Discussion: Application of EBP

Question Description
Discussion: Where in the World Is Evidence-Based Practice?

RE: Discussion – Week 1 Reply #1 Messix, J

Hi Kathleen. I appreciated reading your informative post. I chose to write my main post on the facility that I am employed by. It was nice to gain your point of view regarding a world-renowned institute.

One of the PMHNP’s that worked with me until just a few months ago was employed by The National Institutes of Health (NIH) for over a decade. She has given me many examples of the way her role there helped to shape the PMHNP she is today. Because of her professional history with some of the providers and researchers there, she made them her first point of contact when she sustained debilitating symptoms for 3 days following receiving her first COVID vaccination. She informed me of her wealth of respect for the research efforts that are conducted there and the care that is provided.

According to Thomas (2018), organizational culture is defined as the various beliefs, values, assumptions, and interactive strategies contributing to an organization’s unique social and psychological environment. Positive working culture is developed when employees and employees share aligned values with each other and the organization. To ensure the success of organizational culture, the first step is for all employees and employers to clearly understand the organization’s values and the belief of the organization. Barriers caused by an organizational culture can cause nursing leaders to feel powerless, and one of those barriers is a negative environment. For example, having a facility or hospital poorly managed by administration personnel or having an administration team that does not communicate with front-line staff creates low workplace morale. When there is a negative environment created around front-line staff, there is a lack of production, increased call-outs, and high turnover rates. “Authority Is maintained centrally, reducing the effectiveness of front-line staff” (Jackson et al., 2021). Employees begin to feel excluded start to feel that the facility or hospital is not ensuring their beliefs and values stay aligned in the best interest of the patients.

Per the instructions for this reply post, I looked up the NIH website to gain insight into the information you provided. I first looked at the mission and goals statements and quickly discovered that evidence-based practice is mentioned in their goals. According to NIH, one of their goals includes, “…to develop, maintain, and renew scientific resources…” (NIH, 2018). Next, I searched evidence-based practice and was able to find a web page dedicated to EBP that includes two manuals that anyone can use to research recommendations of best practices. (NIH, 2021). I was excited to find these manuals and plan to use them to conduct research on best practices for my behavioral health inpatient, outpatient, and emergency psychiatric service teams at work.

Based on the information I gained from my former co-worker, the education I gained from your post, and the knowledge I gained from my own search, my opinion remains high of the work that NIH does. It is evident to me that NIH uses evidence-based practice as its guiding force in its approach to healthcare.

References

National Institutes of Health (NIH). (2017). Mission and goals. Accessed on 09/02/2021. https://www.nih.gov/about-nih/what-we-do/mission-goals

National Institutes of Health (NIH). (2021). Evidence-based practice and programs. Accessed on 09/02/2021.

https://prevention.nih.gov/research-priorities/dissemination-implementation/evidence-based-practices-programs

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

The Affordable Care Act included a requirement for empirical evidence when it was passed. EBP research has grown significantly. The use of EBP has spread to allied health professions, education, healthcare technology, and other fields. EBP was adopted and promoted by health organizations.

This adoption will be discussed in this Discussion. You will examine the websites of healthcare organizations and determine how much EBP is used by these organizations.

To Get Ready:

Examine the resources and consider the definition and goal of EBP.

Select the website of a professional healthcare organization (e.g., a reimbursing body, an accredited body, or a national initiative).

Investigate the website to see where and how much EBP is present.

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Post a description of the website of the healthcare organization you visited. Describe where, if anywhere, EBP appears (for example, in

the healthcare organization’s mission, vision, philosophy, and/or goals, or elsewhere on the website). Then, explain whether or not the work of this healthcare organization is based on EBP. Finally, explain how the information you discovered on the healthcare organization’s website has changed your opinion of the organization. Provide specifics and examples.

Resources:

Melnyk, B. M., and E. Fineout-Overholt (2018). Evidence-based nursing and healthcare practice: A guide to best practice (4th ed.). Wolters Kluwer, Philadelphia, PA.

