Developing a Culture of Evidence-Based Practice

 Changing clinical practice is complicated and demanding for the nursing profession because it requires administrative support (Melnyk & Fineout-Overholt, 2018). For example, a change of policy or new purchase of equipment for an inmate in the correctional setting needs administrative approval from the Department of Corrections. Hisham et al. (2016) related that physicians seldom practiced evidence-based medicine (EBM) in their routine clinical practice despite the awareness of the positive benefit of EBM. It implies that there are barriers for not implementing change. The purpose of this discussion is to analyze dissemination strategies and identify possible obstacles during the dissemination phase of the EBP.

Dissemination Strategies

To communicate EBP, a strategy that a leader can utilize is the Kick-off meeting in the organization using a PowerPoint presentation and handout packets containing the agenda (Gallagher-Ford et al.,2011). It is essential to do this strategy because the presenter can also access and reply to the different feedback and reactions from the stakeholders. Another key strategy in achieving high reliability in health care organizations is by utilizing the Advancing Research and Clinical practice through close Collaboration (ARCC) model that consists of a 12-month mentorship program (Melnyk, 2012). It is a vital strategy because it has a series of educational, skill-building sessions that focus on the seven-step EBP process and the necessary strategies for building an EBP culture (Melnyk, 2012).

Both the ARCC Model and the Kick-off meeting are most likely favorable to use in communicating EBP. A least strategy is the Journal Club Format. It is effective in the clinical setting in assisting clinicians who want to improve the translation of research into practice (Melnyk & Fineout-Overholt, 2018). However, time constraints and daily commitment to patient care needs are few of the barriers for this strategy to become successful (Melnyk & Fineout-Overholt, 2018).It implies that if a staff is not interested, it can be a grave experience attending the club.

Barriers

Part of the accountability of a physician is to identify current, high-quality research evidence to inform clinical decisions (Melnyk & Fineout-Overholt, 2018). However, a barrier of EBP is the lack of interest, motivation, vision, strategy, and direction among leaders (Melnyk & Fineout-Overholt, 2018). Seeking synergistic opportunities to collaborate EBP, such as leadership support/mentorship, and the need to have tools available on hand is a win-win outcome (Newhouse et al., 2007). Another barrier is the high volume of research evidence coupled with the integration of expertise and patient preference into best practice (Melnyk & Fineout-Overholt, 2018). The Steven Star Model establishes several ways to overcome the obstacle. Knowledge transformation according to this model consist of 5 steps: discovery research, evidence summary, translation to guidelines, practice integration, and process outcome evaluation (Melnyk & Fineout-Overholt, 2018).

Conclusion

Indeed, EBP must become a way of thinking rather than an obligated course that requires an end (Melnyk & Fineout-Overholt, 2018). Models such as the ARCC and a Kick-off meeting through PowerPoint presentation are indeed vital for a systematic approach to practice change. Also, the implementation of the ARCC Model can improve patient outcomes (Melnyk et al., 2017). Furthermore, recognizing the challenges inherent in changing practice, both at the individual or organizational level, is essential for the success of the dissemination (Melnyk & Fineout-Overholt, 2018).

References

Hisham, R., Ng, C. J., Liew, S. M., Hamzah, N., & Ho, G. J. (2016). Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study. BMJ open, 6(3), e010565. https://doi.org/10.1136/bmjopen-2015-010565

Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). (2017). A Test of the ARCC© Model Improves Implementation of Evidence‐Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews on Evidence‐Based Nursing, 14(1), 5–9. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12188

Melnyk, B. M. (2012). Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice. Nursing Administration Quarterly, 2, 127.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C., & White, K. M. (2007). Organizational change strategies for evidence-based practice. The Journal of Nursing Administration, 3

The field of nursing has changed over time. In a 750‐1,000 word paper, discuss nursing practice today by addressing the following:

1. Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
2. Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
3. Identify a patient care situation and describe how nursing care, or approaches to decision‐making, differ between the BSN‐prepared nurse and the ADN nurse.
4. Discuss the significance of applying evidence‐based practice to nursing care and explain how the academic preparation of the RN‐BSN nurse supports its application.
5. Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

