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NUR-590 Evidence-Based Practice Project Presentation

NUR-590 Evidence-Based Practice Project Presentation

NUR-590 Evidence-Based Practice Project Presentation

Introduction and Objectives

Patient safety and need to reduce hospital acquired infections (HAIs)

Hand hygiene Measure among Healthcare Workers in Pediatric settings

Integration of EBP interventions into Care Practice

Purpose of the Presentation

Achieving patient safety implores nurses and other healthcare professionals to develop interventions that improve quality care and reduces occurrence of hospital acquired infections (HAIs). The use of evidence-based practice interventions like hand hygiene protocols and measures that include handwashing with soap and water alongside sanitizers can prevent and reduce the prevalence of hospital acquired infections (Zhao et al., 2017). Nurses in pediatric care settings should set high levels of hygiene to minimize the occurrence of HAIs in these settings. The integration of EBP interventions mitigates the increasing prevalence of HAIs and their associated cost burden to patients, their families and the health care system (Akanji et al., 2017). Hospital acquired infections constitute a significant part of the increased mortality and morbidity and poor outcomes among pediatric patients. The purpose of this presentation is to detail the evidence-based practice project proposal on hand hygiene measures involving handwashing with soap and water alongside use of hand sanitizer by healthcare workers, especially nurses, in reducing and preventing the occurrence of hospital acquired infections in pediatric care settings.

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.

EBP & PICOT Statement for EBP Project

Purpose of EBP

Optimize

Provide

Encourage

Enhance

Decrease

Evidence-based practice continues to be a critical component of enhancing care delivery among patients in different settings. The use of EBP entails incorporation of research evidence together with patient preferences and clinician’s care experience. Evidence-based practice aims at optimization of provider and team behavior to support changes in patient conduct to attain quality care, and provides education to reduce the risks of hospital acquired infections and improve different aspects of care provision (Melnyk & Fineout-Overholt, 2019). EBP also encourages the use of resources and services, and improvement in patients and their families’ satisfaction (Zhao et al., 2018). The EBP project will also focus on enhancing patient safety, improving adherence to hand hygiene measures, and improving outcomes and quality management to reduce adverse events. The project also focuses on decreasing the overall cost of infections, length of stay, and readmissions, and ensure that providers can make better care decisions in managing adverse events resulting from HAIs. The PICOT Question for the project is

Among healthcare worker in pediatric settings (P), how does handwashing with soap and water alongside hand sanitizer (I), compared to handwashing with soap and water alone (C), reduce hospital acquired infections (O), with six months (T)?

Organizational Culture & Readiness

Culture & Support for Change Level

Decentralized and Hierarchy-based model

Patient-centered mission

Focus on Health promotion and Saving Lives

Organizational culture is an essential part of implementing change as it mirrors values, mission, and vision and employee perception to adopting new ways of doing things. A decentralized and hierarchical culture where employees get involved in decision-making and has robust values and norms leads to effective implementation of EBP project proposal. The proposed structure enhances employee motivation and diversification. Decentralization improves communication and ensures implementation of new approaches to doing things to enhance quality care (Melnyk & Fineout-Overholt, 2019).  Organizations ready to implement the proposed EBP interventions should focus on patient-centered care and health promotion to save lives in pediatric settings.

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The project uses the Organizational Capacity Assessment Tool (OCAT) developed by the United Nations Development Program (UNDP). The tool assesses overall readiness to enhance health interventions in organizations. The tool identifies substantive capacities and strengths that exist and the need for more to attain expected outcomes. Implementing the proposed EBP requires organizations to have capabilities and resources with a superb culture based on their mission, purpose and best values. Threats to readiness include need for resources to implement the project and technologies to reduce HAIs. Teamwork leads to effective flow of information to implement the project and attain expected outcomes.

Organizational culture is an essential part of implementing change as it mirrors values, mission, and vision and employee perception to adopting new ways of doing things. A decentralized and hierarchical culture where employees get involved in decision-making and has robust values and norms leads to effective implementation of EBP project proposal. The proposed structure enhances employee motivation and diversification. Decentralization improves communication and ensures implementation of new approaches to doing things to enhance quality care (Melnyk & Fineout-Overholt, 2019).  Organizations ready to implement the proposed EBP interventions should focus on patient-centered care and health promotion to save lives in pediatric settings.

The project uses the Organizational Capacity Assessment Tool (OCAT) developed by the United Nations Development Program (UNDP). The tool assesses overall readiness to enhance health interventions in organizations. The tool identifies substantive capacities and strengths that exist and the need for more to attain expected outcomes. Implementing the proposed EBP requires organizations to have capabilities and resources with a superb culture based on their mission, purpose and best values. Threats to readiness include need for resources to implement the project and technologies to reduce HAIs. Teamwork leads to effective flow of information to implement the project and attain expected outcomes.

Organizations that seek to implement the proposed EBP should enhance their patient-handling processes with a focus on improved quality care to reduce infections by better hand hygiene measures and protocols. Data-analysis tool using a collaborative approach will enhance dissemination of evidence to the entire care team. The deployment of Trans-theoretical model will allow the organizations to prepare for change by aligning their interventions with their needs. These include skills’ training and motivation policies to enact changes to focus on solutions (Melnyk & Fineout-Overholt, 2019). The integration of technology is also critical to enhancing organizations’ readiness since it improves gathering of intelligence.

The stakeholders include healthcare professionals in these settings comprising of nurses, physicians and other professionals and the management. External stakeholders comprise of patients and their familiescare (Melnyk & Fineout-Overholt, 2019). Further, the integration of the Project team and management highlights the importance of ensuring that the organization is ready while use of health information technologies like Telehealth leads to better understanding of the underlying issues to enhance patient safety based on existing deployment and their role in enhancing access and quality care.

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.

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