NURS 8114 EXPLORING EBP QUALITY IMPROVEMENT

Sample Answer for NURS 8114 EXPLORING EBP QUALITY IMPROVEMENT Included After Question

THE ASSIGNMENT

Part 1: Key Project Elements

Complete your paper of 6–8 pages, plus cover page and references page, explaining your investigation of three hypothetical practice sites for an EBP QI project.

Part 2: Implementation Science Presentation

Complete your PowerPoint presentation of 3–5 slides, plus cover and reference slides, to inform hypothetical stakeholders.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.). All papers submitted must use this formatting. 

A Sample Answer For the Assignment: NURS 8114 EXPLORING EBP QUALITY IMPROVEMENT

Title: NURS 8114 EXPLORING EBP QUALITY IMPROVEMENT

Exploring EBP Quality Improvement

Nursing care is central to the development and advancement of healthcare systems. Therefore, constant improvement in this field had become important as a result of the need to improve the quality of care patients receive in healthcare settings. As nurses and other healthcare professionals seek to improve practice and patient outcomes, the significance of end-of-life care has increased, with nurses focusing on identifying effective ways to provide quality care to individuals with terminal illnesses. The objective of this analysis is to investigate quality improvement strategies that can be adopted in different healthcare settings to enhance patient care. A broad range of practice problems exist and they can be addressed using evidence-based practice in various healthcare organization.

Description of Healthcare Settings

Healthcare settings vary in terms of stakeholders and nature of environment. Regardless of the characteristics defining a particular healthcare setting, these environments are appropriate sites for evidence-based quality improvement projects. One of the sites selected for implementing an EBP quality improvement project is an acute care inpatient hospital. The demand for acute care services has increased as the population continues to grow and age resulting to the need responsive services to life-threatening conditions and chronic illnesses (Hirshon et al., 2013).

Therefore, considering the demand of responsive services, an acute care inpatient hospital is a crucial environment where patients can access multiple services. The selected healthcare setting is a private facility that operates under an established healthcare corporation with a chain of hospitals in the United States. The facility operates as a general and teaching hospital recognized for its strong foundation in nursing education and healthcare research. This facility has also operated for several years, serving a significant portion of the population, indicating that it has adequate resources to support an EBP quality improvement project.

Alternatively, a long-term care facility is an appropriate setting for implementing an EPB quality improvement project. Long-term care facilities have gained the attention of the public and healthcare professionals during the COVID-19 pandemic. Findings from recent research indicate that the pandemic has impacted long-term care facilities and nursing homes and their responsive capacity (Palacios-Cena et al., 2021). Besides, the aging population and those who are chronically ill depend on these facilities as they cannot care for themselves independently.

Therefore, the objective of long-term care facilities entails helping patients through their daily activities to improve the overall quality of life. The important roles these facilities play and their contribution towards enhancing people’s well-being necessitates the need to implement an EBP quality improvement project to help identify strategies for improving services in this setting.

A hospice center is another setting considered appropriate for implementing an evidence-based quality improvement project. Hospice care center is identified as an appropriate setting because it is among the facilities where people can access quality end-of-life care. In addition, hospice care is considered important because palliative care has proved to prolong the life span of individuals suffering from life-limiting illnesses (Wajid et al., 2021). Most hospice facilities are publicly funded; therefore, they are categorized as public entities. Implementing an EBP quality improvement project in a hospice care center can benefit the public since patient populations suffering from life-limiting illnesses can access enhanced pain and symptom management, which is crucial during end-of-life care.

Strengths and Weaknesses of Each Setting

Each healthcare setting or organization has strengths and weaknesses that can affect the implementation of an evidence-based quality improvement project. For instance, the acute care inpatient facility has a wide range of healthcare professionals with diverse skills and knowledge. Therefore, research in this setting features multidisciplinary care and quality improvement efforts in this environment will be effective as it will involve a diverse team. Moreover, the facility serves a large population, indicating that the quality improvement project will be based on several medical conditions based on the number of patients receiving acute care services in the hospital.

Despite the strengths of the facility, which may support the implementation of an EBP quality improvement project, one major weaknesses may hinder the effectiveness of the project. The acute care inpatient hospital has multiple levels of management, considering that it operates under a corporation. Therefore, approvals from the senior management are required before the quality improvement project can be executed.

Contrary to an acute care inpatient hospital, a long-term care facility has one level of management in most cases. Therefore, getting approvals for implementing the project is easier in the long-term care facility. Another major strength of the long-term care setting concerns the average life expectancy, which allows researchers adequate time to assess vital aspects required to conduct an EBP quality improvement project. However, gathering reliable data in this setting can be challenging for researchers because most individuals in long-term care have complex health conditions, such as dementia. Gathering consistent information from these patients to support a quality improvement project is difficult.

