NUR 590 Week 5 Assignment Evidence-Based Practice Proposal – Section E: Implementation Plan

NUR 590 Week 5 Assignment Evidence-Based Practice Proposal – Section E: Implementation Plan

Best Practices for Implementing Evidence-Based Practice (EBP)/ Guidelines

Studies show that despite EDP being the gold standard in the provision of patient care, several hospitals among other healthcare organizations take up to 17 years to be able to fully adopt the new practice after it has gained substantial evidence showing its safety and effectiveness among patients (Brownson, Fielding, & Green, 2018). To promote the timely and appropriate implementation of best EBP into clinical practice, four key approaches must be followed.

The first step is to fully understand the data and the new practice being implemented. This is mainly because not all data behind EBP can translate to your organization, despite applying to multiple clinical contexts (Stirman, Baumann, & Miller, 2019). An in-depth understanding of the proposed changes helps leaders adapt only the evidence best practice that best suits the healthcare organization.

The second step is to consider the available resources concerning the data behind the evidence best practice. This will help leaders modify the new practice to fit the resources which are available within the organization (Osborne, 2017). Consequently, this approach will also help in the adoption of strategies that can help reduce costs while optimizing the outcome.

The third step is to establish patient-centered goals. It is important to ensure that the new practice does not only benefit the hospital in promoting the rate of productivity but must also enhance patient-centered care. For instance, when implementing strategies to help inappropriate polypharmacy among the elderly, it is important to focus on approaches that will help reduce multiple uses of prescription drugs, while at the same time ensuring that the patient achieves the treatment goals (Cadogan et al., 2018).

The last step is to identify the organization’s preferences and educate staff members about the new practice. This will help the change leader evaluate the possibilities of adoption and retainment of the new practice among staff members (Osborne, 2017). When the change is fully accepted by the staff members, the process of implementation can then be initiated.

Strategies for Overcoming Barriers in Implementing Evidence-Based Practice

According to most research findings, the most common barriers to EBP implementation include resistance, time and knowledge, and inadequate finances. To be able to overcome these challenges, several strategies will be utilized. The first strategy is to engage appropriate stakeholders. This will help in building trust which will enable the project leader to learn from their experience and provide effective input. The stakeholders will also help in identifying outcome measures (Brownson, Fielding, & Green, 2018). The second strategy is to seek administrative support. The administration will be able to provide insight on other similar projects and how certain techniques were utilized in promoting the implementation of such projects. The administration will also help in promoting a supportive culture among employees to reduce resistance levels. The last strategy is to carry out substantial background research and involve staff members in the implementation process. This will help identify gaps within the current practice and come up with appropriate and readily acceptable EBP such as the 10 items of MAI (Cadogan et al., 2018).

 

Formative Evaluation Plan

The formative evaluation plan aims at fostering the development and improvement of the plan before initiating the implementation step. The evaluation plan will also consider the summative approach in assessing whether the expected results of the project have met the stated goals, by collecting feedback and presenting them to the stakeholders (Stirman, Baumann, & Miller, 2019). The formative evaluation plan will involve completing need assessment questionnaires, conducting implementation analysis, and performing progress analysis. In the implementation of the 10 items MAI into practice, prescribers will be utilized as the main source of feedback (Cadogan et al., 2018).

The need assessment questionnaires will be filled by involved stakeholders regarding the areas of improvement, potential barriers, and facilitators to promoting the change. The implementation analysis will involve assessment of the fidelity to the implementation strategy and the clinical intervention being proposed. Progress analysis on the other hand will focus on monitoring the progress towards implementation and improvement of the set goals during the intervention (Brownson, Fielding, & Green, 2018). The feedback for the evaluation process will include semi-structured interviews with stakeholders, focus groups, structured surveys, electronic health records, charts, document reviews, and management information systems. Feedback will also be collected by direct observations through site visits.

