DISSEMINATION OF EBP

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Evidenced Based Change

Leslie Hill

Walden University

Introduction/Purpose

  • Change is inevitable.
  • Health care organizations need change to improve.
  • There are challenges that need to be addressed(Baraka-Johnson et al. 2019).
  • Challenges should be addressed using evidence-based research.
  • These changes enhance professionalism therefore improving quality of care and quality of life.
  • The purpose of this paper is to identify an existing problem in health care and suggest a change idea that would be effective in addressing the problem.
  • The paper also articulates risks associated with the change process, how to distribute the change information and how to implement change successfully.

Organizational Culture

  • The Organization is a hospice facility
  • Offers end of life care for pain and symptom management
  • The health care providers currently have a positive culture.
  • In the past, they embraced change
  • Employees are willing to implement change if the change will have a positive outcome for patient or employee.

Customization

  • The facility will be customized to meet the needs of this task
  • The facility will be offering physical, emotional, and spiritual services
  • Primarily caring for patient with diagnosis with prognosis of 6 months of less
  • Care givers provide needed activities of daily living and monitor symptoms of patient

  • The current problem is the many pressure injuries among patients
  • 1 out of 5 patients experience pressure ulcer/injury at least once during their care with hospice(Boyko et al. 2018)
  • This issue raises concern
  • Pressure ulcers impact quality of life
  • There are also concerns about the professionalism and ethical considerations of health care givers.
  • The concerns include raising questions regarding the credibility of health care givers and their commitment to their duties
  • These concerns call for the need to change

Current Problem/Opportunity for Change and Scope

  • Health care givers(physicians, nurses, volunteers, etc)
  • Hospice management
  • Patients
  • Community
  • Families
  • Therapists

Stakeholders

  • Resistance
  • Poor leadership
  • Operational disruptions
  • Inadequate resources
  • Inconsistency in documentation

Risks Associated with Change Implementation

  • The evidence-based idea for change/approach is to have a standardized skin and ulcer risk assessment
  • These should be built on existing practices
  • Should be customized to a hospice setting
  • This calls for a clinical pathway(Park et al. 2016)

Idea for Change

  • Extensive analysis of evidence-based studies
  • Create a common understanding and vision for change
  • Analyze target audience (hospice patient) and their unique needs
  • Hold meetings
  • Organize trainings
  • Computer presentations
  • Medium should be cost friendly

Knowledge Creation and Distribution

  • Assign roles and responsibilities
  • Educate health care givers, families, and patients
  • Develop guidelines related to the condition
  • Frequent reviews
  • Periodic review with staff
  • Effective communication

Organizational Adoption and Implementation

  • Standardized care
  • Evidence-based care
  • Shared decision making
  • Improved quality of care
  • Improved care planning

Measurable Outcomes

  • Article 1-Barakat-Johnson M., Lai M., Wand T. & White K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95-102.https :// doiorg .ezp.waldenulibrary. org/ 10.1016/j.colegn. 2018.04.005 This is a level 3 evidence. A qualitative study prompted by the increasing number of injuries caused by pressure ulcers. Researcher used semi-structured questions. The study found that it is important to do preventive dressing. Also emphasized the need for educating patients.
  • Article 2-Park S. H., Lee Y. S. and Kwon, Y. M. (2016). Predictive validity of pressure ulcer risk assessment tools for the elderly: A meta-analysis. Western Journal of Nursing Research, 38(4), 459-483. This is a level 2 evidence that originated from meta-analysis of randomized and controlled trials. The study used 29 previously conducted studies on pressure ulcers. Participants were mainly elderly patients. The study was both qualitative and quantitative. Findings of the research were that the health center used screening tools which are not accurate. Recommendation of the use of valid and accurate tools.

Summary of Articles

  • Article 3-Boyko T., Longaker M. T., and Yang G. (February 1, 2018). Review of the current management of Pressure Ulcers. Journal of Advances in Wound Care, vol. 7, issue No. 2. Pages 57-67.this was a level 1 evidence, a systematic review of both controlled and randomized trials. It was a qualitative study whose subjects were elderly victim of pressure ulcers. Study found that one of the major causes is immobility. Recommended preventive measures
  • Article 4-Ferris, A., Price, A., & Harding K. (2019). Pressure ulcers in patients receiving palliative care: A systematic review. Palliative Medicine, 33(7), 770-782. https://doi-org.ezp.waldenulibrary. org/10.1177/0269216319846023. This was also a level 3 evidence, a review of relevant trials. Participants were elderly patients receiving palliative care. People of varying age, gender and levels of the study took part in the study. Research found that people who do not receive proper health care are the victims of pressure ulcers.

Summary of Articles, Cont.

  • I learned that the different levels of evidence seek to answer different types of clinical questions. I also realized that the level of evidence depends on the type and quality of data used. The highest level of evidence was level 1, which has quality data and is the most used in making clinical decisions. Innovation and techniques used also determine the level of evidence and one should not assume that level 1 evidence is always the best.

Lessons from Levels of Evidence Table

  • After completing the evaluation table, I learned that all the studies had potential outcomes in the area of study. All the studies had findings which would benefit health care, specifically in preventing pressure ulcers. I recognized that different studies have different contributions or approaches to the focus problem.

Lessons from the Evaluation Table

  • After completing this table, I discovered that evidence-based research has a direct impact on clinical practice. Some of the outcomes are measurable while others are not. The extent of outcome depends on the level of evidence and practicability in health care setting.

Lessons from Outcomes Synthesis Table

  • Pressure ulcer/injury is a major concern.
  • Mostly affects the elderly/bedridden
  • Immobile patients are at a higher risk(Ferris et al. 2019)
  • There is need for intervention
  • Change is a collective responsibility
  • It is also multidimensional
  • Communication is imperative
  • Evidence based approach is always effective

Conclusion

References

  • Barakat-Johnson M., Lai M., Wand T. & White K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95-102.Retrieved from https://doiorg.ezp.waldenulibrary.org/10.1016/j.colegn.2018.04.005
  • Boyko T., Longaker M. T., and Yang G. (February 1, 2018). Review of the current management of Pressure Ulcers. Journal of Advances in Wound Care, vol. 7, issue No. 2. Pages 57-67.
  • Ferris, A., Price, A., & Harding K. (2019). Pressure ulcers in patients receiving palliative care: A systematic review. Palliative Medicine, 33(7), 770-782. Retrieved from https ://doi-org.ezp.waldenulibrary. org/10.1177/0269216319846023
  • Park S. H., Lee Y. S. and Kwon, Y. M. (2016). Predictive validity of pressure ulcer risk assessment tools for the elderly: A meta-analysis. Western Journal of Nursing Research, 38(4), 459-483