NUR-590 Benchmark – Evidence-Based Practice Project Proposal: Organizational Culture and Readiness
In 750-1,000 words, analyze the culture and level of readiness of the organization for which your evidence-based practice project is proposed.
Nursing leader’s server as advocates within their organizations. Leaders have requisite knowledge, skills, and understanding and represent the front door into the healthcare service delivery. Nursing leaders need to be comfortable within their administrative structures to use their powers to advocate for the role of nurses. Advocating in policy discussions to help reduce health care cost and improvement in patients’ outcomes and quality of life through collaborative team-based care. (Stevenson, 2021) Advocating for nursing staff can begins with assessing needs. Do the nurses have the correct tools they need to provide best practice care. Are nurses being treated fairly and are they assuring measures to prevent nursing fatigue and burn out such as appropriate breaks and lunches.
- Describe the organization’s culture and explain to what degree the cultu
Benchmark Evidence Based Practice Project Proposal Organizational Culture and Readiness re supports change. Consider organizational and leadership structure, mission and values, interprofessional collaboration/team engagement, communication, perception of the organization by employees, etc.
- Select an organizational readiness tool and assess the level or readiness for change within your organization. Identify the readiness tool and summarize the survey results. Discuss the degree to which the culture will support and sustain an evidence-based practice change. Consider strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources.
Benchmark – Evidence-Based Practice Project Proposal Organizational Culture and Readiness I Provide rationale.
- Discuss what health care process and systems you would recommend for improving quality, safety, and cost-effectiveness for the organization.
- Propose strategies to better facilitate the readiness of the organization.
- Identify the stakeholders and team members for the project. Include what their duties will be in the evidence-based practice project proposal.
- Explain what information and communication technologies are needed for the implementation and how they will be integrated in the setting by the internal stakeholders. Explain how these will help improve nursing practice and care delivery for individuals and populations for your intervention.
EBP is on fall reduction in a medical-surgical ward within 24 weeks
Organizational Culture and Readiness
The successful implementation of the interventions targeting individuals with alcohol abuse disorder will largely depend on the support from the organization. Organizational support in forms such as human and financial support will be needed to promote the effective implementation of interventions. The culture should also facilitate the change process in the organization. Therefore, the purpose of this paper is to analyze the culture and readiness of the organization to facilitate the implementation of the proposed change.
Description of the Organization’s Culture
The use of teamwork in undertaking tasks characterizes the culture of the organization. Healthcare providers utilize inter-professional teams in providing patient care. Inter-professional teamwork contributes to enhanced care outcomes that include safety, quality and efficiency. The culture is also characterized by the use of transformational leadership styles. Transformational leadership aims at promoting the development of the desired competencies by the staffs. Healthcare providers are motivated to play an active role in exploring effective interventions to optimize the care outcomes. The organization also encourages the implementation of new practices and approaches to care to improve patient outcomes. The use of new practices ensures continuous quality improvement in patient care, hence, safety and efficiency in the organization. Based on the above, the organization supports change. Healthcare providers have the required knowledge and skills to implement the proposed intervention. The organization also has systems and processes that will enhance the adoption of the change.
Organizational Readiness
The organizational readiness tool by Barwick (2011) was used for this analysis. The tool examines the readiness of an organization to embrace change by focusing on dimensions that include system and organizational capacity, functional considerations, organizational culture, senior leadership, implementation plan, and training. The organization scored highly in all the dimensions of organizational readiness assessment. It scored 19 in system capacity, 19 in organizational capacity, 20 in functional considerations, 18 in organizational culture, 19 in senior leadership, 18 in staff capacity, 19 in implementation plan, and 18 in training. The assessment tool showed that the organization is ready to implement and sustain change. The readiness could be seen in aspects such as readiness of the staff to engage in activities that will facilitate the change, existence of frameworks for implementing change, and senior leadership that is ready to implement and transform organizational processes. The strengths of the organization in relation to the implementation of the change include empowered staff, enabling leadership, and existence of systems that will facilitate the successful implementation of the change. Some of the weaknesses include staff shortage and inadequate financial resources that may hinder the implementation of the project. Potential barriers that may affect the project will include the lack of stakeholder support for the project and withdrawal of the participants in the project. The resources that will be utilized include nurses, counselors, and financial resources for the implementation of the interventions.
Healthcare Systems and Processes
The human resources processes in the organization should be improved to ensure quality, safety and cost-effectiveness in the
organization. The organization should consider hiring additional nurses to address the current shortage in being experienced in the firm. Shortage in staffing ratio affects quality and safety outcomes in healthcare due to the increase in workload and risk for adverse events due to issues such as medication errors. The costs incurred in an organization also rises due to the need for hiring nurses on a regular basis secondary to high rate of staff turnover (Bragadóttir et al., 2019). Therefore, adequate staffing in the organization is recommended.
