained by other nurses, not going by the EBP protocol provided by the hospital. This can be solved by nurse managers and nurse educators continuously educating nurses on the new EBP protocols and evaluating their effectiveness. In addition, nurses can be each other’s keepers by correcting each other respectfully when patient care is not provided based on the hospital protocol.
References
American Physical Therapy Association (March 23, 2020) Components of Evidence-Based Practice
Mahmoud, M. & Abdelrasol, Z.(2019).Obstacles in employing evidence-based practice by nurses in their clinical settings: a descriptive study. Frontiers of Nursing,6(2) 123-133. https://doi.org/10.2478/FON-2019-0019
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At the rehabilitation hospital one main obstacle to EBP implementation is lack of nurse knowledge regarding EBP. The American Association of Colleges of Nursing (AACN) believes that education has a significant impact on the knowledge and competencies of the nurse clinician. In addition, clinicians with Bachelor of Science in Nursing (BSN) degrees are prized for their skills in critical thinking, leadership, and health promotion and are well-prepared to implement EBP into nursing (AACN, n.d.). At the organization, there are 24 full-time dayshift registered nurses and of these, 4 are BSN educated. This represents approximately 16% of the dayshift nurses with the critical thinking skills and knowledge to incorporate EBP approaches. Nurses educated at the baccalaureate level and higher have been confirmed to have greater EBP competency (Larochelle & Beaudet, 2017).
The first step in addressing and resolving this issue is to gain support from administration and management to cultivate an environment that embraces and promotes continuing education and offer incentives for registered nurses (RNs) seeking to advance their education to the baccalaureate and higher degree levels (AACN, n.d.).
References
American Association of Colleges of Nursing (AACN). (N.d.). AACN Fact Sheet – Impact of Education on Nursing Practice. https://www.aacnnursing.org/news-information/fact-sheets/impact-of-education
Larochelle, N., & Beaudet, L. (2017). [Developing the role of head nurses in promoting evidence-based practices among hospital staff nurses: an integrative literature review]. Rech. Soins Infirm., 28944631. https://pubmed.ncbi.nlm.nih.gov/28944631
The American Academy of Family Physicians defines primary care as “the provision of integrated, accessible health care services by physicians and their health care teams who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. The care is person-centered, team-based, community-aligned, and designed to achieve better health, better care, and lower costs.” (Primary Care, 2019, para 2). As of January 3, 2022, the organization under review was opened. As a new clinical practice, the primary focus is on policy, processes, and interoffice communications. After discussing evidence-based nursing practice with the preceptor, two barriers to implementing evidence-based nursing practice were identified, lack of human resources (shortage of nurses) and financial backing and time. Statistics show nursing shortages and lack of time account for 78.3% and 83.7% of inability to implement evidence-based-practice respectively (Khammarnia et al., 2015). To address the issue of nursing shortages, the shiftwizard offers five solutions:
- Use an onboarding program
- Incentivize behaviors of evidence-based practice
- Invest in long-term training and development
- Convert current nurses into recruiters and compensate for referrals
- Offer altered schedules to accommodate personal and professional time (5 Creative Solutions, 2021).
To best help manage time to allow for the implementation of evidence-based practice, it is advised for nurses to develop organizational skills to help improve nurse-patient relations and patient care creating greater opportunities for nurses to research evidence-based practice (Mathieson et al., 2019).
References:
5 Creative Solutions for the Nursing Shortage. ShiftWizard. (2021). Retrieved April 29, 2022, from https://www.shiftwizard.com/solutions-nursing-shortage/
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in zahedan teaching hospitals, iran, 2014. Nursing research and practice, 2015, 357140. https://doi.org/10.1155/2015/357140
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20, e6. https://doi.org/10.1017/S1463423618000488
Primary Care. American Academy of Family Physicians. (2019). Retrieved April 29, 2022, from https://www.aafp.org/about/policies/all/primary-care.html#:~:text=A%20primary%20care%20physician%20is,providing%20the%20patient’s%20comprehensive%20care.
The site of a seemingly small setting for patient care in our Valley saw the need of testing persons for a new illness. Mid-March of 2020, patients were seen, yet tests were not yet available per Dr. Brian Tyson. Our Valley is approximately 190,000 bordering Mexicali, Mexico with 1.5 million persons. A huge issue addressed was limited space juxtaposed with enormous need of testing and patient care. The main issue faced head on and addressed was fear as clinic staff that first March could “see the virus all around us”, per Tyson, “we were scared, my wife was scared”. Continuing, he shared of newborns and children of his young staff, their own children and teen with Down’s syndrome… “we had no idea how our lives were about to change” (2020). The clinic staff went into action as they faced their fears with the first step via setting up a pop-up tent, tables, chairs and started assessing, registering persons in their cars, yet unable verify if they had the Novel Corona Virus, flu or respiratory infections so common in March (The Desert Review, 2020). Tenacity and perseverance of Tyson in seeking answers to assess for Covid-19 when initially no access to testing; however, they were able to identify the “COVID-19 pattern on a chest x-ray and using the IgM, IgG approach…we started treatment on patients” stated Tyson (2020). Per prior research of southern France’s, Dr. Didier Raoult’s study in the 2005 Journal of Virology showed “Chloroquine was a potent inhibitor of SARS Coronavirus infection and spread” and Tyson began treatment on patients of “hydrochloroquine 400 mg PO BID on the first day and then 200 mg three times/day for days two through five” (Tyson, 2020). He/his team did not prescribe and say good-bye, rather, would re-evaluate them 2 or 3 days later and see them back at 7 and 14 days to assure they were better.
