coursework-banner

Evidence-Based Practice Project Proposal Presentation

NUR-590 Evidence-Based Practice Project Proposal Presentation

Evidence-Based Practice Project Proposal Presentation

Introduction & Purpose of the Presentation

The dissemination of evidence-based practice (EBP) information is an important part of effective care delivery for providers as it allows stakeholders to implement different changes to meet patient expectations. Dissemination involves the spread and sharing of clinical, research, and theoretical findings with goals of transitioning new knowledge to points of care (DeNisco, 2019). Dissemination requires organizations to have effective culture and be ready for change as well as selection of the best EBP model to implement new change. The use of Fall TIPS to reduce falls in medical-surgical units reduces the adverse effects of fall, improves patient safety and overall satisfaction. The purpose of this presentation is to disseminate the outcomes of the proposed EBP project for effective implementation in the medical-surgical unit to reduce the prevalence of patient falls.

EBP Project

The evidence-based practice process involve the integration of research findings, clinician’s care experience and patient preferences. EBP projects focus on optimizing providers and team conduct to support changes for patients to get quality care and reduce adverse effects of falls like injuries and associated complications and costs. Patient satisfaction and engagement are important while implementing EBP in health care settings. In this case, the need to reduce falls through tailoring interventions for patient safety (TIPS) is essential to offering quality care and considering the concerns that patients may have and critical to improving their response to safety measures by providers

PICOT Statement

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls by 20%(O) within 6 months (T)?

Organizational Culture and Readiness

Organizational culture which entails values, mission, vision and operational efficiencies is important on implementing or introducing changes to nursing units or workplace. The implementation of EBP project proposal to reduce falls through Fall TIPS approach requires organizations to have a change-oriented culture and values. Evaluation is essential as it allows project team to determine the level of readiness and acceptance of change. In this case, the organizational structure in the medical-surgical unit is positive. The findings from the Organizational Capacity Assessment Tool (OCAT) created by the United Nations Development Program (UNDP) shows that the unit has decentralized structure that allows engagement and participation of nurses to implement changes to improve the quality of patient care (Ratnapalan, 2019.

The OCAT tool assesses  overall readiness and highlights organizational capacities and strengths. Based on the model, the overall organizational culture and readiness for change is positive since the unit as part of the entire facility has capacities and strengths. These include having effective teamwork to improve communication, integration of providers’ perspectives when implementing new approaches to care, and better communication and effective collaboration among the internal stakeholders. Data analysis tools are also essential to improving overall efficacy of the proposed solution (DeNisco, 2019). The organizational culture also focuses on health promotion and saving lives through involvement of all stakeholders at different levels of care delivery.

Evaluation Plan

The main outcome is to reduce patient falls in the medical-surgical unit by 30% in six months of its implementation. The Fall TIPS will enable nurses and other providers to customize fall prevention intervention based patient’s conditions and preferences and not a one-fits-all approach. The EBP project will employ qualitative design implying that it will use questionnaires and focus groups to collect data. It will also observation to determine the level of implementation (Grove et al., 2019). The statistical test in this case would be the t-test because of its suitability to the project.

Using data collected through semi-structured questionnaires, the researchers will measure patient outcomes and experiences (Lengnick-Hall et al., 2020). They will then tabulate the data to determine if there are changes after the implementation of the Fall TIPS. The research will the deploy computation tools to determine rates of improvement based on the reduction of falls within the unit. Strategies to improve outcome will include re-examination of the implemented intervention through analyzing the process and all associated components at each level. The team will also formulate timelines and explore corrective measures to improve outcomes . The sustenance of the EBP will entail training, continuous monitoring of quality care, and creating teams that will review areas of concern and ensure that Fall TIPS integrate patients and concerns.

References

Amit-Aharon, A., Melnikov, S., & Warshawski, S. (2020). The effect of evidence-based

practice perception, information literacy self-efficacy, and academic motivation

on nursing students’ future implementation of evidence-based practice. Journal of

  professional nursing, 36(6), 497-502. DOI: 10.1016/j.profnurs.2020.04.001.

Centers for Disease Control and Prevention (CDC) (2021). Facts About Falls.

  https://www.cdc.gov/falls/facts.html

Grove, S. K., & Cipher, D. J. (2019). Statistics for Nursing Research-e-book: A workbook for evidence-based

  practice. Elsevier Health Sciences.

