responds ENABLERS AND BARRIERS TO TRANSLATION
jaydenson
respondsENABLERSANDBARRIERSTOTRANSLATION.docxJan 5 11:15pm
Reply from Kasirim Masi
The selected organization is an inpatient psychiatric hospital that offers acute stabilization to individuals undergoing severe mental health crises. The Columbia Suicide Severity Rating Scale (C-SSRS) is not consistently used during psychiatric admissions or when patients exhibit severe changes in mood, behavior, or clinical status. Although the C-SSRS is a validated, evidence-based tool for assessing suicide risk, its inconsistent use raises major patient safety concerns.
When patients' suicide risk is not precisely or consistently assessed, clinicians may overlook important warning signs. This can lead to a failure to change safety precautions (such as observation levels, environmental controls, or treatment intensity) or to escalate care as danger increases. Missed or delayed risk stratification increases the likelihood of suicide attempts and, in some circumstances, completed suicides. According to White et al. (2024), inconsistent translation of evidence-based assessments into everyday practice jeopardizes patient safety.
The selected evidence-based practice (EBP) quality improvement (QI) program aims to standardize and sustain consistent C-SSRS use at two critical points: (1) psychiatric admission and (2) reassessment following clinically significant changes in mood, behavior, or suicide risk. The effort consists of workflow restructuring, targeted staff education, EHR decision assistance, and audit-and-feedback mechanisms. This multidimensional approach parallels best practices in implementation science, which emphasize the necessity of incorporating evidence into daily clinical workflows rather than depending primarily on independent clinician judgment (White et al., 2024).
Enablers to Translating and Applying Evidence
Several enablers contribute to the successful translation of this endeavor. First, the organizational prioritization of suicide prevention acts as a powerful enabler. Suicide risk assessment is both a regulatory requirement and a core patient safety metric, which boosts leadership engagement and support for practice changes. Second, interdisciplinary collaboration improves implementation outcomes. Collaboration between psychiatric nurses, nurse practitioners, psychiatrists, social workers, and informatics professionals encourages shared responsibility for accurate risk assessment. According to White et al. (2024), cooperation is an important enabler for the long-term success of translation initiatives. Third, existing EHR infrastructure allows for the integration of the C-SSRS into admission and reassessment routines.
According to McGoey et al. (2011), incorporating evidence-based interventions into current systems decreases cognitive burden while increasing consistency. Automated prompts and standardized documentation fields help ensure that suicide risk assessments directly inform monitoring levels and safety interventions. Finally, clinicians' awareness of patient safety concerns encourages adherence. Abu et al. (2022) found that perceived relevance to patient outcomes considerably increases the adoption of evidence-based therapies.
Barriers to Translating and Applying Evidence
Time constraints and competing clinical responsibilities in acute psychiatric settings may limit the frequency of reassessments. Role ambiguity over accountability for reassessment might lead to missing evaluations. Furthermore, clinician discomfort in discussing suicide may result in avoidance or inadequate assessments. Cane et al. (2012) describe how beliefs, emotions, and confidence influence clinician behavior during implementation.
DNP Strategies for Addressing Barriers
Addressing these challenges needs systems-level leadership from a DNP-prepared nurse. Workflow redesign reduces time burden by including reassessment triggers into routine care. Clear role delineation promotes accountability. Ongoing education, simulation, and feedback address discomfort and reinforce confidence in suicide risk assessment. Consistent audit and feedback systems improve reliability and sustainability (White et al., 2024; McGoey et al., 2011).
Conclusion
Inconsistent C-SSRS use is a serious patient safety gap that puts people at risk of attempting and completing suicide. This EBP QI program enhances accurate suicide risk assessment and safety monitoring by leveraging organizational enablers, addressing recognized barriers, and utilizing translation science principles. DNP-prepared nurses play a critical role in directing these efforts to protect vulnerable patients and enhance psychiatric outcomes.