University of St. Augustine (USA) informs optimal patient care decisions are (are-able-to-be) provided when the principles of evidence-base practice (EBP) are put into action (2020). USA continues that EBP is a venue utilized across healthcare professions with the most current, highest quality research to alert them of what is optimal in healthcare provision and though no defining degree for what embodies nursing EBP, the approach involves three main components (2020). The three fundamental elements of EBP per FGCU Library (2020) and Physiopedia (nd) include:
1.) “Best external evidence: Evaluate and implement the most current, clinically relevant, and scientifically sound research.” ~~~~Covid-19 was new, yet the site team evaluated the need, made decisions to meet the needs of persons seeking help and medical care.
2.) Individual clinical expertise: Draw on your personal experience of what has worked and not worked in your clinical practice. ~~~~ The team drew upon prior expertise, thinking out of the box to provide patient care the vast numbers seeking assessment and medical care.
3.) Patient values and expectations: Patients value(d) their lives and the lives of their families, co-workers and neighbors and went in droves to the clinic seeking and expecting medical help. They continue to seek and receive medical help and interventions.
Resources
FGCU Library. (2020). Evidence based practice (NUR 4169): What is EBP?. https://fgcu.libguides.com/EBP
Physiopedia. (nd). “Evidence based practice (EBP)”: https://www.physio-pedia.com/Evidence_Based_Practice_(EBP
Tyson, B. (2021). The miracle of the Imperial Valley: Dr. Tyson’s first-person account of COVID-19. The Desert Review. https://www.thedesertreview.com/news/the-miracle-of-the-imperial-valley-dr-tyson-s-first-person-account-of-covid-19/article_a8707136-196b-11eb-bc7b-87d7730460bb.html
University of St. Augustine (USA). (2020). The role of evidence-based practice in nursing. https://www.usa.edu/blog/evidence-based-practice/
When addressing a solution of evidence-based nursing practice, the main issue faced by my organization s implementation, and this is largely due to resistance to change. it goes without saying that change is an uncomfortable phenomenon and as a result, it becomes quite difficult implement change as many people would view it as a threat (Nilsen et al., 2020). For example, when integrating a new Electronic Medical Record, the administration noted some sluggishness implementation, with some nurses taking much longer than usual to adapt to the changes. Behind the scenes, there were conversations about the new EMRs being more effective than the old EMRs and this undoubtedly influenced more personnel to reject or resist the changes, even though the new EMR has been extensively researched and was established as the most efficient.
In order to implement a solution to change, it is first of all vital to understand the triggers to resistance to change. The major trigger to resistance to change is when the nurses feel sidelined in a process that is very much their own, or one that extensively involves nurses. When facility administrators attempt to make decisions on behalf of nurses, and refuse to integrate the opinions of nurses in decisions that will greatly affect nurses, there will most definitely be a general negative opinion about the change, Furthermore, when the nurses are not involved in the decision, they are likely to be knowledgeable about the benefits and functionalities of the EBP (Alatawi et al., 2020). This will also adversely affect how well they can respond to the changes brought about by the system and adopt the changes.
When addressing this issue, the first step, undoubtedly, is to first understand where and how the nurses can be involved in the decision making. This is because the major threat to change is the lack of involvement of the nurses in decision making and thus, the main solution would be to understand where one can involve nurses in the decision making functions. This will involve understanding administrative processes such as procurement and budgeting, and shortlisting processes such as the evaluation of the new changes and systems. The nurses will be immensely beneficial in the process where the new evidence-based practice is assessed. This is because they have competencies and experience and the fact that they are the ones that will be implementing the new evidence-based practice means that they will be the most affected by the shortcomings of the systems, and they all understand the strengths of the systems and what they need to look out for (DuBose et al., 2020). Most importantly, they are best placed to understand what resources are needed to implement EBP and thus, they will most likely select an EBP whose capabilities to implement the facility.
In essence, resistance to change is one of the major issues faced by facilities in implementing change and thus, the best solution that the organizations can implement is eradicating the resistance by involving the nurses in implementation practices. This will play a vital role in not only ensuring that the nurses are aware of the practice, but also its strengths and weaknesses, and thus, this is more likely to improve buy-in to the process.
References
Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35-42. https://www.researchgate.net/profile/Sara-Aljanabi-2/publication/342896986_Barriers_of_Implementing_Evidence-Based_Practice_in_Nursing_Profession_A_Literature_Review/links/5f969f63299bf1b53e45ede6/Barriers-of-Implementing-Evidence-Based-Practice-in-Nursing-Profession-A-Literature-Review.pdf?_sg%5B0%5D=started_experiment_milestone&origin=journalDetail
DuBose, B. M., & Mayo, A. M. (2020, November). Resistance to change: A concept analysis. In Nursing Forum (Vol. 55, No. 4, pp. 631-636). https://onlinelibrary.wiley.com/doi/abs/10.1111/nuf.12479
Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC health services research, 20(1), 1-8. https://doi.org/10.1186/s12913-020-4999-8