NRS 493 Why is understanding the health care system at the local level important to consider when planning an EBP implementation?
NRS 493 Why is understanding the health care system at the local level important to consider when planning an EBP implementation?
Several factors are critical to the implementation of EBP. 3 critical components to implementation is the strategy or “intervention” being used, barriers and facilitators (factors that influence the implementation of evidence in clinical practice) and the desired outcomes of the implementation (Correa, Lugo-Aguirre-Acevedo, Contreras, et. Al, 2020). To decide these factors a needs assessment should be conducted for the facility, as well as the community or population being served. Proper understanding of healthcare systems at a local level is vital when planning an EBP implementation because it requires various resources from the local level, including skilled human resources essential to providing leadership and the necessary competence. The importance of an in-depth understanding of the available human capital at the local level. These include the presence of adequate medical personnel such as nurses, physicians and other professionals necessary for successful implementation of EBP at the local level. Secondly, the organizational structure of the healthcare system at the local level plays a critical role in promoting the implementation of EBP successfully. Organizational factors include providing continuous education on EBP not only one time and providing opportunity for staff to improve their skills. Organizational support is essential in EBP implementation (Sindi, Hamouda & Bankhar, 2017).
Correa, V. C., Lugo-Agudelo, L. H., Aguirre-Acevedo, D. C., Contreras, J., Borrero, A., Patiño-Lugo, D. F., & Valencia, D. (2020). Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview. Health research policy and systems, 18(1), 74. https://doi.org/10.1186/s12961-020-00588-8
Sindi, N. A., Hamouda, G. M., & Bankhar, M. (2017). Factors Affecting Implementation of Evidence Based Practice as Perceived by Nurses’. IOSR Journal of Nursing and Health Science, 06(04), 53–57. doi: 10.9790/1959-0604025357
It is essential to take into account the requirements and preparedness of the population in addition to the resources that are at one’s disposal. Any implementation will typically need overcoming obstacles in some fashion. When planning the implementation of an evidence-based practice (EBP), it is critical to have a solid understanding of the local health care system at the level at which it operates. This is because the implementation must cater to the requirements of the population being served. There is a wide variety of available frameworks for incorporating EBP into healthcare systems; however, not all frameworks will be applicable to every healthcare system. In order for the implementation process to be successful and sustainable, it requires the active participation of stakeholders such as consumers, clinicians, healthcare administrators, leaders, and policymakers (Kilbourne, et al., 2019).
Kilbourne, A. M., Goodrich, D. E., Miake-Lye, I., Braganza, M. Z., & Bowersox, N. W. (2019). Quality Enhancement Research Initiative Implementation Roadmap: Toward Sustainability of Evidence-based Practices in a Learning Health System. Medical care, 57 Suppl 10 Suppl 3(10 Suppl 3), S286–S293. https://doi.org/10.1097/MLR.0000000000001144
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In your post, you highlight the role of organizational structure when it comes to determining the trajectory of EBP implementation. I do agree with this because organizational structure determines a range of issues such as the type of red tape that nurses have to overcome in order to implement evidence based practice. For instance, for organizations that have a hierarchical system, it goes without saying that approvals for things like expenditures going towards EBP implementation would have to be considered (Rangachari, 2020). Therefore, the EBP implementation team will have to submit requests for approval in order to get their expenses or resource needs approved. Now, understanding the healthcare system at the local level would help us understand what resources are needed and what should be available. For instance, when implementing EBP that needs certain equipment, and that equipment is being used to cater to a population with more need for I and thus would not be available would enable nurses to better understand how to approach the situation and possible alternatives that the nurse can put in place in order to implement their EBP. This means that in order to effectively implement EBP, it is vital for nurses to understand local needs, vis-à-vis organizational resources as this would enable the better plan for EBP implementation. Moreover, understanding whether there are resource deficits would also empower the nurses to develop alternative and creative solutions that would facilitate EBP implementation.
