Xr05 ppt

INSTRUCTIONSASSESSMENT.docx

Recorded PowerPoint Presentation to a Quality Improvement Team (5 min)

After completing the Learning Activities in Module 1 and Module 2, reflect on how the application of research findings contributes to evidence-based practice.

· Select one issue that pertains to quality or safety in nursing. The issue may be pertinent to your current place of employment or a hypothetical situation in a healthcare organization.

· Use the Walden Library to search the literature for information related to quality or safety issue you selected. Find at least two scholarly resources that relate to the issue you selected. Note: You are required to use at least two sources, but you may use more than two.

Create a 5-minute video PowerPoint presentation addressing the following points:

· Summarize the issues related to quality and safety that are identified in the two (or more) articles you found.

· Explain the interventions and recommendations from the literature that could be implemented in practice. Be specific and provide examples.

· Describe any additional types of quantitative and/or qualitative data that might be needed to propose a recommendation for quality and/or safety improvements in your practice. Be specific.

· Based on the evidence in your review of the literature on the issue, explain what proposals you would make for improving quality or safety in your practice. Provide a rationale for your proposals with specific details and examples.

Cite all sources in APA format and include a References page on the last slide. Review the guide for Recording or Uploading Audio and Video In Brightspace for instructions on recording your PowerPoint presentation.

Record your PowerPoint presentation with a voiceover. You may also use the camera option to add a talking head to your PowerPoint presentation.

Scenario.docx

Scenario

Susan, a registered nurse in an obstetrics clinic, is reviewing the principles of evidence-based practice (EBP) to identify areas of improvement for her clinical setting. Please help her by responding to the questions in the following scenario.

The use of evidence-based practice (EBP) guidelines is an expectation of which regulatory organizations?

The Joint Commission

2

Centers for Medicare and Medicaid Services (CMS)

3

All of the above

EBP consists of which elements to guide healthcare decisions?

Best evidence available

2

Patient values and circumstances

3

All of the above

I am noticing that there is a delay in scheduling post-partum patients for their follow-up visit. Using the Iowa Model of Evidence-Based Practice, what type of trigger is this?

Knowledge-Focused Trigger

2

Problem-Focused Trigger

3

None of the above

In reviewing the data related to this trigger, what performance measurement standards should I review to determine the best practice regarding this standard?

National Quality Forum (NQF)

2

Agency for Healthcare Research and Quality (AHRQ)

3

All of the above

I found out that the Quality Improvement Department in our healthcare system is using the Lean Model. Which of the following are true about this model?

It emphasizes meeting customer requirements and eliminating errors through process variation.

2

It eliminates waste by designing the most efficient and effective system.

3

It is a holistic management approach used to improve organizational performance.

Evidence-basedpracticequalityimprovementandresearch_Avisualmodel.pdf

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Abstract: Understanding the key similarities and differences between quality improvement, evidence-based practice, and research can help improve nursing practice. This article presents visual models to illustrate the relationship between these processes.

Keywords: evidence-based practice, nursing, quality improvement, research, visual models

BY CRYSTAL A. GRYS, MSN, RN

Evidence-based practice, quality improvement, and research: A visual model

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Many organizations have achieved success with the American Nurses Credentialing Center’s Magnet Rec- ognition Program®, and others are on the journey toward this goal. Inherent in the Magnet Recognition Program is the adoption of practice that is based on the best-possible evidence and a culture of inquiry that adopts a continuous quality improvement mindset.1,2 The inte- gration of quality improvement (QI), evidence-based practice (EBP), and research into the healthcare setting

can improve patient outcomes, in- crease quality, and reduce the cost of care.3 In a broader context, these can also apply to the operational and logistical aspects of practice. Discerning the differences between QI, EBP, and research can be difficult because of their many overlapping features.4 This article aims to help nurses who are unfamiliar with these concepts to be able to compare and contrast the three concepts and put them into context by way of two visual models.

OPEN

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ate new knowledge. Nurses with a DNP, a clinical practice degree, translate new evidence into prac- tice.5 They are also skilled in QI projects since DNP programs re-

quire QI projects as part of the cur- riculum. Approaches to QI projects may include methods like Plan- Do-Study-Act, or tools that are part of Six Sigma or Lean paradigms.6,7

Six Sigma is a process improve- ment approach that is intended to reduce errors and often employs investigational or analytic tools.8

Lean is a method to increase the ef- ficiency and quality of a process by reducing different types of “waste.”7

These approaches are sometimes used together because their meth- ods are related and complementary.8

Nurses with a Bachelor’s degree are educated in EBP, which often uses PICOT (Population, Intervention, Comparison, Outcomes, and Time) to formulate a targeted query of the literature. While PICOT can be a tool to frame a literature search for a QI project or to inform a research project, it is a primary tool for EBP in the translation of evidence into practice.

Key similarities and differences Understanding the key similarities and differences between QI, EBP, and research is important to de- termine the best approach to solve problems. Furthermore, certain problems require particular skill sets, so the alignment of roles and methods is vital for success (see Visual model of similarities and differ- ences between QI, EBP, and research). QI and EBP are similar in that they are both used during practice.4

EBP is used to care for individual patients, address operational and systemic questions, or improve safety or quality outcomes.7 QI projects are used to fix or build a new process specific to the local practice and informed by local data and evidence from the literature.4,7

Research studies are similar to EBP in that they are both primar- ily grounded in evidence from the literature.4 Where they differ is that

EBP, QI, and research in nursing education and practice Nurses with a PhD in nursing, a research-focused degree, ask ques- tions and design studies that gener-

Visual model of similarities and differences between QI, EBP, and research

Note: This diagram uses examples related to the prevention of pressure injuries.