Lengnick-Hall, R., Willging, C. E., Hurlburt, M. S., & Aarons, G. A. (2020). Incorporators, early investors, and

learners: A longitudinal study of organizational adaptation during EBP implementation and

sustainment. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01031-w

Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing &

  Healthcare: A Guide to Best Practice. Wolters Kluwer.

Rebekah, G., & Ravindran, V. (2018). Statistical analysis in nursing research. Indian Journal of Continuing

Nursing Education,19(1), 62-70. https://www.ijcne.org/text.asp?2018/19/1/62/28649

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., … & Bates,

  1. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce

falls and injuries: a nonrandomized controlled trial. JAMA network open, 3(11),

e2025889-e2025889. doi:10.1001/jamanetworkopen.2020.25889

DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:

  Essential Knowledge for the Profession. Jones & Bartlett Learning.

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital

falls prevention with patient education: a scoping review. BMC Geriatrics, 20, 1-12. DOI:

https://doi.org/10.1186/s12877-020-01515-w

Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a

comprehensive bundled intervention for ED fall prevention. Journal of emergency

  nursing, 46(2), 225-232. DOI: 10.1016/j.jen.2019.11.010.

Ratnapalan, S. (2019). 37 Leading and managing change in healthcare organizations. BMJ

  Leader, 3(Suppl 1), A14-A14. http://dx.doi.org/10.1136/leader-2019-FMLM.37

Kelley, R. J. (2022). Preventing Falls in the Surgical Setting by

  Implementing a Fall Prevention Bundle.

  http://hdl.handle.net/10713/18736

Xia, L., Zheng, Y., Lin, Z., Chen, P., Mei, K., Zhao, J., … & Gu, Z.

(2022). Gap between risk factors and prevention strategies? A

nationwide survey of fall prevention among medical and

surgical patients. Journal of Advanced Nursing, 78(8), 2472-

  1. https://doi.org/10.1111/jan.15177

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized

patients: state of the science. Clinics in geriatric medicine, 35(2),

273-283. doi: 10.1016/j.cger.2019.01.007

Patient Safety Net (2019). Falls. https://psnet.ahrq.gov/primer/falls

 

 

Introduction

uAlcohol use disorder is a critical public health problem

uAffects health and wellbeing of patients, families and communities

uBehavioral interventions are effect for alcohol use disorder

uPICOT: In individuals suffering from alcohol use disorder (AUD) (P), does the use of behavioral treatments and coordinated care with other providers (I) compared to non-interventions (C) lead to improvement in handling of alcohol withdrawal symptoms and treatment of alcohol use disorder (0) within 12 months (T)?

Alcohol use disorder is a critical problem that affects a significant proportion of the population in the US. The statistics estimates shows that 25.8% of the adults aged 18 years and above in the US were victims of alcohol use disorder. Alcohol use disorder is recognized a mental disorder that contributes to premature mortality and loss of productivity. Nurses have a critical role to play in ensuring that appropriate care that addresses the needs of patients with alcohol use disorder is offered. Therefore, the purpose of this evidence-based practice project is to propose the use of behaviors strategies with care coordination to improve the withdrawal symptoms and alcohol use among patients with alcohol use disorder.

Hello! Nursing shortages continues to be an ongoing problem, and our patients are affected greatly when we continue to work short. Our patients are growing sicker and are requiring more time and care. Our nursing workload is increasing and the time that we are able to spend with our patients is decreased. When we have such as heavy workload, our time being spent collaborating with our patients and with the physician, decreases. This is where medical errors can happen and can lead to a poor communication amongst the interdisciplinary team, including our patients. Our patient’s quality of care decreases as well. Our patients are at a great risk for infection and poor outcomes when we are not able to spend time understanding and caring for their needs. Our nurses are having to take on such a great deal of workload that we are seeing an increase in our nurse burnout. Our nurses are being burned out by limited resources and shortages; our nurse satisfaction rates are going down. When nurses are feeling unsatisfied with their jobs, our patients care is also affected. Our nurses are not able to practice at the highest level that they can when they are feeling burned out, and unsatisfied with their positions. This is leading to an increase in workload and an increase in errors as well.  We are not able to spend our time and knowledge in using our critical thinking skills. We may not be able to notice with the decrease in time spend on patient care when something may be going on with our patients.

