NUR 590 Evidence Based Practice Project
NUR 590 Evidence Based Practice Project Week 5 Discussion
Week 5 Discussion
DQ1 Identify the components of implementing your evidence-based practice project. What has been the most difficult component, and why? What do you think has gone well? Provide one piece of advice you would give to a colleague about the implementation process.
Implementing any change in a healthcare organization or facility entails several aspects that require one to develop an implementation as is the most important part of any evidence-based practice (EBP) project proposal. Implementation entails the actualization of the ideas developed in the proposal EBP projects are broken into several identifiable steps (Boehm et al., 2020). The implementation plan will focus on hand hygiene measures in pediatric setting among healthcare workers to reduce hospital acquired infections (HAIs). The implementation plan will consist of the setting where the project will take place, time, resources, methods and instruments, intervention of delivery process, and data collection plan. The plan also includes management of barriers, facilitators and challenges and the feasibility of the plan.
Research has concluded multiple barriers to implementing evidence-based practice (EBP) in nursing. Some of these barriers include, but are not limited to: Time constraints, inadequate staffing, patient acuity, personal commitments, education levels, negative attitudes and lack of knowledge towards EBP (Mathieson et al, 2019).
In my current nurse leader role, I have seen all these barriers in action, negatively influencing change insemination. Therefore, I have had to find strategic ways to address these barriers, to make sure initiatives work within the nurses work flow.
My EBP project, utilizing a counseling tool to address obesity management in the primary care setting, could potentially face barriers related to attitudes and knowledge. Tronieri et al, (2019) presented data that some healthcare professionals have negative attitudes towards obesity management in the primary care setting. They feel it should be referred elsewhere, therefore do not take the issue seriously even though according to the United States Preventive Services Task Force (USPSTF), obesity management should be first addressed in the primary care setting (Kushner et al, 2016). The lack of knowledge, education and negative attitudes towards my EBP project and EBP in general, could be potential barriers for my initiative.
References:
Kushner, R. F., Choi, S. W., & Burns, J. L. (2016). Development of a six-factor questionnaire for use in weight management counseling. Patient Education and Counseling, 99(12), 2018-2025, https://doi.org/10.1016/j.pec.2016.06.022
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20, e6. https://doi.org/10.1017/S1463423618000488
Tronieri, J. S., Wadden, T. A., Chao, A. M., & Tsai, A. G. (2019). Primary care interventions for obesity: Review of the evidence. Current obesity reports, 8(2), 128–136. https://doi.org/10.1007/s13679-019-00341-5
DQ2 Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. This could range from support of the evidence-based project proposal to communication gaps. How could you address these problems?
Cohesive collaboration is critical to an organization’s survival and success. Implementation plans may face numerous challenges as a result of a lack of understanding of the issues affecting an organization. This lack of knowledge is prevalent in many organizations where leaders and management are disconnected from the day-to-day operations that help the organization run. When a person rises through the ranks of an organization to a position of leadership, they gain knowledge and experience that other managers would lack if they hired from outside. The person who rises through the ranks has a better understanding of how the organization works, its weaknesses, its strengths, and how it needs to function in order to survive. Nothing will get done if there is a disconnect between stakeholders in higher positions and those responsible for day-to-day operations.
Also Read: NUR 590 Evidence Based Practice Project Week 4 Discussion
Some of the things that one might experience during the implementation phase are resistance and timing. “Lack of
time is often cited as a barrier to implementing EBP. In addition, uncertainty or lack of knowledge about the EBP process is also a barrier, which includes critiquing and appraising the literature related to the clinical problem being addressed” (Ginex, 2018). In busy hospitals lack of time to study and understand new changes and policies can be a barrier. On time of this, resistance to change can also be a barrier. In there is already a flow that nurses are accustomed to even if it is chaotic, having to change that flow requires learning something new or changing ones workflow habits and that can cause resistance to change.
The one suggestion I would give to a fellow colleague would be for them to ask questions, slow down the pace in order for them to understand the new policy and give themselves time to become accustom to it and to always remember that it will take them time to learn something new before they can master it.
Reference:
Ginex, P. (2018). Overcome Barriers to Applying an Evidence-Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-chang
Stakeholders are the people involved in carrying out the process under review or individuals who become affected with the change in practice (“John Hopkins Nursing”, 2021). It is important to determine the potential stakeholder barriers that will be encountered in order to address them accordingly. The two stakeholder barriers that can be experienced are resistance to change and lack of authority. Physicians, who are one of the main stakeholders, are perceived to be the least supportive in EBP implementation (Jordan et al., 2021). Without their support, it can make the implementation process difficult. Resistance of practitioners to change from traditional practices to newer concepts introduced in EBP can be a barrier to the implementation process (Jordan et al., 2021). Moreover, some staff nurses feel that they lack authority to make changes in their unit or they do not have the “power” to implement the EBP project. One study suggested that majority of the nurses in a private ICU reported that they lacked the authority to change practice in order to facilitate the implementation of EBP (Jordan et al., 2021).
There are several strategies to gain stakeholder support. First, the support of physicians for the implementation of EBP should be encouraged (Jordan et al., 2021). It is important to keep an open communication between the researcher and physicians. Explaining the goals and benefits of the EBP project in improving patient care can help gain their support. Second, it is recommended to carefully identify individual barriers versus organizational barriers at an early stage (Jordan et al., 2021). Lastly, identifying your stakeholders as well as engaging them early in the EBP process is important because stakeholder buy-in is important for its successful implementation (“John Hopkins Nursing”, 2021). The goal is to gain their trust and confidence and gain as much support as possible for the successful project implementation.
Nurses are the largest stakeholder in the implementation of the EBP project. Nursing professionals encounter barriers every day while doing their jobs, and they encounter even more when trying to utilize EBP. Staff resistance to change is one of the barriers. Staff members in my project area long-term care facility may hesitate to change, especially if they are expected to learn new skills or processes as a result of the implementation of evidence-based practice. Staff members can also resist evidence-based practices if they don’t believe in it’s effectiveness or don’t see how it aligns with the facility’s goals (Mathieson et al., 2019). A second barrier to implementing evidence-based practices in long-term care facilities is limited resources, such as time and budget. The lack of staffing or inadequate training resources can make it difficult to implement evidence-based practices.
The barrier of resistance to change can be overcome by educating and training staff on the benefits of evidence-based practice. Providing staff members with opportunities to ask questions and provide feedback during training sessions can also be helpful. It is important to involve staff members in the process so that their concerns and ideas are taken into consideration, and to create a sense of ownership and investment in the project (Mathieson et al., 2019). By forming working groups, holding regular meetings, and providing feedback, this can be achieved.
Reference
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. https://doi.org/10.1017/S1463423618000488