Discussion: Making The Case For Evidence-Based Practice
Discussion: Making The Case For Evidence-Based Practice
Discussion 1
Comparison of Organizational Readiness Tools.
Organizational readiness tools are useful in assessing the ability of an organization to accept the proposed change and adopt it into practice. A selected tool must address both the capacity and motivation of the organization towards participation in the change initiative. The motivation of the staff is an important factor that will determine the willingness of members to accept change (Abimbola et al., 2019). As a result, various tools exist that can be used to assess readiness including the TeamSTEPPS assessment tool and Capacity Assessment Framework (CAF), which are subject to comparison.
The CAF assesses an organization`s readiness to change through the identification of existing capacities and the additional requirements to meet objectives. The tool analyses the desired capacities against preexisting capacities to enable effective planning (van Herwerden et al., 2019 Discussion: Making The Case For Evidence-Based Practice). In addition, CAF analyzes the abilities of people, technology, processes, and the organization`s system to enable assessment of readiness. The decision to implement a change depends on the assessment of all parameters of the tool while considering its effectiveness.
On the other hand, TeamSTEPPS (team strategy and tool to enhance performance and patient safety) is another evidence-based readiness assessment tool. The tool analyses both weaknesses and strengths capacities of an organization. The tool stresses major skills required for organizational growth including effective communication, vision leadership, mutual support, team structure, and situation monitoring. In addition, the various parameters included in the assessment including assessment of time, resources, and personnel, sustainment of change, and defined need attain a score that correlates with the level of readiness. I chose to use TeamSTEPPS because it incorporates both capacity and motivation assessment, both of which are required for the implementation of change. The organized leadership, mission, vision, and values of the organization team up to favor TeamSTEPPS through enhanced collaboration, team spirit, mutual support, and interprofessional work which favor change implementation.
References
- Abimbola, S., Baatiema, L., & Bigdeli, M. (2019). The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence. Health Policy and Planning, 34(8), 605–617. https://doi.org/10.1093/heapol/czz055
- van Herwerden, L. A., Palermo, C., & Reidlinger, D. P. (2019). Capacity assessment in public health community interventions: a systematic review. Health Promotion International, 34(6), e84–e93. https://doi.org/10.1093/heapro/day071
Discussion 2 – Discussion: Making The Case For Evidence-Based Practice
Issues with Project Implementation.
Evidence-based projects are vital for the provision of patient-centered care aiming at improving outcomes. However, implantation of EBP is a complex process intertwined between balancing the facilitators and barriers to implementation. This project, like any other, I expect both facilitative and barrier events that will influence its implementation.
The foreseen facilitators of EBP implementation will depend on both individual and organizational factors. Known facilitators include enhanced collaborative working environment, improved work relations, organizational support towards change, and approval of effectiveness of the EBP save time and cost-effectiveness. Working with a motivated team who understand the importance of EBP will favor implementation and adoption of the practice to aid in patient care (Mathieson et al., 2019). However, anticipated barriers include staff shortage, time constraints, rejection of change, negative beliefs, limited skills, and limited knowledge about the EBP.
Creating or sustaining a higher level of readiness can be achieved through planning, communication, and encouraging employee participation (Mathieson et al., 2019 Discussion: Making The Case For Evidence-Based Practice). Planning is essential in foreseeing the future hence ensuring allocation of resources that can be used in future endeavors. Effective planning also helps in identifying barriers while helping in developing strategies to overcome challenges. Encouraging employee participation, on the other hand, improves morale and increases a sense of belonging which encourages members to take part in organizational plans as they feel that their efforts are recognized and acknowledged.
Searching literature about the EBP project will provide more insight into the subject matter while comparing the impact of intervention in different settings. Literature provides best practice knowledge which helps in reducing errors while improving project sustainability (Puchalski Ritchie & Straus, 2019). Having enough knowledge about the subject enhances training and support to other staff that favors the implementation of an EBP. Long-term training and supports increase acceptance hence implementation and adoption of the practice.