Proposed Strategies to Facilitate the Readiness of the Organization
Needs analysis will be performed to identify knowledge and skill gap among the healthcare providers in relation to the project. Needs assessment will provide information that will guide the development of goals for training for the staffs. The objectives of the project will also be aligned with the organizational mission. Alignment will ensure the relevance and readiness of the organization to embrace the project (Horntvedt et al., 2018). Staff training will be offered to ensure that they have the required knowledge and skills for the project implementation. Training will also minimize the risk of resistance to change by the adopters due to lack of knowledge, skills and prepared for the project. Lastly, active stakeholder involvement will be adopted to ensure their empowerment and sustained use of the project intervention (Sharma et al., 2018).
Stakeholders and Team Members
The stakeholders for the project will comprise of nurse managers and leaders, registered nurses, counselors, and psychiatric mental health nurse practitioners. Nurse leaders and managers will play the role of supervision and coordination of the project interventions. They will also ensure the effective use of resources to ensure the realization of the goals of the project. Registered nurses will recruit, implement and monitor the participants with withdrawal symptoms. Counselors will provide health education to the participants on the use of behavioral interventions. Psychiatric mental health nurse practitioners will assess the response of the participants to the selected treatments. The stakeholders will work as a team to ensure the realization of the desired outcomes in the project.
Information and Communication Technologies
Computers will be used in the project for data storage. The healthcare providers will also use them in accessing the sources of evidence-based data that they need to inform their practice. Projectors will also be needed in the project for patient education and presentation of results and training the providers of care and patients. Short messaging services will be used as sources of reminders to the patients on the need for the consistent utilization of the required behavioral interventions. Short messaging will also be used to empower participants to engage in self-management behaviors for the project. The importance of the above technologies to nursing is that they will promote safety, efficiency, quality, and patient-centeredness in project implementation (Nasution & Hariyati, 2018).
Conclusion
In summary, the organization is ready to implement the proposed interventions. The leadership and organizational culture support the change initiatives. The organization has an enabling culture that encourages the use of innovative practices in patient care. Therefore, a focus will be placed on ensuring the minimization of threats and weaknesses by optimizing opportunities and strengths of the organization in the implementation of the proposed initiative.
References
Barwick, M. A. (2011). Checklist to Assess Organizational Readiness (CARI) for EIP Implementation. 5.
Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2019). The extent to which adequacy of staffing predicts nursing teamwork in hospitals. Journal of Clinical Nursing, 28(23–24), 4298–4309. https://doi.org/10.1111/jocn.14975
Horntvedt, M.-E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: A thematic literature review. BMC Medical Education, 18(1), 172. https://doi.org/10.1186/s12909-018-1278-z
Nasution, L. A., & Hariyati, R. T. S. (2018). Mobile Health Application in Implementation of Maternity Nursing Care: Literature Review. Journal of Nursing Care, 1(1), 34–41. https://doi.org/10.24198/jnc.v1i1.15762
Sharma, N., Herrnschmidt, J., Claes, V., Bachnick, S., Geest, S. D., & Simon, M. (2018). Organizational readiness for implementing change in acute care hospitals: An analysis of a cross-sectional, multicentre study. Journal of Advanced Nursing, 74(12), 2798–2808. https://doi.org/10.1111/jan.13801
Healthcare organizations adopt evidence-based practice (EBP) interventions to enhance patient outcomes through the provision of quality and patient-centered care. Effective implementation of the EBP proposed project requires these organizations to identify both facilitators and barriers through use of tools that evaluate readiness and culture for change (Melnyk et al., 2022). The organizational culture and readiness assessment is a critical step in ascertaining if the organization is prepared for the EBP implementation. Dearing (2018) advances the need for EBP project implementers to use simple tools to assess the culture and readiness of an entity to implement EBP. The purpose of this paper is to provide the outcomes of the organizational culture and readiness assessment to implement the proposed EBP project.
Organization’s Culture and Level of Readiness
Organization’s culture is a vital part of its readiness for change as it has values and attributes, assumptions, and common goals that all stakeholders share and focus on in their operations and processes. The leadership structure in the organization is supportive of the change while the culture is also change-oriented. The leadership encourages participation of all providers, especially nurses who have new ideas. The culture supports change because it values innovative ways of offering patient care. The mission and the values of the organization like transformative care provision based on integrity, respect, and honesty imply that the organization has an effective culture. The evaluation also shows that the organization and its leadership value inter-professional collaboration and engagement of team through effective communication (DeNisco, 2021). The employees’ perception in the organization is positive as many believe in making change a normal occurrence for better outcomes and care delivery. Therefore, the EBP project will enhance the level of readiness for the organization to implement more projects to improve quality of care delivered to patients.