Case Scenario to be completed

–APA Format.-Introduction or abstract page-Summary or Conclusion page-Four pages minimum, no including Introduction or abstract,  summary or conclusion, and Bibliography pages-It is completely unacceptable to Copy and Paste from the Internet, or other resources 

The following position is advertised on a career Web site: RN I Surgical Job Travel Involved: None. Job Type: Full-Time. Job Level: Minimum Education Required: Associate Degree Skills: Category: Nursing FTE: 0.9. Position Summary: Description/Purpose of Position: Responsible for providing patient care based upon the nursing process; being effectively involved with maintaining the standard of care for assigned patients through assessment, planning, implementation, and evaluation. Oversees and guides employees who are under your supervision. Requirements Description/Purpose of Position: Responsible for providing patient care based upon the nursing process; being effectively involved with maintaining the standard of care for assigned patients through assessment, planning, implementation, and evaluation. Oversees and guides employees that are under your supervision. Minimum Qualifications: Education: Graduate of an accredited school of Nursing. License/Certification: Current RN license in the state of XXX. Current BCLS Certification. Other: Must be able to demonstrate the knowledge and skills necessary to provide care/service appropriate to the age of the patients served on the assigned unit/department. Note: An RN graduate is a nurse who has completed a course of study at a school of nursing and is eligible for the NCLEX. The RN graduate performs directly under the supervision of the charge nurse or RN designee.

1. List three substantive questions you might expect to be asked in an interview for the job, and summarize your answers.

2. Describe three to five ways in which you could prepare for the interview to make the most positive impression.

3. Be sure to describe what you would wear and what material you would bring with you.

Your best friend, Lindsey, and you are working together in the surgical ICU. Often you cover for her when she goes to lunch or on breaks. You notice that often her clients complain of being in pain, even though she has told you that she medicated them right before she left the unit. You also notice that she appears to be very jumpy and short-tempered and a bit disheveled when she comes to work. You are suspicious that she is using the medications that she says she is giving to her clients.

1. What should you do first?

2. What might be the consequences if you decide to do nothing?

Research and select an emerging health care issue. This can include but is not limited to the following:

• Opioid crisis
• Escalating drug prices
• Cybersecurity issues
• Behavioral health care
• Aging population
• Health care employee burnout
• Health care information transparency Using the information you’ve learned in the course, discuss how you would design a policy for the health care issue you selected. Remember to take into consideration the various aspects of the policy development cycle and level of implementation (federal, state, or local).

  Respond using 525 to 700 words to the following prompts:

• What is the issue, what is the problem associated with the issue that you want to work toward solving, and who are the main stakeholders who can influence the success of the policy?
• Why is this issue important and what is the target population?
• How would you suggest implementing the policy and at what level (federal or state government)?
• How would you propose the policy be evaluated and when would the evaluation occur?
• What possible courses of action (revisions) would likely be needed if the evaluation of the policy suggests that the proposed policy is not fulfilling its intended purpose?
• Cite at least 2 reputable references. Reputable references include trade or industry publications, government or agency websites, scholarly works, a textbook, or other sources of similar quality.

Review the IOM report, “The Future of Nursing: Leading Change, Advancing Health,” and explore the “Campaign for Action: State Action Coalition” website. In a 1,000-1,250 word paper, discuss the influence the IOM report and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.

Include the following:

1. Describe the work of the Robert Wood Foundation Committee Initiative that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
2. Outline the four “Key Messages” that structure the IOM Report recommendations. Explain how these have transformed or influenced nursing practice, nursing education and training, nursing leadership, and nursing workforce development. Provide examples.
3. Discuss the role of state-based action coalitions. Explain how these coalitions help advance the goals specified in the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
4. Research the initiatives on which your state’s action coalition is working. Summarize two initiatives spearheaded by your state’s action coalition. Discuss the ways these initiatives advance the nursing profession.
5. Describe barriers to advancement that currently exist in your state and explain how nursing advocates in your state overcome these barriers.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide