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NUR 590 Evidence Based Practice Project Week 2 Discussion

NUR 590 Evidence Based Practice Project Week 2 Discussion

NUR 590 Evidence Based Practice Project Week 2 Discussion

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DQ1 Do you foresee any issues with implementation of your project? Identify stakeholders who could assist in supporting you, and any theoretical frameworks (organizational change, leadership, role-specific) or models that could help you adapt.

Translational research appears to be a tool used to close the gap between evidence-base practice and the clinical delivery of direct nursing care. It is described as a way to improve population health and the delivery system. Translational science looks for ways to implement evidence based practice, so being something entirely different than EBP, it works hand in hand with EBP to improve patient outcomes. Translational research digs in to make a clear understanding of what implementation strategies work, the people they work for and answers the question of why. This body of knowledge, translation science, provides a base for guiding the selection of implementation strategies. (Titler, 2018) The are levels of translational research, T1 developing treatments and interventions, T2 testing the effectiveness of those treatments and interventions and T3 is dissemination and implementation for change. In addition another resource describes 5 phases beginning with T0 through T5. T0 starts with basic research, preclinical. T1 is testing on a small group of humans, T2 and T3 are more trials on an even larger group of humans. T4 is the outcome research / translation to practice and lastly T5 goes out to the population or translation to the community. This type of research seems more hands on and creates positive outcomes to the patients who are in need of direct and immediate care.

As with any project implementation its best to envision any potential issues before they arise. Therefore, I anticipate a few potential issues with the proposed implementation of my project. The first foreseen issue identified for the proposed implementation of my evidence-based project are financial concerns and will continue to be an ongoing concern. I was able to identify a couple of strategies to help with the financial concerns including executive leadership engagement in the process. Being fully transparent with the executive leadership team regarding the implementation plan including cost and methods of saving will aid in gaining their support. Another financial strategy would be to develop a team of subject matter experts/educators on the Physician Orders for Life-Sustaining Treatment (POLST) program utilizing the system Respecting Choices Model within the system. With the

development of the program within the system there will be a reduction in further cost to outside resources.

The second foreseen issue is a lack of clinician buy in to the program and change management. In order to address this area education, engagement, and communication are necessary strategies. The education will include up-to-date best practices, refresher courses, audit, and review. The engagement strategies include ensuring confidence in their work, standardized workflow, ensuring collaboration and stakeholder involvement. The communication strategies include ongoing updates on education and engagement opportunities, events, current POLST literature, and development of newsletter.

The third anticipated problem is a lack of quality in the POLST process and order sets. The quality of the work is a multifactorial issue that is heavily reliant on the first two foreseen issues. “The quality of POLST documentation is only as good as the preceding conversations” (Abbott, 2019, p. 297). As a result, if there is a lack of financial support or clinician buy-in, POLST quality will suffer.

Also Read: NUR 590 Evidence Based Practice Project Week 1 Discussion

Research on POLST implementation is actively being reviewed and updated therefore in order to  ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.

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I anticipate problems with the proposed implementation of my project, including financial difficulties. My research focuses on the importance of continuous CPR during defibrillation. For many decades, the focus of CPR was on airway, breathing, and circulation. The American Heart Association recently announced that circulation would be prioritized over cardiopulmonary resuscitation (American Heart Association., n.d.). This means that early and continuous high-quality compressions have been shown to improve circulation and perfusion during CPR, thereby improving patient outcomes. Interruptions in chest compressions lasting more than 10 seconds, according to Clark et al., 2019, are associated with poor outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting physicians and nurses on board with the new evidence-based practice is a major impediment to implementation.

It is extremely difficult to change people’s habits, particularly if they have been doing so for a long time. A significant amount of education and support from leadership, as well as clinical education, will be required to encourage staff buy-in to this new practice. Furthermore, simulation studies revealed that ECG devices and the LUCUS device were the most beneficial for performing continuous compressions during defibrillation. These devices are extremely expensive and may be beyond the financial means of small rural community hospitals. Due to a lack of funding, small community hospitals will be unable to provide patients with the most up-to-date evidence-based practice care. This is a barrier not only to implementation, but also to providing the best possible care to the patient.

Organizations utilize readiness assessment tools to understand their strengths, weaknesses, threats, and opportunities to explore for their competitiveness and performance. The tools also assess the motivation of the staff to implement change initiatives in their practice. different tools can be used in undertaking organizational readiness assessment. The two tools of interest in this discussion question are the Organizational Readiness to Change Assessment (ORCA) tool and Kotter’s Eight Step change model. ORCA is an organizational readiness assessment tool that determines an institution’s readiness to adopt evidence-based interventions in clinical care. The tool has three scale that measure the quality of organizational context in supporting change, organizational capacity to facilitate the needed change, and strength of evidence associated with a proposed change (Crittendon et al., 2020; Santos, 2021).

Kotter’s Eight Step change model of change is another tool that can be used to assess organizational readiness for change. The model adopts stepwise approach in assessing the need for, introducing, improving, and sustaining change. According to Kotter, change occurs in eight steps that include creating urgency, establishing a team, creating vision and strategies, communicating the vision, removing obstacles, setting short-term goals, keeping change momentum, and ensuring the change sticks to an organization (McMullin, 2020). The use of Kotter’s model ensures the incremental, systematic introduction of change, which can be sustainable in an organization.

The most appropriate tool for assessing my organization is the ORCA tool. The ORCA tool has extensively been used in implementing evidence-based initiatives. The tool provides a multifaceted understanding of the different factors that will affect change process in an organization. It is also easy to use since it does not have several steps that change process must undergo for it to be successful.

 

 

References

Crittendon, D. R., Cunningham, A., Payton, C., Mills, G., Kelly, S., LaNoue, M., & Arenson, C. (2020). Organizational Readiness to Change: Quality Improvement in Family Medicine Residency. PRiMER : Peer-Review Reports in Medical Education Research, 4, 14. https://doi.org/10.22454/PRiMER.2020.441200

McMullin, N. (2020). Exploring Resiliency During the Nursing Student Clinical Experience. The Organizational Improvement Plan at Western University. https://ir.lib.uwo.ca/oip/150

Santos, W. J. (2021). 37. Organizational Readiness to Change Assessment (ORCA)—PRAGMATIC. https://policycommons.net/artifacts/2178055/37/2934034/

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.