On the other hand, hospice care has a unique strength based on its availability in multiple settings, such as at home and in skilled care facilities. Therefore, a hospice care setting provides an appropriate environment for gathering information about the factors influencing patient outcomes in various outcomes. Despite this special strength, some patients in a hospice care center are chronically ill and can hardly do anything on their own. Therefore, determining the effectiveness of an intervention is challenging in this setting.

Summary of Possible Practice Problems for Each Setting

Practice problems are inevitable in typical healthcare settings. Identifying practice problems and the implications of healthcare interventions enables healthcare teams to improve services and create appropriate policies for the future (Clarke et al., 2019). When identifying practice issues, it is important to be organization-specific to enhance the reliability and validity of data gathered. Focusing of problems within a particular organization can also help to ensure that future researchers and professionals can replicate the EBP quality improvement project in other settings. For the acute care inpatient setting, a possible practice problem that can be investigated is patient falls.

The research should focus on reducing patient falls, which are common in acute care settings. In the long-term care facility, the practice problem that can be investigated concerns disregarding patient preferences to ensure individual needs are prioritized throughout the care process. Finally, end-of-life care should be a priority practice problem that should be researched in a hospice care setting. End-of-life care has become crucial in nursing practice, making it an appropriate problem that should be researched to improve the quality of care in hospice center.

Why Practice Problems should be prioritized in a Quality Improvement Project

Prioritizing practice problems in an EBP quality improvement project can lead to positive outcomes of the process and enhance its effectiveness. For instance, patient falls are a common phenomenon in acute care settings. Therefore, focusing in this problem is recommended because acute care inpatient facilities are equipped with safety tools, such as bed alarms that can become effective in reducing patient falls when implemented using a multi-component method. Similarly, long-term care facilities are appropriate environments for exploring the effects of disregarding patient preferences for individuals with different conditions.

The staff at the long-term care facility can be educated on the importance of considering patient opinions during decision-making through different approaches, such as online learning, which its effectiveness can be tested during the project. Practice problems can also be prioritized in the context of a hospice care center because this environment has patients with shorter life expectancy. As a result, evidence-based interventions are appropriate for improving the quality of end-of-life care and they can be implemented during the quality improvement project.

Stakeholder Approvals for Each Setting

As mentioned, various healthcare settings are characterized by different stakeholders. The stakeholders expected to issue approvals for an EBP quality improvement project in an acute care inpatient facility include clinical leaders, the nursing team, and the hospital’s executive management. Key stakeholders in the long-term care facility include a nursing director and the lead physician while a nursing supervisor alongside the facility’s management are the primary stakeholders to issue approvals in a hospice care center. The stakeholders in the three settings understand the daily operations of these facilities. However, most stakeholders in the acute care inpatient setting are not directly involved in overseeing patients like in the case of hospice care and long-term care settings. Regardless of their roles, the quality improvement project will not be successful without their approvals.

Organization and Selected Practice Problem

The selected organization for this assessment is the acute care inpatient facility. Patient fall prevention is also the proposed practice problem for the EBP quality improvement project. The project will be executed after seeking approvals from the facility’s clinical leaders and the executive management. The nursing team, particularly the lead group of the acute care inpatient hospital will also be consulted.

The acute care inpatient setting is considered appropriate because it is common within general care facilities. Moreover, the proposed problem is a common occurrence in acute care; thus, identifying appropriate interventions that can be implemented to address the problem is crucial for advancing nursing practice. Addressing the proposed practice problem will also contribute to improved patient safety, consequently contributing to successful nursing practice.

Conclusion

Evidence-based practice interventions are effective when applied in specific healthcare settings. Although healthcare settings have a common goal, which is to promote healing and improve the quality of life, each organization has different stakeholders who must approve interventions used in EBP quality improvement projects to ensure its benefits align with the goals of a particular setting.

An appropriate quality improvement project should prioritize using valid and reliable data that can be used to improve patient outcomes in the identified three settings where it can be implemented. The information should also be used to address practice problems within the settings where the EBP quality improvement project is being implements. An EBP quality improvement project can be implemented in any setting as long as it helps nurses to promote positive health outcomes.