References
Abu, O. H., Said, N. B., Nair, S. C., Allsop, M. J., Currow, D. C., Salah, M. S., Hamad, B. A., Elessi, K., Alkhatib, A., ElMokhallalati, Y., Bayuo, J., & AlKhaldi, M. (2022). Identifying barriers and facilitators of translating research evidence into clinical practice: A systematic review of reviews. Health & Social Care in the Community, 30(6), e3265–e3276. https://doi.org/10.1111/hsc.13898Links to an external site.
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation science. Implementation Science, 7, 37. https://doi.org/10.1186/1748-5908-7-37Links to an external site.
McGoey, K. E., Rispoli, K., McGuirk, L., DeBor, L., Marshall, S. N., Rubinic, D., & Friedrich, K. (2011). Translating research into evidence-based practices: Reducing the barriers to intervention implementation. https://doi.org/10.1037/e716972011-001Links to an external site.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2024). Translation of evidence into nursing and healthcare (4th ed.). Springer.
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Jan 5 6:21pm
Reply from Angelica Salazar Sherman
Organization and Practice Issue
Serving individuals with serious mental illness (SMI), the chosen organization is an acute inpatient psychiatric hospital. The absence of standardized, evidence-based mental discharge planning is a recurring organizational problem in this context, contributing to high rates of psychiatric readmission, fragmented continuity of care, and extended length of stay (LOS). Research repeatedly shows that when discharge planning is delayed, poorly coordinated, or inadequately integrated with community resources, mental patients have longer LOS and more readmissions (Barruel et al., 2024). Discharge failures are a quality and efficiency gap that directly affects organizational performance and patient outcomes, in addition to being a patient safety risk from a systems perspective.
Selected Evidence-Based Practice Quality Improvement Initiative
I chose evidence-based practice quality improvement initiative involves the implementation of a standardized interprofessional psychiatric discharge planning model, guided by the IDEAL Discharge Planning Framework and research on transitional psychiatric care. This initiative highlights the importance of early discharge planning, structured medication reconciliation, engagement of patients and families, coordinated handoffs, and prompt connections to outpatient psychiatric and community-based services (Kalaiee et al., 2024). The initiative aims to commence at the point of admission and persist throughout the hospitalization period, ensuring that discharge readiness is evaluated systematically rather than addressed as a last-minute task. Research indicates that structured discharge models effectively reduce length of stay, enhance patient satisfaction, and decrease readmission risk when implemented consistently (Alharbi et al., 2025).
Enablers to Translating and Applying Evidence
The successful translation of this EBP QI endeavor is supported by a number of enablers. First, a crucial enabler is interprofessional collaboration. Discharge coordination is improved, communication is improved, and duplication of effort is decreased when nursing, psychiatry, social work, pharmacy, and case management collaborate well (Ernstmeyer & Christman, 2024). Second, nursing leadership participation is a powerful facilitator. Better organizational preparedness, employee engagement, and quality outcomes are linked to evidence-based nursing leadership (Valimaki et al., 2024). Third, by including frontline practitioners in workflow redesign and decision-making, staff involvement and shared governance frameworks promote ownership and sustainability of practice transformation (Brennan & Wendt, 2021). Together, these facilitators combine clinical competence, teamwork, and leadership support to produce a climate that is favorable to successful EBP translation.
Barriers to Translating and Applying Evidence
Despite these supporters, a number of obstacles could prevent implementation. Employee resistance to change is still a major problem, especially when new discharge procedures are thought to increase effort or interfere with long-standing routines (Alsadaan & Ramadan, 2025). Patient safety and continuity of treatment are further threatened by poor communication during handoffs, particularly between inpatient and community clinicians (Haliq & AlShammari, 2025). Furthermore, even well-thought-out discharge procedures might be jeopardized by organizational limitations such a lack of community mental health resources, unstable housing, and insufficient outpatient follow-up capacity (Shields & Davis, 2024). These obstacles demonstrate how difficult it is to apply evidence in actual psychiatric settings.