Plan for Formative Evaluation in this Pandemic Situation

The Covid-19 pandemic has led to several changes in the protocol of how healthcare services are being provided. In the same case, the methods in which formative evaluation will be conducted must be modified to meet the current standards of practice. For instance, reducing contact among people is very crucial in curbing the spread of the virus (Osborne, 2017). As such, face-to-face interviews will be avoided. Instead, feedback will be collected through social media and online platforms such as the use of Emails. Consequently, video conferences will be preferred to conduct discussions rather than crowded conference rooms. However, for those who will be forced to be involved directly with the evaluation process, protocols such as vaccination will be applied.

During week 2, in a simulated scenario when your formative evaluation plan reveals not all of the staff have implemented the evidence-based intervention. What is your next step?

Upon incomplete adoption of the new practice, it is necessary to assess the cause of the situation, come up with appropriate strategies, and promote complete adoption of the change. Feedback will be collected from staff members who will not have adopted the new practice, to find out the reasons behind their lack of participation (Shelton, Cooper, & Stirman, 2018). In most cases, incomplete adoption of change is normally caused by a lack of time or limited knowledge regarding the use of the new approach. As such, it is necessary to work with the employee’s schedule and find an appropriate time to promote education regarding the new practice and its benefits. With a full understanding of the reasons behind the proposed change, and the benefits if implemented, staff members will be more interested to use the new practice and realize the benefits.

What are you learning about project implementation? What issues have you identified? How will you address these? Use these examples as headings or substitute with the same number of examples that are appropriate to your case study project be robust:

• You identify that the staff needs more information about evidence-based practice. What will you do?

Teaching programs will be designed based on the information needed of the staff members regarding evidence-based practice. The teaching programs will utilize effective communication strategies to promote conveying of the knowledge to staff members (Stirman, Baumann, & Miller, 2019). Such strategies include tailoring the message, ensuring that the tailored messages are targeted to audience segments, use of narratives, and framing of the message.

• You identify that staff needs more information about the evidence-based intervention. What will you do?

To promote more information regarding the evidence-based intervention, it is necessary to promote self-initiated background research on the healthcare problem and available interventions use to solve the problem (Brownson, Fielding, & Green, 2018). The staff members will then be provided with brochures and fliers giving background information on the new intervention, and its benefits. Training programs will also be designed to fit the needs of the employees and the patient regarding the new intervention.

• You identify that you need to provide remedial training. How will you accomplish this?

To provide remedial training to staff members, a group of specialists will be involved in assessing the information gap and setting the new training goals. New microlearning approaches will be considered such as short videos to avoid burnouts as a result of long working hours (Stirman, Baumann, & Miller, 2019). Different learning habits will also be involved such as the use of software that has a user-friendly interface especially for the case of the 10 items MAI (Cadogan et al., 2018).

In your simulated Case Study some staff state “I am too busy” or “I do not see a need for change since the ‘way we have always done it’ works fine.” How will you address this?

In this situation, I will have to spare as little time as possible with the employee and try to convince them about the benefits of the new intervention over the current practice. I will provide backup evidence using data and statistics drawn from the organization that has successfully implemented the new approach, and the benefits being realized. I will also give examples of colleges who have already adopted the change and have them explain the benefits from their own experience.

What additional resources may be necessary for a successful implementation?

Additional resources for the implementation of this project will include infrastructures such as computers, wi-fi, and HER software (Shelton, Cooper, & Stirman, 2018). These resources will be used to collect and keep data recorded on the 10 items MAI. Investors may also be needed to help provide adequate finances to support the project.

You have opposition or pushback from the nursing staff about making a change in practice during a pandemic crisis, how would you respond to this pushback?

I will align the needs of the change to the current needs of the pandemic crisis, and explain to them, how this new intervention will benefit the current situation (Stirman, Baumann, & Miller, 2019). With the Covid-19 pandemic, the elderly population is being affected by comorbidities more than ever. This increases the risks of inappropriate polypharmacy, hence the need for the 10 items MAI tool.

 

 

Reference

Brownson, R. C., Fielding, J. E., & Green, L. W. (2018). Building capacity for evidence-based public health: reconciling the pulls of practice and the push of research. Annual review of public health, 39, 27. DOI: 

Stirman, S. W., Baumann, A. A., & Miller, C. J. (2019). The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Science, 14(1), 1-10.

Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual review of public health, 39, 55-76.