Making the Case for Evidence-Based Practice and Cultivating an Inquiry Spirit (pp. 7-32)

(www.mbsdirect.vitalsource.com)

User name:lenickbermudez@gmail.com

Password:Maria0724

https://academicguides.waldenu.edu/az.php?s=19981

Articles:

J. Boller (2017). Nurse educators: Navigating the quadruple aim sweet spot in health care. doi:10.3928/01484834-20171120-01. Journal of Nursing Education, 56(12), 707-708.
E. Crabtree, E. Brennan, A. Davis, and A. Coyle (2016). Improving patient care through evidence-based nursing practice. doi:10.1111/wvn.12126. Worldviews on Evidence-Based Nursing, 13(2), 172-175.
S. C. Kim, J. F. Stichler, L. Ecoff, C. E. Brown, A.-M. Gallo, and J. E. Davidson (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among participants in a regional fellowship program. doi:10.1111/wvn.12171. Worldviews on Evidence-Based Nursing, 13(5), 340-348.
B. M. Melnyk, E. Fineout-Overholt, S. B. Stillwell, and K. M. Williamson (2010). Step by step evidence-based practice Evidence-based practice’s seven steps. 51-53 in the American Journal of Nursing. doi:10.1097/01.NAJ.0000366056.06605.d2. 5-Melnyk, B. M., Gallagher-Ford, L., Long, L. E., and Fineout-Overholt, E. Retrieved from http://download.lww.com/wolterskluwer vitalstream com/PermaLink/NCNJ/A/NCNJ 165 516 2010 08 23 DGSODKGNM 1651 SDC516.pdf (2014). The development of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: skills to improve healthcare quality, dependability, patient outcomes, and costs. Evidence-Based Nursing Worldviews, 11(1), pp. 5-15. doi:10.1111/wvn.12021. doi:10.1111/wvn.12021 retrieved from https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/wvn.12021

6-R. Sikka, J. M. Morath, and L. Leape (2015). The Quadruple Aim: Workplace care, health, cost, and meaning. 608-610 in BMJ Quality & Safety. doi:10.1136/bmjqs-2015-004160. URL: https://qualitysafety.bmj.com/content/qhc/24/10/608.full.pdf

7. https://academicguides.waldenu.edu/az.php?s=19981

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RE: Discussion – Week 1

COLLAPSE

Response Post #1

Emotongha, thank you for your post! The American Nurses Association (ANA) is a well-known organization in the nursing community. I remember being introduced to the ANA in nursing school and signing up for a membership at that time. The ANA website clearly shows that this organization has a strong foundation of evidence-based practice (EBP). There are a multitude of CEU’s available that are focused on EBP. A CEU that is currently available is calling, “Making Data Work for Nursing: Using Nursing Research and Evidence-based Practice to Affect Nursing Outcomes.” (ANA, 2021). This course is focused on providing research and best practices available regarding recovering medication errors to improve patient safety. The ANA also has a strong stance on issues such as the importance of safe nurse staffing, fighting workplace violence, and Medicare reform (ANA, n.d.). additionally, the ANA website has a news section where nurses can find the most up-to-date health care information so they can work to improve their practice and improve health care for everyone.

References

About ana: Ana enterprise. ANA. (n.d.). https://www.nursingworld.org/ana/about-ana/.

Making data work for nursing: Using nursing research and evidence-based practice. ANA. (2021). https://www.nursingworld.org/continuing-education/online-courses/making-data-work-for-nursing-using-nursing-research-and-evidence-based-pra-d28449e4/.

RE: Discussion – Week 1

COLLAPSE

The National Institutes of Health (NIH) is a medical research center that discovers new, fundamental knowledge in order to apply it to life and reduce illnesses (NIH, 2017). A few goals of the organization include creating discoveries to improve the health of individuals and preventing disease by renewing scientific physical resources (NIH, 2017). The website includes many resources about the organization, health conditions and drug information. There are many branches of the NIH such as the National Cancer Institute, National Institute on Aging and National Institute on Drug Abuse (NIH, 2019).

The NIH uses evidence based practice in order to prevent diseases that may negatively impact public health. There is a surplus of research shown on the website that includes evidence based practice. There are links about improving sickle cell disease research and preventing college drinking. The NIH works with the Centers for Disease Control and Prevention to create such important discoveries.