Organizational Culture and Readiness Assessment

uThe organization’s culture is characterized by teamwork

uThere the use of transformational leadership

uEncourages implementation of new practices for care provision

uHealthcare providers ready to implement change

The use of teamwork in undertaking tasks characterizes the culture of the organization. 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. 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. Healthcare providers have the required knowledge and skills to implement the proposed intervention.

uAnalysis sing the tool by Barwick showed the organization ready for change

uExamines functional considerations, organizational capacity, culture, senior leadership, implementation plan and training

uScored highly in most of the assessment areas

uFocus will be on organizational strengths to minimize weaknesses and barriers

The organizational readiness tool by Barwick (2011) was used for this analysis. The tool examines the readiness of an organization to

Evidence-Based Practice Project Proposal Presentation
Evidence-Based Practice Project Proposal Presentation

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. 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.

uThere is a need to improve human resource processes for successful implementation

uNeeds analysis will be done

uObjectives will be aligned with organizational mission

uStakeholders: nurse managers, nurse leaders, registered nurses, counselors, and psychiatric mental health nurse practitioners

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Evidence-Based Practice Project Proposal Presentation

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. Therefore, adequate staffing in the organization is recommended. 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. Staff training will be offered to ensure that they have the required knowledge and skills for the project implementation. 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.

Problem Statement

uAlcohol use disorder is associated with high incidence and prevalence rate

uContributes to premature mortality and loss of productivity

uBehavioral interventions are effective in improving withdrawal symptoms and alcohol abuse

uUse of behavioral interventions not explored in my institution

Approximately 25.8% of adults aged above 18 years old in America suffer from alcohol use disorder. The prevalence of the problem is reported to be high in men (29.7%) when compared to women (22.2%). The rate of visits to the emergency department due to the disorder increased 47% between the years 2006 and 2014. The mortality rates attributed to alcohol overdose is estimated to be 22.1%. The number of people that die due to alcohol-related causes is estimated to be 95000. The economic burden due to binge consumption of alcohol is enormous as seen from the fact that the US incurred losses of $249 billion in 2010 due to alcohol misuse (NIAA.NIH, 2020). Behavioral treatments have been shown to be effective in helping patients with alcohol abuse disorder manage their withdrawal symptoms and reduce binge intake of alcohol. Behavioral treatments enable patients to develop effective coping knowledge and skills that enable them to overcoming the cravings for alcohol (Carroll & Kiluk, 2017). The effectiveness of the treatments are long-lasting, and provide an effective approach to enhancing the effectiveness of pharmacological interventions utilized for the problem (Carroll & Weiss, 2017). Despite the existence of evidence support the use of behavioral treatments, their use in treating patients with alcohol abuse disorder has not been explored in my organization.

Literature Review

uLiterature analysis supports use of behavioral interventions and care coordination

uOptimizes care outcomes e.g. safety, quality and efficiency

uBehavioral interventions feasible

uEffects are long-lasting in managing alcohol use disorder

The reviewed studies showed that alcohol abuse disorder is a critical problem that affects a significant proportion of the American population. The effects can be seen from the high rate of alcohol misuse, loss of productivity, disability, and mortality due to the disorder. The reviewed evidence showed that alcohol use disorder can be managed effectively using behavioral interventions and care coordination. The interventions increase the development of effective coping skills by the participants towards symptoms of alcohol abuse. The consequence is the reduction in alcohol craving and urge for consumption by the affected populations. Behavioral interventions have sustainable effectiveness in patients with alcohol use disorder. The incorporation of care coordination results in enhanced outcomes in the treatment process. Therefore, the efficacy of the treatment informs its use in the proposed project.

Change Model

uTrans-theoretical model will be used

uExplores individual behavioral change and influencing factors

uGuides sustainable organizational change

uGuides assessment of the effectiveness of the change interventions

The implementation of the proposed project will be guided by the trans-theoretical model of change. The trans-theoretical model of change explores the ways in which people make decisions to change their behaviors. The model provides systematic approaches that can be utilized in healthcare to achieve sustainable change. It provides insights into the critical determinants of change that influence organizational success and performance. The trans-theoretical model is applicable to the proposed project because it provides insights into the ways in which the desired behavioral change to support the initiative can be introduced in the organization. It also provides information on the ways in which the stakeholders can assess the effectiveness of the project in achieving its objectives.