References

Clarke, G. M., Conti, S., Wolters, A. T., & Steventon, A. (2019). Evaluating the impact of healthcare interventions using routine data. BMJ (Clinical Research ed.)365, l2239. https://doi.org/10.1136/bmj.l2239

Hirshon, J. M., Risko, N., Calvello, E. J., Stewart de Ramirez, S., Narayan, M., Theodosis, C., O’Neill, J., & Acute Care Research Collaborative at the University of Maryland Global Health Initiative (2013). Health systems and services: the role of acute care. Bulletin of the World Health Organization91(5), 386–388. https://doi.org/10.2471/BLT.12.112664

Palacios-Ceña, D., Fernández-Peña, R., Ortega-López, A., Fernández-Feito, A., Bautista-Villaécija, O., Rodrigo-Pedrosa, O., Arnau-Sánchez, J., & Lizcano-Álvarez, Á. (2021). Long-Term Care Facilities and Nursing Homes during the First Wave of the COVID-19 Pandemic: A Scoping Review of the Perspectives of Professionals, Families and Residents. International Journal of Environmental Research and Public Health18(19), 10099. https://doi.org/10.3390/ijerph181910099

Wajid, M., Rajkumar, E., Romate, J., George, A. J., Lakshmi, R., & Simha, S. (2021). Why is hospice care important? An exploration of its benefits for patients with terminal cancer. BMC Palliative Care20(1), 70. https://doi.org/10.1186/s12904-021-00757-8

Proposed Health Care Setting and Practice Problem

The chosen location for the initiative is an acute care inpatient facility. Acute care is typically of a shorter duration, in contrast to chronic or long-term care. Acute care is often delivered in a hospital environment by a team of skilled physicians who can diagnose, treat, and care for various diseases, symptoms, and injuries. CAUTIs are the chosen practice issue of attention (Parker et al., 2020). As per the CDC, a significant proportion of hospitalized patients, ranging from 15% to 25%, undergo urinary catheterization during their admission, which exposes them to the potential risk of developing a Catheter-Associated Urinary Tract Infection (CAUTI) (Hughes et al., 2023). Every year, approximately 13,000 deaths are linked to CAUTIs. With a fatality rate of around 10%, they are also the primary source of subsequent bloodstream infections. This quality improvement project aimed to improve the understanding of hospital nurses regarding indwelling urinary catheter care. The goal was to reduce the incidence of cauti in hospitalized patients. This method has effectively enhanced the quality of care within acute care hospitals while being sustainable and cost-efficient.

Conclusion

Healthcare settings utilize evidence-based practices to enhance efficiency, safety, and the quality of patient care. Implementing EBP interventions necessitates obtaining the endorsement of essential stakeholders, irrespective of the project’s location. The selected location for the evidence-based practice quality improvement project is the acute care setting, with the identified issue being CAUTIs. Nurses have a crucial role in preventing CAUTIs in hospitalized patients. Following evidence-based practice guidelines can significantly influence the outcomes and burden of CAUTIs.

References

Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P., Hole, A., Moore, L. J., Brown, R., Melnyk, B. M., & Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence-based Nursing, 20(1), 6–15. https://doi.org/10.1111/wvn.12621

Hagle, M., Dwyer, D., Gettrust, L., Lusk, D., Peterson, K. D., & Tennies, S. A. (2020). Development and implementation of a model for research, Evidence-Based practice, quality improvement, and innovation. Journal of Nursing Care Quality, 35(2), 102–107. https://doi.org/10.1097/ncq.0000000000000422

Hughes, A., Marlin, C. C., Umana, A. N., & Williams, J. (2023). Multi-Modal strategies for implementation of CAUTI prevention guidelines in an inpatient rehabilitation hospital to improve patient outcomes. American Journal of Infection Control, 51(7), S9. https://doi.org/10.1016/j.ajic.2023.04.157

Keen, A., Radecki, B., Snyderman, W., Rader, T., Hemmelgarn, A., & Sierp, A. (2023). INnovation, QUality Improvement, Research, and Evidence-Based Practice (INQUIRE). Journal of Nursing Care Quality, 39(1), 18–23. https://doi.org/10.1097/ncq.0000000000000724

Kesten, K., & Echevarria, M. (2021). Strategies for Strengthening quality improvement projects in a Doctor of Nursing Practice program. The Journal of Doctoral Nursing Practice, 14(1), 10–16. https://doi.org/10.1891/jdnp-d-20-00034

Moore, D. C., Payne, S., Van Den Block, L., Ling, J., Froggatt, K., Gatsolaeva, Y., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B. D., Van Hout, H., Pasman, H. R. W., Oosterveld-Vlug, M., Koppel, M. T., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij‐Dassen, M., Hockley, J., . . . Wichmann, A. (2020). Strategies for implementing palliative care education and organizational interventions in long-term care facilities: A scoping review. Palliative Medicine, 34(5), 558–570. https://doi.org/10.1177/0269216319893635

Otts, J. A., Pittman, J., Riley, B. H., Mestas, L., & Hall, H. (2023). Academic-practice partnership to prevent and manage pressure injuries. Journal of Wound Ostomy and Continence Nursing, 50(6), 463–473. https://doi.org/10.1097/won.0000000000001019