Organizational Readiness & Degree of Support by the Culture
Organizational culture also impacts the evaluation of readiness in implementing the EBP project. The primary areas of assessment for the proposed change include beliefs, leadership, quality improvement, and degree of awareness. To evaluate the readiness level for the organization, the selected assessment tool is the organizational readiness to change assessment (ORCA). The tool focuses on the level of evidence for the proposed change and the entity’s capacity to execute change and the suggested context (Dearing, 2018). On the application of the survey tool, the results indicate that nursing leadership was well prepared to implement the change because it communicates the importance of EBP to the clinical staff. The implication is that based on this tool, the level of readiness in the organization is about 4.5 out of the possible 5. The results of the scale-based survey completed showed that the organization was fairly prepared to incorporate EBP in the clinical setting. The nursing team and other stakeholders, especially those supporting nursing, were aware of the need to make changes to the current processes and operations.
The culture will also support the proposed EBP since it is change-oriented, participative, and transformative. The organizational culture in the facility encourages input from all stakeholders. However, a core weakness may be its inability to establish limits and effective ways of presenting change issues. Possible barriers may include financial support and sufficient resources to implement the EBP in the facility (DeNisco, 2021). Stakeholder support will be critical as the evaluation shows increased support from all players. Again, the timing of the proposal is effective as it emerged during the evaluation that the organization has been keen on implementing initiatives aimed at improving the quality of care.
Health Care Process and System
Improving quality, safety and cost-effectiveness in this organization would require changes in the process and systems of the organization. The organization should establish processes that are patient-centered and encourage submission of opinions and views from diverse individuals and stakeholders. The organization should establish systems that leverage on health information technologies to improve assessment of patients and delivery of care (Tzeng et al., 2021). The incorporation of monitoring technology will assist nurses and physicians to adhere to the correct procedures and processes for all patients under their care. Further, patient involvement ensures that they are aware and understand their treatment plans. This will enhance their safety and ensure that they exercise their ethical principles of autonomy and beneficence. Cost efficiency approaches would also be significant for the organization. Therefore, the entity should consider patient care approaches that lead to better experiences and outcomes.
Strategies to Facilitate Readiness of the Organization
The initial strategy to facilitate change in the organization is to define and align it with the business goals of the entity. Through this approach, the organization demonstrates its readiness for change. Secondly, the organization should identify those who will be affected by the change through knowing the purpose of change and its long-term effects on the various levels of its operations (Melnyk et al., 2022). The third strategy is having an effective communication model to create awareness, enhance participation of all people, and ensure that employees do not resist change.
Stakeholders and Team Members
The EBP project will have different stakeholders with diverse roles. These include project manager, nurse leaders, organizational managers from different departments, especially the executive and quality assurance manager, the finance manager, and nurses. Patients will be also critical stakeholders as the end users of this EBP project proposal. The project manager will be in charge of all processes and operations as well as the deliverables of the initiative (Tucker et al., 2019). The nurse leaders will ensure that nurses implement the TIPS care bundle while the organizational manager will allocate financial resources. The quality assurance manager will ensure that the TIPS model leads to quality outcomes and protects patients from harm (Tzeng et al., 2021). Patients will be the end users with better outcomes aimed at preventing falls during their stay in the facility.
Information & Communication Technologies Required in the EBP Implementation
The use of TIPS bundled model to reduce falls will integrate diverse information and communication technologies to improve care delivery. These will include electronic health records, the use of patient portals, and clinical decision support systems (CDSS). The project will also require integration of telehealth and even telemedicine for patients to get alerts among other integrated technological aspects. These will improve nursing practice by allowing nurses to closely monitor patients and customize their interventions based on status and other aspects (Khasnabish et al., 2020). The use of these technologies will enhance patient participation in decision making and ensure that all providers align their treatment goals with patient preferences.
Conclusion
The readiness of an organization to implement EBP interventions is based on the effective assessment and evaluation using recommended tools. In this case, the evaluation demonstrates that the organization is ready for change based on its supportive culture and management. As such, all stakeholders and team members must integrate effective technologies to attain the goals of the proposed EBP project of using TIPS model to reduce falls among patient in medical-surgical settings.
References
Dearing, J. W. (2018). Organizational Readiness Tools for Global Health Intervention: A
Review. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2018.00056
DeNisco, S. M. (2021). Advanced practice nursing: Essential knowledge for the profession.
Jones & Bartlett Learning
Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best
practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.
Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins
Tucker, S., Sheikholeslami, D., Farrington, M., Picone, D., Johnson, J., Matthews, G., … &
Cullen, L. (2019). Patient, nurse, and organizational factors that influence Evidence‐Based fall prevention for hospitalized oncology patients: an exploratory study. Worldviews on Evidence‐Based Nursing, 16(2), 111-120. DOI: 10.1111/wvn.12353.
Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.
(2021). Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. Journal of Nursing Care Quality. https://doi.org/10.1097/ncq.0000000000000547
Among healthcare staff in the clinical and acute care setting who are victims of workplace violence (WPV), will implementing violence prevention tactics and policies, reduce healthcare staff abuse? By using this intervention, the hope is to reduce the outcome of staff bullying and violence by patient’s, family members and among each other in a timeframe of approximately a year.
My hope is to reduce WPV in healthcare and have nurse want to show to work and not feel overwhelmed by the sheer lack of support from management and the system alike. By implementing higher security, violence prevention as well as place policies in to protect staff instead of condemning them. Verbal and physical abuse at the workplace have been sweeps under the rug too many times and it keeps being an issue that has gone long enough. The way to aid nurses is not by assuming they “signed up for this” and ” understand it comes with the territory” the way to support nurses is by standing with them and prevent the abuse that has become commonplace among the healthcare setting. Limit the amount of visitors that can come to the patients side, have a zero tolerance for verbal and/or physical abuse from visitors or patients, as well as prepare nurses to de-escalate violent behavior. The workplace is a setting where nurses spend most of their waking moment in, and becoming victims in this environment is grounds for having tired, overworked and staff that will quit without interventions in place to prevent WPV. The toll that this exerts in nurses’s physical, mental, and professional lives negatively impacts not just their work but also has a significant impact at home (Hassankhani et al., 2018). Thus, exerting a substantial burden in nurses affecting direct patient care.
Hassankhani, H., Parizad, N., Gacki-Smith, J., Rahmani, A., & Mohammadi, E. (2018). The consequences of violence against nurses working in the Emergency Department: A qualitative study. International Emergency Nursing, 39, 20–25. https://doi.org/10.1016/j.ienj.2017.07.007
As an anticipated advanced practice nurse, I have an ethical and professional responsibility, to address failing processes in patient care by seeking and considering evidence-based research and translate the knowledge into practice to produce positive patient outcomes (DeNisco, 2021). My proposed intervention involves the utilization of evidence-based counseling tools to guide the provider-patient dialogue, in order to influence behavioral change related to obesity management in the primary care setting. Research has concluded that obesity management is not adequately addressed in the primary care setting (Kushner et al., 2016).
The collective research on obesity management in the adult primary care setting, raised for me to explore the clinical question: For Advanced practice nurses in the primary care setting (P), how would utilizing an evidence-based behavioral change counseling tool to guide monthly provider-patient interactions (I), compared to using standard dialogue (C) decrease the body mass index (BMI) in obese patients (O) over the course of one year (T)?
References:
DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.
Kushner, R. F., Choi, S. W., & Burns, J. L. (2016). Development of a six-factor questionnaire for use in weight management counseling. Patient Education and Counseling, 99(12), 2018-
2025, https://doi.org/10.1016/j.pec.2016.06.022
PICOT:
For acute care nursing staff caring adult patients (P) how does implementing the Braden skin risk stratification tool (I) compared to current practice (C) affect pressure injury rates (O) over 3 months (T).
Hospital-acquired Pressure injuries creates major financial strain to healthcare institutions ever since The Centers for Medicare and Medicaid Services have stopped reimbursement for all stage 3 and stage 4 hospital-acquired pressure injuries since 2008(CMS, 2020). The CMS considers stage 3 and 4 pressure injuries can be preventable harm to patients. Most pressure injuries can be prevented if effective measures are undertaken including a systematic skin assessment, risk assessment, bed & chair support surfaces, repositioning and mobilization, and nutritional support implemented (Bredesen et al.,2015). Risk assessment is a central component of Pressure Injury prevention (National Pressure Ulcer Advisory Panel and Alliance, 2019). It is important to use a valid and reliable assessment tool to identify high-risk patients and implement appropriate interventions for the prevention of pressure injuries. The practice of prevention of pressure injuries is the responsibility of all healthcare personnel. Nurses play the lead role in PI prevention and management, thus this practice should be initiated and directed by nurses which should be easy to use and incorporated into electronic medical record systems in such a way that they become part of the routine workflow (Rowe et al., 2018). The quantitative review and meta-analysis study by Huang et al.(2021) included studies from digital databases spanning over 32 years in the adult population which included hospitals and long-term care facilities, with a Braden risk score cut-off value of 10-20, The key findings were that the Braden skin risk scale was best applicable and most suitable for hospitalized Caucasian patients below 60 years of age, to identify at-risk patients for pressure injuries when 18 was the cut -off value determined at risk. The study concluded that the Braden score is one of the most widely used skin risk assessment scales due to its reliability and validity among other skin risk assessment tools.