Stages of the Model

uPre-contemplation

uContemplation

uPreparation

uAction

uMaintenance

uTermination

The pre-contemplation phase is the first stage where the adopters of a proposed change do not intent to take any change to improve their performance or change their current situation. The second stage in the trans-theoretical model is contemplation. The adopters become aware of the need for change in their routines in this step. They demonstrate willingness to embrace change by exploring the ways in which their status quo can be improved. s in which their current behaviors are harmful to others and them. Preparation is the third step in the trans-theoretical model. Preparation is characterized by the individuals targeted by the change being ready to implement actions that would lead to a change in their behaviors. They engage in activities that would enable them to achieve the ultimate aim of behavioral change. The fourth step in the trans-theoretical model is action. Action is the process whereby the adopters of the change have begun adopting interventions that would ensure behavioral change. As a result, they have the motivation to continue improving their behaviors by incorporating behaviors that will contribute to further improved outcomes. Maintenance is the other stage in the trans-theoretical model. The individuals targeted by change in this step have incorporated the new changes into their daily routines. The focus is now placed on ensuring that relapse to earlier behaviors is prevented. They also work towards ensuring that their organization supports the change initiatives that were implemented to improve the care outcomes. Termination is the last stage where the desired behavioral change has been achieved.

Application of the Stages

uPre-contemplation: Participants unaware of change

uContemplation: Awareness about change increases

uPreparation: willingness to embrace change achieved

uAction: Exploration of other interventions for successful change

uMaintenance: Focusing on change sustainability

uTermination: Participants not ready to revert to their old behaviors

The pre-contemplation phase is the first stage where the adopters of a proposed change do not intent to take any change to improve their performance or change their current situation. The applicability of this stage to the project is that nurses and other healthcare providers will not be aware of the need for behavioral approaches for patients with alcohol use disorder. As a result, they do not show any intentions to change their behaviors to ensure that they can improve the health outcomes of the patients affected by the disorder. The second stage in the trans-theoretical model is contemplation. Nurses explore the ways in which behavioral interventions and car coordination will improve the withdrawal symptoms in patients with alcohol use disorder. Preparation is the third step in the trans-theoretical model. The applicability of this step to the proposed project is that the nurses will be ready to provide behavioral interventions to improve withdrawal symptoms in patients with alcohol use disorder. They implement the initiatives that are needed to ensure the desired change in treatment outcomes among patients with substance use disorder. The fourth step in the trans-theoretical model is action. The applicability of this stage to the project is that nurses would have determined the benefits of care coordination and the use of behavioral interventions in improving withdrawal symptoms and those associated with alcohol use disorder. Nurses are therefore motivated to explore the different ways in which the behavioral change can be sustained. Maintenance is the other stage in the trans-theoretical model. The applicability of this stage to the project is that nurses would have incorporated the new behavioral interventions and care coordination into their daily routines in caring patients with alcohol use disorder. The focus is on ensuring that the use of earlier interventions of patient care are not utilized anymore in the institution.

Implementation Plan

uSetting will be the psychiatric department

uParticipants will be patients suffering from alcohol use disorder

uInformed consent will be obtained

uTimeline will be 12 months

The setting for the proposed project will be the psychiatric unit in a tertiary hospital. The psychiatric unit addresses the care needs of different patients suffering from mental health problems that include alcohol use disorder. The potential subjects for the project will comprise mainly of patients diagnosed with alcohol use disorder. The participation of the subjects will be voluntary. As a result, informed consent will be obtained from them prior to their initiation in the project. The proposed timeline for the project is 12 months. It is expected that the timeline will be adequate to enable the undertaking of the entire project activities.

uHuman and financial resources needed

uEstimated budget is $68000

uNeed for changes in clinical systems and processes for success of the change

uQuantitative design will be used

uQuestionnaires for data collection

Human, financial and material resources will be needed for the project. Human resources will comprise of healthcare providers that will educate the selected participants about the use of behavioral interventions in minimizing withdrawal symptoms and symptoms of alcohol use disorder. The project will also require financial resources. Money will be needed for use in the purchase of the needed resources as well as remuneration of the healthcare providers who will be involved in the implementation of the project. Material resources will also be needed for the successful implementation of the project. The materials needed will include reading materials, booklets for patients, and projectors for the training. The successful implementation of the project will require a budget of $68,000. There will be a need for a change in clinical processes for the successful implementation of the project. Healthcare providers will be required to incorporate behavioral strategies into the interventions that they will utilize in caring patients with alcohol use disorder. The project will utilize quantitative design. The project will aim at determining the effect of the intervention on observed clinical outcomes. The clinical outcomes will be measured in numbers, making quantitative design the most appropriate. Outcome and process measures will be used in monitoring the implementation of the proposed intervention. Outcome measures will focus on whether the desired goals and objectives are being achieved at every stage of the project. Process measures will focus on the determination of the effectiveness of the interventions utilized to achieve the set outcomes. Questionnaires will be used for data collection. Questionnaires will provide both objective and subjective data about the project success and its effectiveness in enhancing the care outcomes for patients with alcohol use disorder (Schmidt & Brown, 2021).