Rangachari P. (2020). Understanding Evidence-Based Practice (EBP) Implementation in HCOs Through the Lens of Organizational Theory. Journal of healthcare leadership, 12, 35–48. https://doi.org/10.2147/JHL.S258472
Long-term care encompasses a wide range of services to meet an individual’s care demands throughout a long period. In addition, when people can no longer undertake normal tasks, these facilities help them live as freely and safely as possible. Therefore, for various reasons, a thorough grasp of the local healthcare system is essential when developing an EBP deployment considering this project. EBP development necessitates a variety of local inputs. Intellectual resources and decent money are two of these assets. In addition, smart, professional resources are needed to provide supervision and the requisite expertise during the successful implementation of the strategy. As a result, having a thorough awareness of the available human capital at the local level is critical in developing an EBP, which will help address nursing shortages in the lengthy-term care facilities (Schmidt et al., 2019). These include having enough health workers, such as nurses, doctors, and other specialists, executing EBP successfully at the local level. Again, the structure of an organization of the healthcare system at the local level is crucial in encouraging successful EBP adoption.
Moreover, EBP adoption may be influenced by local characteristics that nurses should know before implementing the project. Acknowledging local characteristics is crucial since they define the society’s distinctive requirements and the facility. In addition, recognizing people’s local concerns aids professionals in determining where proof is required to modify the approach. For instance, nursing shortages in long-term care facilities may be associated with several factors; among them is a reduced enrollment of nursing students in training institutions, and other challenges may have also accompanied this. Therefore, before implementing an EBP, it is important to recognize the health care system at the local level since this is the backbone of this project as it addresses several concerns (Zhao 2022 et al., 2022).
In conclusion, Evidence-based practice can be successfully implemented locally through transformative leadership, cooperation, and shared vision with the hospital and community partners. Because the change in practice will need to be executed by a supportive staff, the local hospital’s culture must be examined. To overcome nursing shortages in long-term care facilities, revolutionary leadership is critical. The work context in which the evidence-based practice suggestion will be implemented must be considered ahead of time.
Schmidt, M., Schmidt, S. A. J., Adelborg, K., Sundbøll, J., Laugesen, K., Ehrenstein, V., & Sørensen, H. T. (2019). The Danish health care system and epidemiological research: from health care contacts to database records. Clinical epidemiology, 11, 563.
Zhao, J., Bai, W., Zhang, Q., Su, Y., Wang, J., Du, X., … & Hu, J. (2022). Evidence-based practice implementation in healthcare in China: a living scoping review. The Lancet Regional Health-Western Pacific, 20, 100355.
You mentioned that reduced enrollment of nursing students may be the cause of the nursing shortage. What I’ve found is that it is not reduced enrollment, but rather a lack of faculty staff to teach at nursing institutions. The article by Reese and Ketner states that “hiring and retaining qualified nursing faculty remains a significant challenge; the current faculty shortage only intensifies the situation” (Reese & Ketner, 2017). Getting your masters in nurse education is a prerequisite for becoming a nurse educator. I would love to get my master’s and become a nurse educator, but I do not have $30,000 to do so since I have two children at home, and saving for their education is a priority. I chose to get an ADN because of the cost and speed of entering the workforce as a single mother. I had some difficulty at first finding a position at an acute care hospital and eventually had to travel to a suburb to start my career at a trauma level 3 hospital. I have since transferred to a trauma level 1 hospital closer to home but still in a suburb. My eventual plan after graduating with my BSN is to transfer again to the trauma level 1 acute care hospital that is 7 minutes from my house, in Dallas, TX. I am also planning to get my OCN and chemotherapy certification because I want to remain in oncology and also grow my career.
Your patient population is at a long-term care facility. The article by Petges and Sabio points out that “BSN programs do not have the capacity to accommodate all qualified applicants for admission, leaders in both ADN and BSN education have begun to work collaboratively to create a seamless academic progression through clinical partnerships and dual-enrollment agreement” (Petges & Sabio, 2020). When I was hired in 2018, I was told that I had two years to complete my BSN. Thankfully, since I have been working towards that goal but fell short of the timeframe, no one is pressuring me in terms of job security.
Again, the nursing shortage is a multi-layered issue. Those nurses who do get a master’s in nursing get paid more in leadership positions than being a nurse educator so the incentive to teach is low. However, recruiting and retaining nurse educators is key to training the next generation of nurses to help alleviate the nursing shortage. EBP is successful when safe nurse staffing is the norm and nurses have the education to implement the practice.
Petges, N., & Sabio, C. (2020). Understanding the Enrollment Decisions of Associate Degree Nursing Students: A Qualitative Study. Teaching and Learning in Nursing, 15(1), 25–31. https://doi.org/10.1016/j.teln.2019.08.006
Reese, C. N., & Ketner, M. B. (2017). The Nurse Educator Institute. Nurse Educator, 42(5), 224–225. https://doi.org/10.1097/nne.0000000000000380
We have a massive problem with nurses leaving the bedside; RNs & CNAs have struggled with workplace stress and mental health concerns. Skilled nursing facility staff reported a hire burnout rate in 2019, and in recent years, long hours have only worsened the issue. Create a safe workplace for your nurses and nursing assistants. Start by making a dedicated wellness space so team members can comfortably relax, eat, and nap between shifts. Consider offering healthy meals, fitness programs, or childcare assistance to support your team in and outside of work. Establish a habit of giving employees monthly or quarterly “mental health days” to help relieve workplace stress. Ensure that shift schedules are flexible so staff can unwind during their time off. Consider adding resources like on-site or virtual counseling, mental health self-screening, and wellness workshops. It’s imperative, therefore, for your HR team to employ recruiting strategies that promote employee retention and job satisfaction.
Nurse educators have a vital role in mentoring student nurses to develop evidence-based practice (EBP) skills, access research products, and participate in research projects. Requires more innovative teaching approaches that promote active participation, creativity, and critical thinking in students, such as online teaching and learning, accessing electronic resources, video conferencing, and research-based teaching and learning. The nursing shortage is further complicated by the many nurses retiring from the workforce. According to the BLS projects, nearly 176,000 new healthcare jobs will open each year as Baby Boomer nurses retire. A total of one million nurses are expected to leave the workforce by 2030. The rising demand for nurses will significantly strain the current workforce.
Mthiyane, G. N., & Habedi, D. S. (2018). The experiences of nurse educators in implementing evidence-based practice in teaching and learning. Health SA = SA Gesondheid, 23, 1177. https://doi.org/10.4102/hsag.v23i0.1177
Evidence-based practice is considered the gold standard of quality care. The availability of new evidence is being produced at an increased rate. “It is estimated that nearly one million new articles are posted on PubMed annually” (Duff et al., 2020, p. 1). Patients, regulatory agencies, and healthcare funders are aware of this fact which has raised the expectation on healthcare professionals and the healthcare system to provide high quality patient care. Unfortunately, despite overwhelming evidence which proves the benefits of evidence-based practice, patients continue to receive ineffective care which has the potential to be harmful. Two studies conducted in the United States and Australia, found that four out of every ten people do not receive evidence-based care (Duff et al., 2020). With the understanding that healthcare providers already face many challenges in providing care, funding, appraisal, and integration of new evidence in their routine care practices can be difficult. For this reason, proper understanding of the local health care system is crucial to the successful implementation of evidence-based care (Duff et al., 2020).
When evaluating the local health system, the assessment should include reviewing environmental processes, support, facilities, and context. By having a thorough understanding of the local health system, health care professionals can recognize the need for specific evidence-based care as well as identify available community resources or lack thereof to support its initiative. Evidence-based practice readiness includes both personal and organizational readiness (Schaefer & Welton, 2020). It is imperative the individual understand the reasoning behind the need for evidence-based care as the best quality of care available to meet the needs of a growing medically complex population. As leaders in health care, nurses have a position to be able to address all areas of evidence-based practice readiness: nursing, training, equipping, and leadership (Schaefer & Welton, 2020).
In terms of anecdotal research, the preceptor emphasized the importance of having a supportive practice environment to influence consistent delivery of evidence-based care. The preceptor mentioned is currently the sole practice provider at an adult proactive health clinic which also services in the capacity of primary care. She provided details on how she wanted to introduce proactive health care as a measure to address the growing number of chronic disease conditions which plague southern rural communities. To do this she focused on obtaining education to introduce bioidentical hormone replacement therapy as well as clinical-grade Nutriceuticals to optimize patients’ hormones to serve as a building block for better health. As you can imagine a thorough local health care system review had to be conducted. Questions which rose where, “Will the community support this initiative?” “What is the need for it?.” and “How do I go about providing it to the community at large and who is a candidate.” As I prepare my capstone change proposal, a few things I will consider are the availability of community resources to support diabetes self-management education and training initiatives and the active involvement of patients and their families. The need for both is necessary for the success of its implementation.
Duff, J., Cullen, L., Hanrahan, K. et al. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementations Science Communications, 1(85), 1-9. https://doi.org/10.1186/s43058-020-00070-0
Schaefer, J. D., & Welton, J. M. (2018). Evidence-Based Practice Readiness. Journal of Nursing Management, 26(6), 621-629. https://doi.org/10.1111/jonm.12599