My perception of NIH was always positive, but doing my own research on the website made an even bigger impact on my opinion of the organization. Each part of the website is broken down to find anything that a person is looking for. I am able to look for medical research initiatives, research resources, science highlights and much more. The website is very transparent with the public, which is something I love when it comes to science.

References

National Institutes of Health. (2017). Mission and Goals. https://www.nih.gov/about-nih/what-we-do/mission-goals

National Institutes of Health. (2019). List of NIH Institutes, Centers and Offices. https://www.nih.gov/institutes-nih/list-nih-institutes-centers-offices

Discussion – Week 1 Michelle Olson

COLLAPSE

Main Post-Michelle Olson

Description of The Joint Commission

According to The Joint Commissions’ (TJC) webpage, they are the oldest and largest standard-setting and accrediting body in health care. TJC Board of Commissioners is comprised of physicians, administrators, nurses, quality experts, consumer advocates, and educators (The Joint Commission, 2021a). The mission of TJC is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Its vision is that all people experience the safest, highest quality, best-value health care across all settings (The Joint Commission, 2021b). To improve patient outcomes TJC acknowledges the significance of utilizing evidence-based practice (EBP) (Melnyk & Fineout-Overholt, 2018). TJC standards are revised consistently to reflect the developments and improvements made through rigorous research and data collection (The Joint Commission, 2021c).

The Joint Commission and Evidence-Based Practice

Evidence-based practice (EBP) is embedded in the standards that TJC promotes in its accrediting process for health care organizations. According to the TJC webpage, standards are established through the scientific literature, including EBP, expert agreement, and evaluated by the Board of Commissioners. Additional standards are added when they correspond to increase in quality of care, patient safety, positively affect health outcomes, meet, or improve law and regulation, and can be specifically measured (The Joint Commission, 2021d). When a health care facility incorporated EBP in its system, it improves patient outcomes, empowers staff, decreases cost, and overall enhances the quality of healthcare delivered (Melnyk & Fineout-Overholt, 2018). When a healthcare system combines EBP with the accreditation of TJC, the facility is making a firm declaration that they deliver the highest quality of care to all (The Joint Commission, 2021e).

The Joint Commission Accreditations are Grounded in Evidence-Based Practice

The TJC standards are developed around quality and safety issues that are defined by EBP or with TJC committee discussions; draft standards are developed through advisory panels, focus groups, experts, and other stakeholders and are then distributed nationally for review and made available for comment on the standards field review page of the Joint Commission website. After this rigorous review process, the standards are reviewed and approved by executive leadership and then published for health care field use. Improvements are made as needed when new literature and evidence are published Finally, open-ended feedback is pursued to establish continuous improvement (The Joint Commission, 2021d). An example of a standard that TJC is currently focusing on is antibiotic stewardship. Improving the use of antibiotics and preventing antibiotic-resistant infections is a safety priority (The Joint Commission, 2021d). By having this process in place when developing standards and surveying organizations, there is an assurance that EBP is utilized.

Personal Perception of The Joint Commission

TJC accreditation process does hold a health care system and the staff employed there accountable to carry out EBP to achieve the best possible patient outcomes. Unfortunately, many healthcare systems have difficulty implementing EBP due to lack of knowledge, resistance to change due to the cultural environment, negative attitude towards EBP, lack of time and resources to evaluate EBP, administrative resistance, and lack of autonomy (Melnyk & Fineout-Overholt, 2018). To overcome these barriers having an accrediting body such as TJC helps break down the obstacles in utilizing EBP and will help facilitate changes as the standards are formulated around EBP. When TJC surveys an organization, the major stakeholders are aligned, administrative support is called upon, committees are developed to produce strong EBP policies. and procedures and guide sustainability (Melnyk & Fineout-Overholt, 2018). According to Crabtree et al. (2016), organizational cultures can be changed and enhanced through education and mentorship. Educational programs related to EBP increase in the application of EBP resources, improve skills and knowledge, and adjust attitudes towards EBP (172-175). After researching the TJC website and reading the resources on EPB and the quadruple aim, I feel strongly that TJC is a worthy accrediting body for health care systems.