uSystematic interventions for delivering the intervention to be used

uMultiple stakeholders will be needed

uPotential barriers: lack of interest among participants

uProject is highly feasible

The delivery of the intervention will require a number of interventions. The they will include performing organizational need assessment, seeking approval from the organization, training healthcare providers, monitoring and evaluation. Stakeholders will be needed for the successful implementation of the project. One of the stakeholders will be the healthcare providers. The healthcare providers will comprise mainly of the psychiatric mental health nurse practitioners and registered nurses working in the psychiatric department. The healthcare providers will be involved in the direct implementation of the project. They will provide health education and assistance to the patients about the use of behavioral interventions in managing withdrawal symptoms associated with alcohol abuse disorder. The other stakeholder will be nurse managers and leaders. The potential barrier that may be experienced in the implementation of the project is the lack of interest in the project by patients with alcohol use disorder. The patients may not be willing to participate in the project due to low level of awareness, perceived lack of time, and fear of the unknown outcomes of the project. The barrier will be addressed by providing adequate information to the patients about the importance of the project. The project is highly feasible for implementation in the organization. The organization has supportive culture that will ensure its successful implementation. It also has supportive leadership that will ensure the effective implementation of the project.

Evaluation Plan

uOutcomes: improvement in withdrawal symptoms, reduction in alcohol abuse, and sustainability of the change

uQuestionnaires for data collection

uValidity, reliability and applicability to be maintained

uMean will be calculated for the obtained data

One of the expected outcomes in the project will be the improvement in the withdrawal symptoms that patients experience in the project. The reduction in the symptoms is attributed to the development of coping skills by the participants. The other anticipated outcome of the project is the improvement in the symptoms of alcohol use disorder. It is also anticipated that the project utilization in the organization will be sustained. The effective tool for data collection that will be used in the project is questionnaires. Patients with alcohol use disorder that participated in the project will be provided with self-administered questionnaires to provide information about their experiences with the project. The validity of the questionnaires will be maintained by asking objective and relevant questions to the participants. Reliability will be achieved by undertaking a pilot test among the participants. Applicability will be achieved by ensuring that scientific methods of inquiry and data analysis are utilized in the project. Mean will be calculated for the data obtained in this project. Mean will provide an accurate measure of the effectiveness of the intervention in addressing the care needs of patients with alcohol use disorder.

uResponsive interventions will be adopted if positive outcomes are not achieved

uProject will be maintained if found positive

uExtended if outcomes are inconclusive

uRevised if strategies are ineffective

uDiscontinued if it has negative outcomes’

The first strategy that will be adopted if the results are not positive is revising the used interventions in the project. The lack of realization of the desired positive results will imply that the strategies that were used might have not aligned with the project outcomes. Revising the strategies may therefore improve the outcomes. The second strategy is examining the utilization of resources in the project. Efficient utilization of resources is likely to improve the project outcomes. Investigation of the manner in which the resources have been utilized may provide insights into the factors that might have led to poor outcomes. The project will be maintained if it is found to have positive effects on patients with alcohol use disorder. The project will be extended if the results obtained within the stated period are inconclusive. The project will be revised if the adopted strategies are found to be ineffective in delivering the anticipated outcomes. The project will be discontinued if found to have harm or negative effects to the participants.

Conclusion

uAlcohol use disorder is a critical public health problem

uAffects health, wellbeing, productivity and causes premature deaths

uBehavioral interventions and care coordination effective in its management

uIt is anticipated that the project will contribute to change in the organization

References

uBarwick, M. A. (2011). Checklist to Assess Organizational Readiness (CARI) for EIP Implementation. 5.

uCarroll, K. M., & Kiluk, B. D. (2017). Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychology of Addictive Behaviors, 31(8), 847–861. https://doi.org/10.1037/adb0000311

uNIAA.NIH. (2020). Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

uRay, L. A., Grodin, E. N., Leggio, L., Bechtholt, A. J., Becker, H., Feldstein Ewing, S. W., … & Koob, G. F. (2021). The future of translational research on alcohol use disorder. Addiction biology26(2), e12903. doi:10.1111/adb.12903

uRombouts, S. A., Conigrave, J., Louie, E., Haber, P. & Morley, K. C. (2019). Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings: protocol for systematic review. Systematic Reviews, 8(275). https://doi.org/10.1186/s13643-019-1157-7

uSlade, E., Dwoskin, L. P., Zhang, G. Q., Talbert, J. C., Chen, J., Freeman, P. R., … & Bush, H. M. (2021). Integrating data science into the translational science research spectrum: A substance use disorder case study. Journal of Clinical and Translational Science5(1).doi: https://doi.org/10.1017/cts.2020.521

The dissemination of evidence-based practice (EBP) information is an important part of effective care delivery for providers as it allows stakeholders to implement different changes to meet patient expectations. Dissemination involves the spread and sharing of clinical, research, and theoretical findings with goals of transitioning new knowledge to points of care (DeNisco, 2019). Dissemination requires organizations to have effective culture and be ready for change as well as selection of the best EBP model to implement new change. The use of Fall TIPS to reduce falls in medical-surgical units reduces the adverse effects of fall, improves patient safety and overall satisfaction. The purpose of this presentation is to disseminate the outcomes of the proposed EBP project for effective implementation in the medical-surgical unit to reduce the prevalence of patient falls.

The evidence-based practice process involve the integration of research findings, clinician’s care experience and patient preferences. EBP projects focus on optimizing providers and team conduct to support changes for patients to get quality care and reduce adverse effects of falls like injuries and associated complications and costs. Patient satisfaction and engagement are important while implementing EBP in health care settings. In this case, the need to reduce falls through tailoring interventions for patient safety (TIPS) is essential to offering quality care and considering the concerns that patients may have and critical to improving their response to safety measures by providers

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls by 20%(O) within 6 months (T)?

Organizational culture which entails values, mission, vision and operational efficiencies is important on implementing or introducing changes to nursing units or workplace. The implementation of EBP project proposal to reduce falls through Fall TIPS approach requires organizations to have a change-oriented culture and values. Evaluation is essential as it allows project team to determine the level of readiness and acceptance of change. In this case, the organizational structure in the medical-surgical unit is positive. The findings from the Organizational Capacity Assessment Tool (OCAT) created by the United Nations Development Program (UNDP) shows that the unit has decentralized structure that allows engagement and participation of nurses to implement changes to improve the quality of patient care (Ratnapalan, 2019.

The OCAT tool assesses  overall readiness and highlights organizational capacities and strengths. Based on the model, the overall organizational culture and readiness for change is positive since the unit as part of the entire facility has capacities and strengths. These include having effective teamwork to improve communication, integration of providers’ perspectives when implementing new approaches to care, and better communication and effective collaboration among the internal stakeholders. Data analysis tools are also essential to improving overall efficacy of the proposed solution (DeNisco, 2019). The organizational culture also focuses on health promotion and saving lives through involvement of all stakeholders at different levels of care delivery.

Falls are a major concern and public health issue because they affect quality of care and patient safety. The Centers for Disease Control and Prevention (CDC) (2021) observes that one in every four older people experiences falls. Close to 800,000 individuals are hospitalized each year due to falls, especially in critical care settings. more than 95% of hip fracture occur due to falls and falls are the most prevalent cause of traumatic brain injuries (Heng et al., 2020). The Centers for Medicare and Medicaid Services (CMS) categorize falls as never events since a majority of them are preventable. Falls also increase hospital stays and increase cost of care. Therefore, reducing falls is a critical part of improving patient safety ad overall care delivery (PSNet, 2019). Existing literature supports the use of Fall TIPS as an EBP intervention to reduce and prevent falls.

The proposed interventions should be appropriate through a review of existing literature consisting of previous research studies to support implementation and expected benefits to the targeted population. In this case, through a comprehensive search of the literature, one can ascertain if the interventions meets the stakeholders’ goals and aspirations (Zhao et al., 2018). The literature review for the project involved the definition and use of terms associated with Fall TIPS and its benefits for patients, especially in medical-surgical settings. The review also employed appropriate search engines and databases associated with the nursing issue to ensure that the generated articles focus on the problem under investigation (Khan et al., 2018). The main inclusion criteria included article published within the last five years, articles that capture aspects of the PICOT question and focus on effective interventions to reduce falls and efficacy of Fall TIPS implementation.

