NRS 493 GCU The Primary Goal of Evidence-Based Practice Response Discussion

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I need four replies to my peers discussion questions, one reference each, only within the last 5 years 100 to 200 words each should be enough. I’ve included their discussions questions.

Question:After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal. Explain how your proposal will directly and indirectly impact each of the aspects.

Peer Responses 1)Although the goal of EBP is to improve health care, the cost must be addressed and considered in the value equation. Practice changes require an upfront investment of time and resources. These investments create an improvement in outcomes, whether clinical (e.g., reduced infections), organizational (e.g., shorter length of stay), or fiscal (e.g., reduced unplanned readmissions, which helps the organization avoid Medicare penalties). Any of these may have cost implications. Some EBP improvements may not create cost savings but may achieve an equally valuable outcome (e.g., patient satisfaction) that helps fulfill the organizational mission. (hfma.org, 2018 )). After discussing with my mentor regarding the implementation of EBP, it is important that financial, clinical, and quality aspects areas are critical areas to consider when developing EBP. The financial aspect that needs consideration in the development of the evidence-based practice project is whether the evidence-based solution would help in reducing the cost of health care services for the targeted population. The change project intends to reduce the cost of health care by reducing the fall rate among hospital patients. Which then leads to a reduction in fall-related medical costs.

For quality consideration, the intervention must help in promoting the anticipated patient outcomes, which includes reducing falls-related injuries or death, thereby promote the patient’s quality of life and reduce hospital length of stay. Change projects, such as reeducation intervention to promote the quality of care. EB risk assessment increased prevention activities to purposeful rounding, improves the quality of care, and increases patient satisfaction. To further ingrain EBP within health care professional practice, EBP processes, whether related to developing, disseminating or implementing evidence, be embedded in a more structured way into everyday clinical care to promote active and consistent engagement with EBP continuously ( ebm.bmj.com, 2019). The clinical aspect that needs consideration is the availability of health care staff with relevant expertise and knowledge to facilitate the evidence-based solution in the medical-surgical unit. The current staffing shortage in the health care system is a reason to consider the skill required to implement Evidence-based projects. Its availability and the implications on the workload of the health care professionals in an organization.

Laura Cullen, D. (n.d.),( 2018) Evidence-based practice and the bottom line: An issue of cost. Retrieved April 21, 2021, from https://www.hfma.org/topics/article/58754.html.

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., . . . Hegarty, J. (2019, June 01). Evidence-based practice education for healthcare professions: An expert view. Retrieved April 21, 2021, from https://ebm.bmj.com/content/24/3/103

2)When developing any change proposal, financial consideration must be taken into consideration. How will the individuals in the study be compensated? Who will pay for the time away from their existing responsibilities? How will the materials required for the project be paid for? Is there an outside financial interest in the change? From the early stages of a project, planning, evaluating, and approval of projects, staff’s time and compensation must be taken into consideration (Tucker, Gallagher-Ford, & Jang, 2020).

Planning for an evidence-based practice change, improved quality outcomes are often one of the goals for the project. Having high levels of staff engagement and teamwork often improve quality outcomes. Working in environments that promote nursing teamwork, enhances engagement, and improves quality outcomes (Sohal, 2020).

A clear understanding of evidence-based practice and the implementation of changes needs to exist to improve clinical practice. Nursing students receive education regarding research evaluation and implantation; after graduation opportunities to continue research activities are often not supported by hospital and institutional leadership. Without continued support, nurses may lose knowledge and motivation to further their research and project proposals into clinical practice (Schuessler, et al., 2018).

My change proposal will have a minimum financial burden as the education can be conducted in a short period of time during a nurses regular shift. Hospital administration and department management support this project as the department will not be required to hire outside consultants to train staff. This had been done in previous years but the expense to train one nurse was too much to continue using their services. Currently the department has less than ten ultrasound trained nurses. Nursing staff not trained have requested multiple times to add additional training opportunities as they would like to learn how to use this technology. Informal surveys in the emergency department have discovered that about 30% of staff would like to learn and use this technology. By having a large portion of nursing staff trained, hopefully additional staff can participate and gain additional comfort levels to discuss project ideas with management.

References

Tucker, S. J., Gallagher-Ford, L., & Jang, E. (2020). EBP 2.0: Implementing and Sustaining Change: The Evidence-Based Practice and Research Fellowship Program. American Journal of Nursing, 120(2), 44. https://doi-org.lopes.idm.oclc.org/10.1097/01.NAJ….