References
- 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), e6. https://doi.org/10.1017/S1463423618000488
- Puchalski Ritchie, L. M., & Straus, S. E. (2019). Assessing organizational readiness for change comment on “development and content validation of a transcultural instrument to assess organizational readiness for knowledge translation in healthcare organizations: The OR4KT.” International Journal of Health Policy and Management, 8(1), 55–57. https://doi.org/10.15171/ijhpm.2018.101
Discussion 3
Significance of Frameworks or Models
EBP encourages the integration of high-quality and quantitative research findings, and clinical expertise to make individualized clinical decision-making to positively influence patient care while reducing the cost of care. For the successful integration of an EBP to be successful, there is a need for the existence of a readiness culture through leadership support, availability of resources, and adoption of an appropriate framework. The use of frameworks forms the basis for the generalizable implementation of scientific knowledge through the enhanced description of the problem, guides analysis, and enhances periodic evaluation of implementation efforts (Duff et al., 2020 Discussion: Making The Case For Evidence-Based Practice). Models ensure quick incorporation of the latest research findings into patient care. As a result, the framework guides decisions made throughout the research while guiding perception towards research, analysis, data interpretation. Therefore, organizations must choose models that best fit care context aligning with improvement goals, addressing priority clinical problems, and guiding systematic approach that enhances collaborative change practice.
Failure to adopt an appropriate model in implementing EBP may lead to research bias. Bias results from skewing of the intended process through the introduction of a systemic error tailored towards a specific outcome (van der Steen et al., 2019). Bias can either be addressed in terms of information, selection, or confounding bias. Choosing an inappropriate model that fails to align with the goals of the research will likely distort intended outcomes that may cause errors. Errors in EBP will negatively impair clinical decision-making that negatively affects the quality of care and patient satisfaction.
References
- Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation Science Communications, 1(1), 85. https://doi.org/10.1186/s43058-020-00070-0
- van der Steen, J. T., ter Riet, G., van den Bogert, C. A., & Bouter, L. M. (2019). Causes of reporting bias: a theoretical framework. F1000Research, 8, 280. https://doi.org/10.12688/f1000research.18310.2
Discussion 4
Framework and Models for Evidence-Based Practice
Several EBP frameworks and models exist, each strives to address different concepts that can be used in integrating an EBP project into practice. Few known models include Lowa Model for EBP to promote quality care, advancing research and clinical practice through the close collaboration model (ARCC), the John Hopkins nursing EBP model, and the promoting action on research implementation in health services (PARIHS) framework (Huybrechts et al., 2021 Discussion: Making The Case For Evidence-Based Practice). All these models have been used in various settings resulting in tremendous results with none being superior to either. Each model outlies the importance of a systematic approach to EBP change.
Understanding the needs and importance of each model will help in deciding the best model for EBP implementation. For instance, the Lowa model addresses EBP sustainability, implantation of interprofessional change, and patient-centered care by all clinicians while encouraging a multiphase, team-based approach. Spirit of inquiry is essential in identifying a clinical problem and identifying decision points while offering evaluative feedbacks to identify loops to facilitate the implementation of change (Huybrechts et al., 2021 Discussion: Making The Case For Evidence-Based Practice). The phases of the model include interprofessional team formation, literature review, critique, and synthesis; carrying out piloting for implantation; continuous evaluation; and dissemination of outcomes. Discussion: Making The Case For Evidence-Based Practice
My model of choice is the ARCC model. This model, unlike the Lowa model, focuses on resource building and training of mentors who enable implementation and sustaining an EBP within an organization and point-of-care (Melnyk et al., 2017). I believe that training champion nurses to educate and monitor other clinical teams will help in the implementation of daily bathing of central lines as the practice of infection prevention. Furthermore, the model has seven major steps; cultivating a spirit of inquiry; development of PICOT question; collecting, critical appraisal, integration of EBP with patient preference and clinical expertise; and continuous evaluation and dissemination of change practice. These steps provide a well-structured pathway if adhered to can lead to the success of an EBP project. Discussion: Making The Case For Evidence-Based Practice
References
- Huybrechts, I., Declercq, A., Verté, E., Raeymaeckers, P., & Anthierens, S. (2021). The building blocks of implementation frameworks and models in primary care: A narrative review. Frontiers in Public Health, 9, 675171. https://doi.org/10.3389/fpubh.2021.675171
- Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© Model improves implementation of evidence-based practice, healthcare culture, and patient outcomes: A test of the ARCC© model improves implementation of evidence-based practice. Worldviews on Evidence-Based Nursing, 14(1), 5–9. https://doi.org/10.1111/wvn.12188
Discussion: Making The Case For Evidence-Based Practice Instructions
Discussion question 1:
Compare two organizational readiness tools. Identify the tool you selected and explain why it is most appropriate for assessing your organization.
DQ 2:
Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.
Discussion: Making The Case For Evidence-Based Practice DQ 3:
Discuss the significance of frameworks or models in guiding research or evidence-based practice projects. How can choosing an incorrect framework or model create bias in research?
Discussion: Making The Case For Evidence-Based Practice DQ4:
Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.
2 references per question
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