The proposed project reviewed several research studies based on the inclusion and exclusion criteria to ascertain support for the intervention to enhance patient safety and quality of care through fall prevention using the Fall TIPS model. Literature synthesis and critical analysis show increased support for the intervention of using Fall TIPS model to reduce falls. Studies by LeLaurin et al. (2019); Xia et al. (2022); Kelly (2022), and Dykes et al. (2020) agree that fall prevention bundles through the TIPS model reduce incidences of falls and improve overall patent safety. The studies show that Fall TIPS is effective and should be implemented on diverse settings that include medical-surgical units because of their benefits like being customized to meet patient needs and situations. The studies also emphasize the need for effective guideline for providers to enhance their adoption of fall TIPS in their practice settings.

The selected model is the Iowa EBP framework. The Iowa model focuses on the entire healthcare system and stakeholders who comprise of patients, practitioners, and infrastructure. The framework uses a problem-solving and implores staff to question the current nursing practices and if they can improve care through using current evidence. The model is effective for the project as it focuses on promoting quality care using EBP interventions (DeNisco, 2019). The initial stage of the model is identification and selection of a health problem while the second stage involved determining if the issue is healthcare organization’s priority areas for patient care (Melnyk & Fineout-Overholt, 2019). The third stage requires reflection about the issue of interest and engaging stakeholders while the fourth stage is to identify availability and merit of the chosen evidence (Cullen et al., 2020). The fifth stage entails implementation of a pilot change based on the available evidence and its credibility. The sixth stage is to appraise the pilot practice change based on the degree of success and subsequent dissemination of findings to the providers and organizations.

The project will be set in the medical-surgical unit/ward with the patients as the main participants. They will have informed consent and voluntary accept to participate in the study. The implementation timeline would be six months. The timeline will have different aspects as defined by the project scope and activities. Nurse training and requirement definition as well a project schedule will be part of these activities. Resources needed will include both financial and human for the implementation of the project. The project will employ a qualitative approach in collecting data. The qualitative approach is appropriate as it allows the use of different techniques like interviews, observation, review of literature and even focus groups (Tang, 2019). The implementation team will use an audit tool and a patient survey. The survey tool will collect feedback and opinions from participants on the effectiveness of the fall TIPS framework. Using these tools will help determine the overall effects of the Fall TIPS

The delivery of the intervention will entail having an inter-professional team consisting of different healthcare providers in the medical-surgical unit. The interventions will entail staff training on all components of the TIPS bundles, development of safe toileting, effective communication and patient education. The project will have different stakeholders who would include nurses and nurse leaders, nurse managers, project team and manager, trainers and patients as well as their families (Amit-Aharon et al., 2019). Others will be organizational management and health information technology vendors. The implementation plan will encounter barriers and challenges like resistance to change, limited resources to implement the plan, and insufficient knowledge and skills by nurses on Fall TIPS (Pop et al. (2020). There will also be facilitators like sufficient resource allocation. The project’s overall feasibility is high due to its cost-effectiveness and associated benefits to patients and the healthcare system.

The main outcome is to reduce patient falls in the medical-surgical unit by 30% in six months of its implementation. The Fall TIPS will enable nurses and other providers to customize fall prevention intervention based patient’s conditions and preferences and not a one-fits-all approach. The EBP project will employ qualitative design implying that it will use questionnaires and focus groups to collect data. It will also observation to determine the level of implementation (Grove et al., 2019). The statistical test in this case would be the t-test because of its suitability to the project.

Using data collected through semi-structured questionnaires, the researchers will measure patient outcomes and experiences (Lengnick-Hall et al., 2020). They will then tabulate the data to determine if there are changes after the implementation of the Fall TIPS. The research will the deploy computation tools to determine rates of improvement based on the reduction of falls within the unit. Strategies to improve outcome will include re-examination of the implemented intervention through analyzing the process and all associated components at each level. The team will also formulate timelines and explore corrective measures to improve outcomes . The sustenance of the EBP will entail training, continuous monitoring of quality care, and creating teams that will review areas of concern and ensure that Fall TIPS integrate patients and concerns.

References

Amit-Aharon, A., Melnikov, S., & Warshawski, S. (2020). The effect of evidence-based

practice perception, information literacy self-efficacy, and academic motivation

on nursing students’ future implementation of evidence-based practice. Journal of

  professional nursing, 36(6), 497-502. DOI: 10.1016/j.profnurs.2020.04.001.