Examples of QI, EBP, and research QI • Standardizing skin inspection and risk assessment to reduce pressure injuries • Optimizing the use of sepsis bundles • Implementing a process to remove indwelling urinary catheters within a certain

time frame • Examining ways to reduce medication administration errors • Reviewing specimen labeling practices to reduce errors • Employing a gap analysis to determine how to better prepare nurse preceptors

EBP • A clinical nurse educator implementing a patient positioning program to reduce

the risk for pressure injuries • A nursing informaticist using evidence to inform the design of a decision sup-

port tool for a new visit type • A nurse leader using evidence to implement a new staffing model to improve a

unit’s operational efficiency • A nurse leader implementing a resource prioritization system for annual plan-

ning and budgetary/financial management

Research • A randomized controlled trial studying new wound care approaches, such as a

new pressure-relieving support surface • A randomized controlled trial evaluating the efficacy of a nurse visit after dis-

charge for patients with a myocardial infarction

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research is used to generate new ev- idence using the scientific method, which involves testing a hypothesis, observing and analyzing results, and using the results to establish a knowledge base, while EBP initia- tives translate existing evidence on patient care or optimization of operations.7,9 Research studies are similar to QI projects in that both ask questions to solve problems.4

Research studies produce results that are generally applicable to many other similar settings, while the results of a QI project are often limited or specific to a particular practice or population.7,10

While QI, EBP, and research have been well defined, a concep- tual model showing their interplay could help display attributes and relationships in a way that may engage a wider audience of learn- ers (see Visual model of the functional relationship between QI, EBP, and research).4,7 Questions inspired by a curious practice can spur research studies that generate new knowl- edge and feedback into the practice as new evidence. When there are problems or issues related to qual- ity or efficiency in the practice, QI activities can yield process im- provements. Reviewing examples of QI, EBP, and research can bet- ter illustrate the differences and similarities (see Examples of QI, EBP, and research).

Integrating QI, EBP, and research throughout the organization is important to optimize clinical out- comes. These activities are often ongoing across an organization and facilitated by team members who serve in different roles. As such, it is useful to clearly define the roles and processes to ensure that they are resourced appropriately. By understanding the interplay of QI, EBP, and research, nurses may find it easier to begin contributing to these activities. Engaged nurses may find it rewarding to align their efforts

with QI, EBP, or research knowing that their efforts will support the Quintuple Aims of Healthcare, in- cluding population health, patient experience, quality outcomes, caring for healthcare providers, and health equity.11-13 ■

REFERENCES

1. American Nurses Credentialing Center. 2019 Magnet Application Manual. American Nurses Credentialing Center; 2019.

2. Carter EJ, Mastro K, Vose C, et al. Clarifying the conundrum: evidence-based practice, quality improvement, or research?: The clinical scholarship continuum. J Nurs Adm. 2017;47(5):266-270. doi:10.1097/NNA.0000000000000477.

3. Melnyk BM, Morrison-Beedy D. Generating evidence through intervention research versus using evidence in evidence-based practice/ quality improvement. In: Melnyk BM, Morrison-Beedy D, eds. Intervention Research and Evidence-Based Quality Improvement. 2nd ed. Springer Publishing Company; 2018. doi:10.1891/9780826155719.0001.

4. Shirey MR, Hauck SL, Embree JL, et al. Showcasing differences between quality improvement, evidence- based practice, and research. J Contin Educ Nurs. 2011;42(2):57-68; quiz 69-70. doi:10.3928/00220124-20100701-01.

5. Gaines K. DNP vs Ph.D. in nursing - what is the difference? https://nurse.org/education/dnp-or- phd-in-nursing-difference/.

6. Donovan EA, Manta CJ, Goldsack JC, Collins ML. Using a Lean Six Sigma approach to yield sustained pressure ulcer prevention for complex critical care patients. J Nurs Adm. 2016;46(1):43-48. doi:10.1097/NNA.0000000000000291.

7. Polit DF, Beck CT, eds. Quality improvement and improvement science. In: Nursing Research: Generating and Assessing Evidence for Nursing Practice. 11th ed. Wolters Kluwer; 2021.

8. Lee JY, McFadden KL, Gowen CR 3rd. An exploratory analysis for Lean and Six Sigma implementation in hospitals: together is better? Health Care Manage Rev. 2018;43(3):182-192. doi:10.1097/HMR.0000000000000140.

9. Winstead-Fry P. The scientific method and its impact on holistic health. Adv Nurs Sci. 1980;2(4):1-8.

10. The Federal Register. Code of Federal Regulations Title 45, Subtitle A, 46.102. 2022. www.ecfr.gov/current/title-45/subtitle-A/ subchapter-A/part-46/subpart-A/section-46.102.

11. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi:10.1377/ hlthaff.27.3.759.

12. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576. doi:10.1370/afm.1713.

13. Nundy S, Cooper LA, Mate KS. The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA. 2022;327(6):521- 522. doi:10.1001/jama.2021.25181.

Crystal Grys is a Team RN at Mayo Clinic Arizona in the Division of Community Internal Medicine in Scottsdale, Ariz., and instructor in nursing, Mayo Clinic College of Medicine and Science. She is enrolled in a DNP program at Duke University.

Copyright © 2022 The Author. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Com- mons Attribution Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

The author has disclosed no financial relationships related to this article.

DOI-10.1097/01.NURSE.0000889812.89287.45

Visual model of the functional relationship between QI, EBP, and research

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