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. https://doi.org/10.1111/wvn.12126

Melnyk, B.M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4^th ed.). Philadelphia, PA: Wolters Kluwer

The Joint Commission. (2021a). Facts about the joint commission. https://www.jointcommission.org/about-us/facts-about-the-joint-commission/

The Joint Commission. (2021b). Mission and Vision. https://www.jointcommission.org/about-us/#08ceda0dc745434fb6891232e0290e82_e39ab377a6ae4acc99142664a6e4548e

The Joint Commission. (2021c). Joint commission FAQs. https://www.jointcommission.org/about-us/facts-about-the-joint-commission/joint-commission-faqs/

The Joint Commission. (2021d). About our standards. https://www.jointcommission.org/standards/about-our-standards/

The Joint Commission. (2021e). Why achieve accreditation. https://www.jointcommission.org/accreditation-and-certification/become-accredited/why-achieve-accreditation/

RE: Discussion – Week 1, Main Post

COLLAPSE

Evidence-based practice became a common theme in healthcare in 2010 when the Affordable Care Act was implemented, and subsequent reimbursement was based on the quality of the healthcare provided. (Laureate, 2018a). Maryland hospitals receive their reimbursement based upon providing the best patient outcomes. Best patient outcomes occur when evidence-based practice is incorporated into the patients’ plan of care. High-quality healthcare measures such as readmission rates are used to determine the amount of reimbursement an organization receives. This concept is known as a global budget. Evidence-based practice leads to better outcomes and better outcomes lead to increased patient satisfaction, which is one of the 4 aspects of the quadruple aim. (Laureate, 2018b). Improved patient outcomes maximize the revenue for hospitals that operate under a global budget. This is a win-win situation for both the healthcare organization and the consumer.

I am providing a review of Calvert Health Medical Center’s website as this is my place of employment. Despite being employed by this organization as a clinical leader, I can attest to the fact that I have not viewed the external website previously. Employees of CHMC utilize the intranet daily, but what I came to realize is that the information that the public receives from the external website is drastically different. Completion of this assignment allowed me to gain perspective through the lens of a prospective patient.

Calvert Health Medical Center (CHMC) is a small, rural, independent hospital located in Southern Maryland. This hospital facility is 102 years old and serves over 400 patients, on average, per day. CHMC provides specialty services such as diagnostic imaging, surgical services, and behavioral health treatment to those who seek care.

The behavioral health service line at CHMC includes emergency psychiatric services (EPS), partial hospital programming (PHP), and acute inpatient levels of care. The EPS team is comprised of social workers who assess patients coming into the emergency department and determine what level of care is most appropriate. PHP is an outpatient program that is comprised of nurses, counselors, social workers, and psychiatric nurse practitioners. This program serves adolescent and adult populations. Acute inpatient also accepts both adolescent and adult patients however the criteria for this level of care is stringent and is reserved for individuals who are suicidal, homicidal, or who lack the capacity to make appropriate decisions for themselves.

Upon reviewing CHMC’s website, I was immediately able to find its mission and vision statement. Their mission statement includes the term “high-quality healthcare”, indicating that evidence-based practice is at the forefront of the care they provide. (CHMC, 2021). I continued my search throughout their website to find more examples of the use of evidence-based research and was pleased to see terms like, “embracing opportunities for change through innovation” and “increasing compliance with best-practice standards” easily found. (CHMC, 2021).

My perception of CHMC and the services they provide has not changed. I am proud to be employed at this facility and I know that the words on their website are more than just words. There is a clear representation of their dedication to providing compassionate and effective care to the local community. As an employee, I can attest to the fact that our patients truly matter and the care we provide is always with the patient’s best outcome in mind.

References

Calvert Health Medical Center (CHMC). (2021). Mission & vision. Accessed on 08/30/2021.

https://www.calverthealthmedicine.org/Mission-Vision-Values

Laureate Education (Producer). (2018a). Evidence-based practice and the quadruple aim [Video file]. Baltimore, MD: Author. Accessed on 08/30/2021.

https://class.content.laureate.net/e629d0f21e13d5ab08d41efb3539f10d.html

Laureate Education (Producer). (2018b). Introduction to evidence-based practice and research [Video file]. Baltimore, MD: Author. Accessed on 08/30/2021.

https://class.content.laureate.net/e629d0f21e13d5ab08d41efb3539f10d.html