Centers for Disease Control and Prevention (CDC) (2021). Facts About Falls.

https://www.cdc.gov/falls/facts.html

Grove, S. K., & Cipher, D. J. (2019). Statistics for Nursing Research-e-book: A workbook for evidence-based

  practice. Elsevier Health Sciences.

Lengnick-Hall, R., Willging, C. E., Hurlburt, M. S., & Aarons, G. A. (2020). Incorporators, early investors, and

learners: A longitudinal study of organizational adaptation during EBP implementation and

sustainment. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01031-w

Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing &

  Healthcare: A Guide to Best Practice. Wolters Kluwer.

Rebekah, G., & Ravindran, V. (2018). Statistical analysis in nursing research. Indian Journal of Continuing

Nursing Education,19(1), 62-70. https://www.ijcne.org/text.asp?2018/19/1/62/28649

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., … & Bates,

  1. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce

falls and injuries: a nonrandomized controlled trial. JAMA network open, 3(11),

e2025889-e2025889. doi:10.1001/jamanetworkopen.2020.25889

DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:

  Essential Knowledge for the Profession. Jones & Bartlett Learning.

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital

falls prevention with patient education: a scoping review. BMC Geriatrics, 20, 1-12. DOI:

https://doi.org/10.1186/s12877-020-01515-w

Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a

comprehensive bundled intervention for ED fall prevention. Journal of emergency

  nursing, 46(2), 225-232. DOI: 10.1016/j.jen.2019.11.010.

Ratnapalan, S. (2019). 37 Leading and managing change in healthcare organizations. BMJ

  Leader, 3(Suppl 1), A14-A14. http://dx.doi.org/10.1136/leader-2019-FMLM.37

Kelley, R. J. (2022). Preventing Falls in the Surgical Setting by

  Implementing a Fall Prevention Bundle.

http://hdl.handle.net/10713/18736

Xia, L., Zheng, Y., Lin, Z., Chen, P., Mei, K., Zhao, J., … & Gu, Z.

(2022). Gap between risk factors and prevention strategies? A

nationwide survey of fall prevention among medical and

surgical patients. Journal of Advanced Nursing, 78(8), 2472-

  1. https://doi.org/10.1111/jan.15177

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized

patients: state of the science. Clinics in geriatric medicine, 35(2),

273-283. doi: 10.1016/j.cger.2019.01.007

Patient Safety Net (2019). Falls. https://psnet.ahrq.gov/primer/falls

Propose strategies for disseminating your evidence-based practice project proposal. Consider the necessary stakeholders who need to review or approve the proposal (both internal and external) and what methods you will use to communicate. 

Dissemination is an important step in the evidence-based practice project. By disseminating the information to stakeholders you are informing them of the evidence and outcomes you have found and produced within your project. This is a necessary step to facilitate uptake and adoption of interventions to improve patient outcomes (Cunnigham-Earves, 2020). The right stakeholders need to be involved with receiving and presenting the information within the project. In order for the project to induce a practice change it must be convincing to the stakeholders involved in allowing for that practice change. The evidence can speak for itself but it is important to consider who the key stakeholders are for the intervention to stick and sustain into practice. Some traditional strategies involved in disseminating information are meetings (virtual or in person), conference presentations or posters, academic journals, and academic social media groups. It is important to consider the target audience for this intervention involving adolescent sickle cell patients. There are internal and external stakeholders involved in this intervention and the dissemination of this project needs to be carefully considered to encourage acceptance among stakeholders. For the internal stakeholders at the leadership level who will be involved in accepting the practice change into policy the idea of a presentation showcasing the positive outcomes and evidence created through the project. This presentation can be recycled to some of the other stakeholders involved to show the positive work that was done on their behalf. For the external stakeholders it may be more important to consider a presentation at a local or national conference or virtual meeting with small groups to disseminate the data and evidence to increase alliance with the intervention. 

 

Reference: 

 

Cunningham‐Erves, J. Tilicia Mayo‐Gamble, Vaughn, Y., Hawk, J., Helms, M., Barajas, C., & Joosten, Y. (2020). Engagement of community stakeholders to develop a framework to guide research dissemination to communities. Health Expectations, 23(4), 958-968. Engagement of community stakeholders to develop a framework to guide research dissemination to communities – ProQuest