DNP-Prepared Strategies to Address Barriers
As a DNP-prepared nurse, overcoming these barriers necessitates deliberate leadership, systems thinking, and the application of implementation science strategies. To address resistance, it is essential to integrate staff education with shared governance and co-design strategies, enabling frontline clinicians to engage in customizing discharge workflows to align with unit-specific conditions (Brennan & Wendt, 2021). Standardized discharge tools, structured handoff protocols, and interprofessional discharge huddles effectively address communication barriers and reduce information gaps (Alharbi et al., 2025). The DNP role involves advocating for enhanced partnerships with outpatient providers, community psychiatry programs, and housing resources to address organizational and community-level constraints, utilizing implementation frameworks to tailor evidence to the local context (Flaubert et al., 2021). The DNP-prepared nurse employs these strategies to act as a clinical scholar and change agent, guaranteeing the implementation and sustainability of evidence-based discharge planning.
Conclusion
There is a significant chance to promote care continuity, lower LOS, and improve patient outcomes by putting into practice a systematic, evidence-based mental discharge planning program. Interprofessional collaboration and leadership support facilitate translation, but we must actively address obstacles such as resistance, communication, and system restrictions. Through evidence-based leadership, stakeholder involvement, and implementation science knowledge, DNP-prepared nurses are well positioned to spearhead this endeavor, eventually improving mental care quality and safety.
Angelica S Sherman
References
Alharbi, S., Elmassry, L., Aljuaid, E., Attar, A., Nuñez, J., Joseph, M., Diamat, K., Alzahrani, M., & Algubaishi, S. (2025). Reengineering patient discharge with Lean methodology and RED framework: A model for safer, faster, patient-centered transitions. Global Journal on Quality and Safety in Healthcare, 8(4), 148–160. https://doi.org/10.36401/JQSH-25-10Links to an external site.
Alsadaan, N., & Ramadan, O. M. E. (2025). Barriers and facilitators in implementing evidence-based practice: A parallel cross-sectional mixed methods study among nursing administrators. BMC Nursing, 24(1), 403. https://doi.org/10.1186/s12912-025-03059-zLinks to an external site.
Barruel, D., Perozziello, A., Lefèvre, H., Msellati, A., Launay, C., & Dauriac-Le Masson, V. (2024). Predictors of the length of stay in psychiatric inpatient units: A retrospective study for the Paris Psychiatry Hospital Group. Frontiers in Psychiatry, 15, 1463415. https://doi.org/10.3389/fpsyt.2024.1463415Links to an external site.
Brennan, D., & Wendt, L. (2021). Increasing quality and patient outcomes with staff engagement and shared governance. OJIN: The Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/ojin.vol26no02ppt23Links to an external site.
Ernstmeyer, K., & Christman, E. (Eds.). (2024). Nursing management and professional concepts (2nd ed.). Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK610469/Links to an external site.
Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021, May 11). Nurses leading change. The Future of Nursing 2020-2030 - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK573918/Links to an external site.
Haliq, S. A., & AlShammari, T. (2025). Communication handover barriers among nurses and paramedics in emergency care settings. BMC Nursing, 24(1), 634. https://doi.org/10.1186/s12912-025-03286-4Links to an external site.
Hult, M., Terkamo-Moisio, A., Kaakinen, P., Karki, S., Nurmeksela, A., Palonen, M., Peltonen, L. M., & Häggman-Laitila, A. (2023). Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews. Nursing Open, 10(9), 5920–5936. https://doi.org/10.1002/nop2.1876Links to an external site.
Kalaiee, Z. M. R., Ghafouri, R., Zandi, M., & Nasiri, M. (2024). Effect of implementing the IDEAL discharge model on satisfaction of patients referred to a trauma emergency department. PLOS ONE, 19(6), e0304969. https://doi.org/10.1371/journal.pone.0304969Links to an external site.
Shields, M. C., & Davis, K. A. (2024). Inpatient psychiatric care in the United States: Former patients’ perspectives on opportunities for quality improvement. Journal of Patient Experience, 11, 23743735241257810. https://doi.org/10.1177/23743735241257810Links to an external site.
Valimaki, M., Hu, S., Lantta, T., Hipp, K., Varpula, J., Chen, J., Liu, G., Tang, Y., Chen, W., & Li, X. (2024). The impact of evidence-based nursing leadership in healthcare settings: A mixed methods systematic review. BMC Nursing, 23(1), 452. https://doi.org/10.1186/s12912-024-02096-4Links to an external site.
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