Leading Organizations for Quality Improvement Initiatives////Research for Evidence Based Practice

Research for Evidence Based Practice 

INTRODUCTION AND EXPERIENCE WITH RESEARCH

respond to  two of your colleagues by expanding upon your colleague’s post or suggesting an additional alternative perspective on EBP.

PEER #1

Penny Pope

Initial Post: NURS8201C - Discussion: Introduction and Experience with Research

Introduction

My name is Penny Pope and I am a veteran nurse passionate about patient care and developing the sector. My nursing career began in 1986, and I have explored many aspects in the field of nursing during my extensive career. I was thrilled to become a Family Nurse Practitioner (FNP-BC) in 2013 and started my career working for a rural practice working in urgent and primary care and then started also doing pain management as my supervising physician was also a pain provider. I worked for around three years and then opened my own medical practice. I owned and operated my medical practice for four years and then merged my practice with a larger group and started a four year fellowship in interventional pain management with this new merger.  I have learned a lot about healthcare operations and administration during the owning and running of my own medical practice to include running a medical practice in a rural setting with a large indigent population. Currently, I work as a subclinical investigator for clinical research, and also as an interventional pain management provider.

Nursing Research Initiatives with a Focus on Education of Patients

As a registered nurse with over thirty seven years of experience in the field, I have been blessed with the privilege of rendering my services in diverse healthcare establishments. Among these opportunities, one that truly resonated was my involvement in multiple nursing research initiatives, such as an extensive analysis on educating patients towards diminishing readmissions coupled with garnering insights into nurses' perspectives regarding alleviating pain levels among geriatric individuals (Gray & Grove, 2020). Through this kaleidoscopic exposure to the realm of academic investigation, I acquired a profound comprehension of its nuances, along with realizing how crucial it is to employ evidence-based practices toward enhancing patient outcomes. As a DNP provider will allow me to head task force initiatives and spearhead quality improvement initiatives as well as being a patient advocate for quality health care issues within my community.

I have been able to implement into my current practice the Behavioral Risk Assessment (BRE) Program that targets Medicare patients and provides this patient population with education, needed resources and feedback on current treatment modalities and treatment plan initiatives. This program also provides to the providers a overview of the patient when they are not at an appointment as the patients are followed up with at least twice per month or more if needed allowing us to be able to flag at risk patients in need of assistance, meals, medical interventions, as well quick pick up on any mental health issues or changes. The BRE program has been a huge success within our facility and has shown to decrease the number of hospital admissions and re-admissions due to this program's start with my current employment.

Evidence Based Practice in my Current Position

The tenets of evidence-based practice (EBP) have been fervently embraced by my present establishment, which has an unwavering dedication to propagating the incorporation of scientific research into clinical decision-making processes. This ethos is vividly exemplified through regular assemblies convened for our workforce to dissect contemporary findings and how they can be judiciously assimilated into our praxis (Walden University, n.d). Apart from this avenue, we are privileged with access to a plethora of online sources, such as Cochrane Library and PubMed that impart timely knowledge on cutting-edge investigations. To further consolidate its stance in upholding EBP principles, the organization initiated numerous measures, including standardized treatment protocols and precise action pathways aimed at ensuring optimal standards are duly observed during patient care.

Importance of Nursing Research and Evidence Based Practice

Upon looking into the materials provided for this week's educational endeavors, I have been enlightened with a deeper comprehension of the vital role nursing research and evidence-based practice play in enhancing patient well-being (Walden University, 2020). Notably, my understanding has been reinforced through an exploration of chapters dedicated to elucidating how research development has shaped evidence-based nursing practices and ethics intrinsic to successful research conduct. Nurses must hone their ability as judicious consumers of empirical data while upholding ethical principles throughout the process. My fervent eagerness persists as I look forward to further unearthing diverse techniques and philosophies within the realm of nursing research, propelling me toward optimal application in practical settings.

References

Gray, J. R., & Grove, S. K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier

Walden University, LLC. (2020). SAGE research methods online: Introduction to SAGE research methods online Links to an external site..  https://academicguides.waldenu.edu/library/srmo Links to an external site.

Walden University Oasis: Writing Center. (n.d.). Citations: Overview Links to an external site.  https://academicguides.waldenu.edu/writingcenter/apa/citations Links to an external site.

PEER #2

Roslyn Stewart

Current and Previous Role in Nursing Practice and Research

My nursing practice involves sixteen years of nursing experience with both hospital and community involvement. I have an MSN in nursing education, with passion for educating and creating processes to streamline portions of task work so that more focus can be applied to patient care. In the past, I was on the research committee and the professional practice council at a tertiary care hospital. I assisted with hosting “Lunch and Learn” sessions to teach nurses about the importance of research and EBP. Though I participated in the committees and helped with the sessions, I still had a lot to learn about conducting a thorough literature review and analysis. I have also been away from formal research since becoming a travel nurse for the last three years. However, I have recently participated in informal literature searches and EBP as a travel nurse.

 

Experience with EBP

One example of EBP was the use of the PDSA model in a small test of change (McEwen & Wills, 2019).  As a travel nurse, one hospital system where I worked had a process where some common medications were in the medication station (Pyxus) while other medications could be in the refrigerator, patient individual bin, or in a different Pyxus on the other side of the unit. This was causing a delay in medication pass and wasted much time as nurses spent much time searching for meds or on the phone with pharmacy. I submitted a process improvement request through the unit suggestion box. I am grateful the management team were open to ideas for process improvement. We identified the amount of time looking for medications and mapped out the delay in care. The management team collaborated with the pharmacy and clinical support teams to develop a feature that was then added to the EHR, informing nurses where medications were located. By utilizing this new technology feature, I and other nurses were able to complete medication passes sooner, improving time management in this unit that was later expanded to hospital-wide.

Another example of EBP was noticed in the hospital where I was most recently working. This EBP was in place before my coming and involved patient ratios for telemetry nurses and required breaks. Nurse to patient ratio is 4:1. The charge nurse does not take patients and there is a break nurse. This follows the evidence which informs that nursing ratios affect patient care. Khanna et. al. (2022) identified that higher ratios resulted in longer patient hospital stays.  Tenorio et. al. (2021) concluded higher ratios were associated with increases in missed patient care. Carlesi et.al. (2017) found that patient safety events, mainly falls and harm, increased in direct relation to higher patient to nurse ratios and increased nursing workload.

 

Organization Support for EBP

As a travel nurse working at multiple hospital facilities, I have found that most are either actively utilizing EBP or at least open to the use of EBP. Each location is different in the process of incorporating EBP.  I have seen EBP in action in many venues, with differences in dissemination and implementation of EBP within larger multi-hospital organizations versus smaller community hospitals. Each environment brings strengths and challenges. Working in these various places helped me to determine the approach to use to implement EBP based on the setting. Renolen et. al. (2019) explains different approaches to EBP. In the larger hospitals and/or system hospitals, I have noticed it is easier for EBP to begin at the individual or unit level and become a system wide standard after the small test of change. This is confirmed by Renolen et. al. (2019). EBP can alternatively begin as a hospital level formal systemwide initiative, but this is much easier executed in a smaller hospital as long as resources are present (Renolen et. al., 2019).

 

References:

Carlesi, K. C., Padilha, K. G., Toffoletto, M. C., Henriquez-Roldán, C., & Juan, M. A. C. (2017). Patient safety incidents and nursing workload. Revista Latino-Americana de Enfermagem, 25. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=psyh&AN=2017-17003-001&site=eds-live&scope=site. 

 

Khanna, A. K., Labeau, S. O., McCartney, K., Blot, S. I., & Deschepper, M. (2022). International variation in length of stay in intensive care units and the impact of patient-to-nurse ratios. Intensive & Critical Care Nursing, 72.  https://doi.org/10.1016/j.iccn.2022.103265 Links to an external site.

 

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer

 

Renolen, A., Hjälmhult, E., Høye, S., Danbolt, L. J., & Kirkevold, M. (2019). Evidence‐based practice integration in hospital wards—The complexities and challenges in achieving evidence‐based practice in clinical nursing. Nursing Open, 6(3), 815–823.  https://doi.org/10.1002/nop2.259 Links to an external site.

 

Tenorio, M. R., Aletreby, W. T., Shammari, B. A., Almuabbadi, B., Mwawish, H., & Montegrico, J. (2021). The Interrelation between nurse-to-patient ratio, nurse engagement, and missed nursing care in King Saud Medical City: Basis for development of nurse–patient quality of care. Saudi Journal for Health Sciences, 10(2), 116–124. https://doi.org/10.4103/sjhs.sjhs_74_21