Osborne, S. (2017). Making evidence-based perioperative practices stick: An introduction to an implementation science approach. ACORN: The Journal of Perioperative Nursing in Australia, 30(4), 53-55. https://search.informit.org/doi/10.3316/informit.317274992620092

Cadogan, C. A., Ryan, C., Gormley, G. J., Francis, J. J., Passmore, P., Kerse, N., & Hughes, C. M. (2018). A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care. Pilot and feasibility studies, 4(1), 1-12.

Evidence-Based Practice Proposal – Section E: Implementation Plan

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:

Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.

Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.

Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.

Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.

Explain the process for delivering the (intervention) solution and indicate if any training will be needed.

Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.

Describe the strategies to deal with the management of any barriers, facilitators, and challenges.

Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.

Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

Topic 1 DQ 1

Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response.

Science teaches us to explore and question. In medicine, it the same. There is always something to explore in medicine, whether its to improve upon interventions or to learn complex diseases. Throughout my career as a nurse and nursing student, it was always expressed to me that in order for me to become a successful nurse I would need to engage in continuing education for the life of my career. In life, we should always strive for continuing education for personal development and growth. The future of nursing will require nurses to question, explore and take initiative making decisions on patient care, interventions, in leadership and public health. “Explain the importance of a spirit of inquiry in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty” (National League of Nursing, 2014, para. 1). The COVID-19 pandemic was a wake up call in that we as a nation need to focus on improving our nursing practice. Nurses will need to be encourage and pushed into leadership roles, executive positions and in the areas a research and development. Many nurses took the lead in saving their patients and hospitals as the pandemic ravaged hospitals throughout the country. There was also a spike in people researching how to get into the field of medicine (particularly in nursing and nursing research). There became a fascination into epidemiology, public health and medical research as people and nurses became curious about vaccine development and how outbreaks of disease and virus happen. As a advanced registered I would encourage evidence based culture by being an example of someone who uses EBP and work in collaboration with other staffers to implement EBP research into the real world. During the heigh of the pandemic, EBP research was used to help patients as other interventions and methods failed.

Implementing EBP

 

In the field of advanced nursing practice, there are various ways advanced nurses implement EBPs. Nurse practitioners implement and EBP “when she/he prescribes a treatment for a patient that is substantiated by scientific research; Often, nurse practitioners look for an experimental study that compares the efficacy of a treatment with an untreated control group” (Nurse Practitioner Schools, 2021).

 

Certified mid-wifery

 

For nursing midwives, EBP is are used to enhance the lives of the mother, child and community. Mothers are the backbone of communities and the health and safety of woman determines the health and safety of their respective communities. Areas of challenges are identified and EBP are used to improve the lives of women in order to safely carry, deliver and raise children.

References:

National League of Nursing. (2014). Practical/Vocational Nursing Program Outcome: Spirit of Inquiry. https://www.nln.org/docs/default-source/default-document-library/spirit-of-inquiry-final.pdf?sfvrsn=0

Nurse Practitioner Schools. (2021). Guide to Evidence-Based Nursing Practice for NPs. Retrieved from https://www.nursepractitionerschools.com/resources/guide-to-evidence-based-nursing-practice/

 

A spirit of inquiry could be rephrased as curiosity and desire for increased knowledge by on current best practices as defined by research. Currently it can take many years for new information to be put into practice to achieve the quadruple aim of EBP: improvement of healthcare quality, improved patient outcomes, reduced costs, and empowered clinicians (Melnyk & Fineout-Overholt, 2019). Some ways to evaluate EPB includes quality improvement projects as well as outcome management (Melnyk & Fineout-Overholt, 2019).

Nursing informatics is the study and integration of nursing with information technology, like EHRs and statistics, to support all care team members in decision making. Advanced practice nurses can encourage EBP and inquiry by identifying and solving problems. Therefore, nursing informatics (NI) can use help improve processes and the floor nurses’ experiences with EHR. One way my organization is doing this currently is re-educating nurses on the EHR system, Meditech. Nurses have been showing each other “one thing I learned.” Therefore, while in class the nurse may heave learned one thing, by sharing that learning, nurses have reinforced their learning while picking up other time saving tips.

 

 

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed

• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• The is a great resource