Topic 6: Evaluating Practice Change

 

 

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Evidence-Based Practice Proposal

Section A: Organizational Culture and Readiness Assessment

Evidence-based practices (EBP) are increasingly adopted by the health care organizations to help in maximizing patient outcomes and ensure provision of patient-oriented, quality care. Essentially, a meaningful adoption of EBP can be realized when the health care organization is ready and able to recognize the limitations and facilitators that may influence the process of EBP implementation (Schaefer & Welton, 2018).Therefore, to foster the implementation of the current EBP project at the VA healthcare system, the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS) will be used as a tool to assess the organizational readiness for EBP (Egeland et al., 2016). The assessment revealed that VA healthcare system was ready for new EBP implementation.

Barriers and Facilitators

The major project barriers included lack of commitment to EBP adoption by the health care staff. Moreover, time limitation impeded the implementation of the project. This is due to overwhelming workload, which cannot allow the staff to review the emerging evidence. As a result, there was inadequate experience in EBP application. Conversely, the facilitators of the project included availability of existing providers who were ready to promote the EBP. Moreover, the project enjoyed management support.

High Scores and Low Scores

Concerning the high scores, the EBPAS assessment tool comprises of 19 categories and the VA healthcare system showed exemplary performance in 12 categories. Among the best scored categories included management support and the willingness by the health care providers to adopt EBP (Egeland et al., 2016). Contrarily, low scores were demonstrated in six categories, with major one being inadequacy of leading professionals in EBP implementation such as librarians to direct nurses and other providers on EBP implementation.

Integration of Clinical Inquiry

To optimize application of EBP, healthcare providers in VA health care system will be provided with training on EBP to encourage them and increase their confidence. The training will be crucial in identifying and working on areas that need improvement. Moreover, a study will be performed on the areas that need improvement to identify potential solutions to improve in them. Consequently, policy to direct EBP implementation will be designed to help in adopting the identified solutions.

Section B: Proposal/Problem Statement and Literature Review

Refining PICOT into Problem Statement

The focus of this project was on training on mindfulness meditation in nursing. Currently, the health care environment is complex, technologically laden, and highly stressful, which interferes with the ability of nurses to fully discharge their duties. This intricate nature of nursing practice and the adverse working conditions leads to risk of stress and burnout among nurses. In particular, the stress in nurses is attributed to many factors such as poor shift rotation, heavy workload, failing to reward or acknowledge nurses, intricate interpersonal relationships, and continuous need of knowledge. Consequently, the complex, technologically laden, and highly stressful environment reduces the ability of nurses to fully operate as required, especially during patient interactions. As a result, nurses lose attention (mindlessness) in provision of patient care, which leads to an environment where a nurse can make clinical decision without a thoughtful, conscious determination of the situation at hand (Sankoet al., 2016). As such, this EBP project sought to advance cultivation of mindfulness mediation among nurse professionals. Mindfulness mediation is believed to have capability to enhance nurses’ empathy, overall attention, and presence with patients and families. Since this paper sought to synthesize the research on mindfulness mediation into problem statement and literature review and create a refined PICOT statement. The refined PICOT statement would be:In nurses (P), does training on Mindfulness meditation (I), compared to no intervention (C), reduce stress levels (O) within six months (T)?

There are many studies that have been performed that can support the refined PICOT statement. Janssen et al. (2018) performed an exploratory study with the aim of getting an in-depth understanding of the influence of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees. The study involved systematic review of databases such as PubMed, PsycINFO, and CINAHL to find studies on the impact of MBSR and MBCT on different aspects of mental health. The key finding in the study is that MBSR leads to reduction in stress, depression, anxiety, psychological distress, and occupational stress. Employees who exercise personal achievement, mindfulness, relaxation, quality of sleep, and self-care also recorded positive changes. However, the limitation of the study is the use of different methodological quality study levels.

Kriakous et al. (2020) sought to inform the current evidence-based practice and enhance knowledge on the value of MBSR on enhancing the psychological functioning of health care professionals. The study involved systematic review to explore qualitative studies, pre-post designs, randomized controlled trials, and controlled clinical trials with follow-up period of 12 months. The major finding in this study is that MBSR significantly reduces the experiences of depression, stress, and anxiety among the health care professionals and also increases their levels of self-compassion and mindfulness. However, the study also revealed that MBSR cannot effectively minimize burnout or enhance resilience. The limitation of this study is use of weak systematic literature review to moderate quality articles and used small sample sizes and self-selected samples.

Lin et al.  (2019) conducted a study to determine the influence of a modified MBSR program on stress, affect, and the resilience level among nurses in general hospitals in mainland China. A randomized controlled trial was utilized through random assignment of 110 nurses to intervention and control groups. The results indicated that intervention group showed lower levels of stress, and improved positive affect, high levels of resilience. The limitations of the study include utilization of small sample size, which can result in challenges in validity of the study. The convenient sampling method used in identifying hospitals can also limit the representation of sample population.

In Penque (2019), the aim was to assess the impact of MBSR on work-related factors such as empathy, mindfulness, work satisfaction, serenity, job burnout, incidental overtime, and self-care. The study used mixed methods such as longitudinal, correlational, quasi-experimental, and pre-test and post-test. The study was conducted among 61 RNs employed at a 619-bed tertiary care hospital located in the upper mid-western US. The major finding is that MBSR reduces burnout and enhance particular psychological factors such as mindfulness, self-compassion, and serenity among nurses. The limitation of the study included lack of comparison group and limitation of sample population in one geographical area, which limits generalizability.

Van der Riet et al. (2018) conducted a study to critically assess the literature on the effectiveness of mindfulness mediation programs on nurses and nursing students. The study reviewed literature using databases such as EMBASE, ERIC, SCOPUS, Medline, EMCORE, CINAHAL, and PsycINFO. The findings revealed that mindfulness mediation have positive impact on nurses and nursing students by improving anxiety, welfare, empathy, depression, burnout, and stress. However, the limitation of this study includes review of studies that employed small sample size, which reduces the representativeness and generalizability of the outcomes.

Conclusion

Based on the EBPAS assessment conducted, VA healthcare system is ready to adopt the EBP project on mindfulness meditation in nursing. However, the adoption of EBP faces barriers such as lack of commitment by the staff and time limitation. On the other hand, the facilitators include availability of existing providers who were ready to promote the EBP and management support. To optimize application of EBP, healthcare providers in VA health care system will be provided with training on EBP to encourage them and increase their confidence. Overall, this EBP project sought to advance cultivation of mindfulness mediation among nurse professionals to enhance nurses’ empathy, overall attention, and presence with patients and families.

 

 

References

Egeland, K. M., Ruud, T., Ogden, T., Lindstrøm, J. C., & Heiervang, K. S. (2016). Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness. Health research policy and systems, 14(1), 1-10.https://doi.org/10.1186/s12961-016-0114-3

Janssen, M., Heerkens, Y., Kuijer, W., van der Heijden, B., & Engels, J. (2018). Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PloS one, 13(1), e0191332. https://doi.org/10.1371/journal.pone.0191332

Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2020). The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness, 1–28. Advance online publication. https://doi.org/10.1007/s12671-020-01500-9

Lin, L., He, G., Yan, J., Gu, C., &Xie, J. (2019). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace health & safety, 67(3), 111-122.

Penque, S. (2019). Mindfulness to promote nurses’ wellbeing. Nursing Management, 50(5), 38.https://doi.org/10.1097/01.NUMA.0000557621.42684.c4

Sanko, J., Mckay, M., & Rogers, S. (2016). Exploring the impact of mindfulness meditation training in pre-licensure and post graduate nurses. Nurse education today, 45, 142-147.Doi: 10.1016/j.nedt.2016.07.006

Schaefer, J. D., & Welton, J. M. (2018). Evidence based practice readiness: A concept analysis. Journal of nursing management, 26(6), 621-629. https://doi.org/10.1111/jonm.12599

Van der Riet, P., Levett-Jones, T., & Aquino-Russell, C. (2018). The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse education today, 65, 201-211. https://doi.org/10.1016/j.nedt.2018.03.018

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I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

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Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource