Implementation of Evidence Based Practice, Term Paper Example

Abstract

Evidence based practice is a modern invention in nursing care delivery. It encompasses articulating scientific knowledge significant to establishing reasons for undertaking specific, measures, procedures and reacting to patients/client needs in a highly professional manner.

Introduction

Allison Metz, Karen Blase and Lillian Bowie (2007) posit that one of the greatest challenges facing Advanced Nursing Practitioners is implementing a new program or practice. They further advance that constraints arise when there is insufficient information regarding strategies that promote effective and efficient program implementation (Metz, 2007).

Importantly, form research studies they discovered that implementation strategies are available only on paper and their relevance to real life situations may be obsolete. Essentially, they merely describe interventions without providing applications as to resources and activities required to execute them (Metz, 2007). This discussion embraces a proposal for implementing evidence based-practices for an institutional level.

Institutional Assessment Planning – Evidence based Practice

In the scenario rendered for project implementation no structures exist for evidenced-practice execution. However, as a manager, I must conduct my own investigations as institutional assessment planning is undertaken. This encompasses four broad areas of assessment. They are student learning; institutional development; employee performance and assessment of resources.

From the functional perspective evidence based practice according to the CSAP must correlate within established guidelines if institutional change is targeted. These include being listed on Federal Registries of evidence-based interventions. It must have been reported in a peer reviewed study. The intervention must be based on theory; it has to be similar in content to what appears on the registry or study; the intervention must be documented; be reviewed by a panel and deemed appropriate for executing the implementation. (Melnyk & Fineout-Overholt,  2005).

As such, the first step is to assess what evidence based practices are inculcated and whether they are conducted according to protocol. This would mean appointing an institutional assessment manager who will correlate key members of each department into a team. They will be commissioned to investigate if nursing education curriculum promotes evidence based practices and whether the hospitals acknowledge it in dispensation of services. If they do how equipped employees are to function according to evidence based guidelines. Finally, assess the availability of resources within the institution for evidence based practice interventions (Szelest, 2005).

In this assessment planning intervention the team is expected to identify goals and objectives consistent with the institution’s mission as well as the goal of ensuring that nurses deliver evidence based practices at patient’s bedsides. Thereafter, they must project qualitative and quantitative measurements of the outcome along with a timetable for implementation. This would evaluate if goals are achievable when transferred into practice. It is also a requirement that this team clearly identify strategies for transferring their findings into practice (Szelest, 2005).

Implementing Evidence-Based Practice Structures and Activities

Research has shown where the implementation of high-quality evidence-based practices is only successful when well-trained, well-prepared practitioners invade the system with their skills and efficiency (Buysse & Wesley, 2006).  In my institution it is clear that the skills and structures may not be readily available, but it is my duty to utilize available resources through training. The process can be facilitated by collaborating with supervisors, coaches and program managers for successful intervention. Strategic recommendations of the institutional assessment planning team will be reviewed as an audit feedback for implementation purposes (Mercer & Pignotti, 2007).

Marita Titler (2008) studied the evidence for evidence based implementation to argue that while evidenced- based practices for a number of conditions exist there has been limited research on how to effectively implement these practices and evaluate whether they are being conducted at patient’s bedsides. This is supportive of Allison Metz, Karen Blase and Lillian Bowie‘s (2007) contention regarding implementing structures and activities for evidenced based practice in institutional settings.

Titler (2008) continues to advance that it is only by putting into practice what is known can an Assistant Vice President Evidence Based Practice assess if nursing care is being executed from an evidence based practice perspective (Titler, 2008). The author suggests that a multifaceted interventional approach is effective for successful implementation. This would be my approach in establishing structure and activities ensuring that evidenced based interventions are practiced at patients’ bedsides.

For example, with reference to evidenced -based-medication administration intervention when an individual approach only is adapted conflict in charting could ensue due to nurses’ varying knowledge concerning evidence-based guidelines. However, with establishment of clinical information systems these activities can be standardized across the institution. Evidence based information is programed into the system for all professionals to follow with accuracy.

Supporting activities would entail creation of three management portfolios. They are a practicing committee; staff education committee and interdisciplinary evidence based work groups. This structure is expected to implement training activities, which would address nature of the EBP be implemented; enhance users knowledge of the evidence; communicate use of clinical information system strategies and align the institution with existing social system evidence based protocol (Titler, 2008).

Expanding on the activities aspect of this implementation process of evidence based translation into practice intervention at an institutional multidisciplinary level Melnyk & Fineout-Overholt (2005) offered a 10 step model approach, which in my opinion would be very beneficial to my institutional diffusion.

They embody identifying the problem, which was undertaken in the institutional assessment planning/audit feedback. Next is validating evidence; comparing with other sources of evidence; integrating into clinical expertise; establishing structures and activities for change implementation; evaluating costs, time and resources (Melnyk & Fineout-Overholt, 2005). It would appear that this section of the step explains the implementation activities.

Culminating these events are evaluating the practice change; marketing it as successful; expanding its success across the entire institution and designing strategies for sustaining there evidence to prove that nurses do implement these measures at patients’ bedsides.

Conclusion

The foregoing discussion presented an institutional structural development proposal for evidence based practice in the organization. These are no structures for the implementation of evidence based practice in this organization. However, it was advanced that adapting a clinical information system could be the first approach towards adapting a structure. Supporting activities embrace an interdisciplinary approach collaborating three categories of activity specialists embodying a practicing committee; staff education committee and interdisciplinary evidence based work group manager.

References

Buysse, V., & Wesley, P.W. (2006). Evidence-based practice: How did it emerge and what does it really mean for the early childhood field? Zero to Three, 27(2), 50-55

Melnyk. B. & Fineout-Overholt, E. (2005). Evidenced –based practice in nursing and  healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.

Melnyk. B. & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. Philadelphia: Lippincott Williams & Wilkins.

Metz, A. Blasé, K., &  Bowie, L.  (2007). Implementing Evidence based Practices: Six “Drives’ of Success. Research to Results Trends. Retrieved November 14^th 2012 from  http://www.childtrends.org/files/child_trends-2007_10_01_RB_6successdrivers.pdf

Szelest, B. (2005). Developing an Institutional Assessment Plan: Product and Process. New York University at Albany

Titler, M (2008). The Evidence for Evidence-Based Practice Implementation. Agency for Health Care Research Quality.