Schuessler, Z., Castillo, L., Fessler, S., Herrmann, R., Kuntz, D., & Spencer, B. (2018). A qualitative description of nurses’ experiences with incorporating research into practice. The Journal of Continuing Education in Nursing, 49(7), 299–306. https://doi-org.lopes.idm.oclc.org/10.3928/0022012…

Sohal, L. (2020). Implementing a Nursing Professional Model to Improve Staff Nurse Engagement and Teamwork. Journal of Continuing Education in Nursing, 51(3), 124–131.

Question: Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?

Peer Responses 3)Most elderly patients, in general, have complications that are as a result of other health conditions. Also, polypharmacy and memory loss make their situation worse, which necessitates the need for more attentive care (Farrington, Richardson, & Bridge, 2019). For cancer patients, this is necessary, especially when managing the effects of the therapy and medications. Their vulnerability necessitates seriousness as they may harm themselves. Emotional suffering and physical pain that is unbearable for elderly patients inspired my desire to develop better patient care alternatives for these patients. Home-based nursing care maintains a close relationship between a nurse and a patient which is essential as the needs of the patient are easy to identify. Besides, the patient’s well-being and stresses are minimal as he or she has someone to take care of the medical needs such as ensuring that medicine prescriptions are followed (Tralongo et al., 2011). This type of care is patient-centred as the home-based nurse concentrates on, and addresses the challenges of one patient. Undoubtedly, such a nurse is in a position to notice the health changes and propose critical steps to address them. Patient care influences the outcome of patients, both emotionally and physically.

References

Farrington, N., Richardson, A., & Bridge, J. (2019, June). Interventions for older people having cancer treatment: A scoping review. Journal of Geriatric Oncology, 11(5), 769-783. Retrieved August 17, 2020, from https://doi.org/10.1016/j.jgo.2019.09.015

Tralongo, P., Ferraù, F., Borsellino, N., Verderame, F., Caruso, M., Giuffrida, D., . . . Gebbia, V. (2011, September 9). Cancer patient-centred home care: a new model for health care in oncology. Therapeutics and Clinical Risk Management, 7, 387-392. doi:10.2147/TCRM.S22119

4)The identified issue is the high rate of surgical site infections (SSIs) in colorectal surgeries (CRSs). In the first phase of this project, I was considering implementing a widely used and proven strategy for SSI prevention which is a prevention bundle that contains, pre intra and post-operative interventions (Edmiston et al, 2018). This bundle has several components which require interventions pre-operative phases such as chlorhexidine bath, intraoperative phase with normothermia, an on-time antibiotic with redosing, chlorhexidine surgical prep, closure tray for facia closure, and postoperative interventions such as removal of surgical dressing with 48 hours of surgery and daily washings of incision with chlorhexidine (Edmiston et al, 2018). Considering the fact that the medical center has many challenges to get the resources/materials, I decided to start the project concentrating on the intraoperative bundle, correcting some existing wrong practices which hinder the post-operative recovery and patient safety.

The current proposal is implementing seven-component bundle prevention intraoperatively in colorectal surgeries to reduce the SSIs. These components are evidence-based and are widely used in the healthcare arena, modified according to the need of each facility (Gorgun et al, 2018). This project requires managing the availability of all the needed resources such as closure tray, prep kit, gown and gloves, auditing tool, and educational materials. It requires working with the sterile processing department to form a closure tray and supply department to include additional prep materials and gowns and gloves in the care cart. Communication with the entire perioperative team is essential in making this plan real. Educational activities related to the proposal can be done using PowerPoint presentation, group discussion, Email, and Microsoft Teams communication media. My plan is to empower the evidence base practice council members to take the lead of the project to educate, guide, audit, document, and assess the progress of the project. The current plan is derived from the current need of the facility and its work culture.

Gorgun, E., Rencuzogullari, A., Ozben, V., Stocchi, L., Fraser, T., Benlice, C., & Hull, T. (2018). An Effective Bundled Approach Reduces Surgical Site Infections in a High-Outlier Colorectal Unit. Diseases of the colon and rectum, 61(1), 89–98. https://doi.org/10.1097/DCR.0000000000000929

Edmiston, C. E., Jr., Leaper, D. J., Barnes, S., Jarvis, W., Barnden, M., Spencer, M., Graham, D., & Johnson, H. B. (2018). An Incision Closure Bundle for Colorectal Surgery. AORN JOURNAL, 107(5), 552–568. https://doi-org.lopes.idm.oclc.org/10.1002/aorn.12…

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