Parker, V., Giles, M., King, J., & Bantawa, K. (2020). Barriers and facilitators to implementing a multifaceted nurse‐led intervention in acute care hospitals to reduce indwelling urinary catheter use: A qualitative study. Journal of Clinical Nursing, 29(15–16), pp. 3042–3053. https://doi.org/10.1111/jocn.15337

Shadle, H. N., Sabol, V., Smith, A. R., Stafford, H., Thompson, J., & Bowers, M. T. (2021). A Bundle-Based approach to prevent Catheter-Associated urinary tract infections in the intensive care unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934

Singh D. A. (2021). Effective Management Of Long-Term Care Facilities. Jones & Bartlett Learning.

Introduction

Change is an important aspect in health organizations. Change contributes to the development of new aspects of undertaking tasks in organizations. Health organizations require change to address their current and emerging needs. Change also enables health organizations to implement interventions that contribute to the improvement in safety, efficiency and quality of care. Nurses and other healthcare providers have critical roles to play in relation to the implementation of change. They explore organizational issues that can be addressed using evidence-based interventions to promote safety and quality of care. Therefore, this presentation examines the approach to addressing the issue of medication errors in nursing practice.

Framework  

Addressing the issue of medication errors is achievable with the use of a change model such as Lewin’s model of change. Lewin proposed a theory of change that can be used to implement change. According to Lewin, change occurs in steps that include refreezing, change, and unfreezing. The theory shows that for a change to happen, people must be moved from their existing status quo to a new state of performance and behaviors. Lewin hypothesized that unfreezing is the first step in the change process where the adopters of change learn about the need for change. The adopters however lack the knowledge and skills needed for the implementation of change. Lewin therefore recommended the need for interventions such as training to increase the adoption of change. The second step in Lewin’s model is change. This is the step where the adopters of change have adopted the change in their practice. The adopters implement change in trial basis. The last step is refreezing where the adopters of change have implemented change in their daily use and are not willing to revert to their traditional behaviors. The framework by Lewin therefore promotes sustainability of change interventions in health organizations (Singh & Ramdeo, 2020).

Practice Problem

The selected practice problem that should be addressed is medication errors. Medication errors comprise critical public health issues that threaten the safety and quality of patient care. Medication errors result in unintentional harm to patients due to the side and adverse effects of medications (Latimer et al., 2017). Nurses contribute to the majority of incidences of medication errors due to their involvement in medication-related processes such as handling and administration. Medication errors increase the burden of a disease to patients. This is attributed to increased care needs as well as hospital stay. There is also the increased costs as well as utilization of care resources in health organizations (Mieiro et al., 2019). Medication errors in nursing can be prevented using evidence-based interventions. Therefore, the proposal seeks to explore the use of barcode system of medication administration to prevent medication errors (Musharyanti et al., 2019).

Implementation Approach and Stakeholders 

The approach to implementing changes to address the issue of medication errors will comprise of a number of steps. The first step is needs assessment. Needs assessment aims at identifying the knowledge and skills of the nurses. The information obtained from needs assessment guides the development of training objectives for the nurses involved in the implementation of change. The second step is training where the nurses and other stakeholders are educated on the required knowledge and skills for the implementation of change. Training eliminates issues such as resistance to change. The third step is implementation where barcode system of medication administration is used in medication handling processes. Evaluation is the last step where the effectiveness of the change is determined. The rates of medication errors are evaluated to determine whether the change led to a decline or not. The stakeholders that will be involved in addressing the issue will include nurses, physicians, nurse managers and nurse leaders (Claretha, 2020).

References

◦Claretha, H. (2020). Implementation Strategies for Improving Diversity in Organizations. IGI Global.

◦Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students’ awareness of medication errors and their prevention. Nurse Education Today, 52, 7–9. https://doi.org/10.1016/j.nedt.2017.02.004

◦Mieiro, D. B., Oliveira, É. B. C. de, Fonseca, R. E. P. da, Mininel, V. A., Zem-Mascarenhas, S. H., & Machado, R. C. (2019). Strategies to minimize medication errors in emergency units: An integrative review. Revista Brasileira de Enfermagem, 72, 307–314. https://doi.org/10.1590/0034-7167-2017-0658

◦Musharyanti, L., Claramita, M., Haryanti, F., & Dwiprahasto, I. (2019). Why do nursing students make medication errors? A qualitative study in Indonesia. Journal of Taibah University Medical Sciences, 14(3), 282–288. https://doi.org/10.1016/j.jtumed.2019.04.002

◦Singh, R., & Ramdeo, S. (2020). Leading Organizational Development and Change: Principles and Contextual Perspectives. Springer Nature.