DNP 820 Topic 7 DQ 1

What is the ultimate goal of evidence-based practice? What are some strategies health care organizations can employ to better promote a culture of evidence-based practice? Provide examples and relevant literature to support your response

What is the ultimate goal of evidence-based practice?

EBP is the integration of external evidence, patient preferences, clinical practice, values, decision-making, and problem-solving approach that uses evidence to determine what would be the best practices for achieving the desired patient outcomes (Morgan, 2021). EBP is an approach to decision-making that uses external scientific evidence, expert opinion, and patient needs to provide the evidence needed for diagnosis, decision-making, and intervention. Components of EBM are represented in relation to one another as the conscientious, explicit, and judicious use of the current best evidence in making decisions. The goal of EBP is to use the best available knowledge for a valid decision-making strategy that impacts research evidence, expertise, and the needs of a target audience (Morgan, 2021).

What are some strategies healthcare organizations can employ to better promote a culture of evidence-based practice?

Gallagher‐Ford, (2014) stated that the unique responsibilities of healthcare organizations related to EBP include embracing and role-modeling EBP in their own practice and creating cultures and environments that support and sustain EBP. Asking research questions help to determine the contributions EBP offers to our DPI projects which include;

Validation: Some of the research questions we can ask ourselves before settling on which project to do is, how do we know that our present practices are the best ones? As learners, this question challenges the assumption that our preferred practices are the best ones.

Verification: What evidence are we using to make decisions? Based on the hierarchy level of evidence, this question reveals whether we have sufficient sources to make critical decisions. We are required to use resource articles that are original and level 1 or 2 in the evidence-based hierarchy.

Clarification: Sometimes, results do not produce the desired outcomes. This question determines whether desired goals are being achieved and if the outcome can be accepted or not.

Evaluation: Are there any unintended consequences from our current practices? This question assesses whether there is a need for a change in current practices.

Application: How can EBP methodology enable us to attain our stated goals? This question focuses on aligning methodology and sources of evidence with the goals by employing best practices.

Morgan, (2021) stated that the following three assessment questions provide a guideline for evaluating strategies and their outcomes.

1. Are the results true? (validity)
2. What are the results? (reliability)
3. Are the results producing the desired outcomes? (applicability)

Providing an example using my PICOT Question

“Among adult patients in a home health care setting, does the implementation of the American Association of Clinical Endocrinology Clinical Practice Guideline on the use of continuous glucose monitoring compared to current practices impact hemoglobin A1C over 12 weeks?”

According to Morgan, (2021), this step is relevant in the development of PICOT to formulate a question., particularly if a timeframe is significant to the desired outcome.

Topic                                           Question                                   Sample answer

The Population of interest   What group do you want info on? Adult patients in a home

health care setting

Intervention            What event do you want to study the effect of?  Diabetic patients

using Dexcom G6

continuous glucose

monitoring machine

Comparison                         Compared to what?                      Compared to current practices

Better or worse than no

intervention at all or than

another intervention?             Impact hemoglobin A1C

Outcomes                            What is the effect of the

intervention?

What is the outcome?

The time involved to                             12 weeks

demonstrate an outcome?

Reference

Morgan, J. R. (2021). Evidence-Based Practice in Mission: A Method for Establishing Best Practices and Achieving Desired Goals. Source: International Bulletin of Mission Research, 45 (1), 26-41. Retrieved from https://eds-s-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=d19fd499-7fab-42d7-bbe6-b4bda68fd72c%40redis

Gallagher‐Ford, L. (2014). Implementing and sustaining EBP in real-world healthcare settings: Transformational evidence‐based leadership: Redesigning traditional roles to promote and sustain a culture of EBP. Worldviews on Evidence-Based Nursing, 11(2), 140-142. Retrieved from https://eds-s-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=d9cfb677-fea2-46ec-92f2-1a232b29a5b6%40redis

RESPOND HERE

MARGARET I agree with you that evidence-based practice (EBP) integrate external evidence and patient preferences in decision-making process. As a result, EBP is assumed to be factual and reliable healthcare practice. Most healthcare organizations have acknowledge the value of evidence-based practice in promoting patient safety and positive patient outcomes (van Os et al., 2019). The positive feedback from different healthcare organizations have attracted other institutions to integrate the same approach in their healthcare service delivery. EBP is an approach to decision-making that uses external scientific evidence, expert opinion, and patient needs to provide the evidence needed for diagnosis, decision-making, and intervention. The protocol used in EBP increases the credibility of the clinical decisions. The goal of EBP is to utilize factual information to improve quality of clinical decisions (Saunders & Vehviläinen‐Julkunen, 2018). Healthcare providers are expected to create a suitable environment for application of EBP. Therefore, having competent workforce will help in promoting a culture of evidence-based practice. Besides, qualified healthcare professionals acknowledge the importance of evidence-based practice.

References

Saunders, H., & Vehviläinen‐Julkunen, K. (2018). Key considerations for selecting instruments when evaluating healthcare professionals’ evidence‐based practice competencies: A discussion paper. Journal of Advanced Nursing, 74(10), 2301-2311. https://doi.org/10.1111/jan.13802

van Os, J., Guloksuz, S., Vijn, T. W., Hafkenscheid, A., & Delespaul, P. (2019). The evidence‐based group‐level symptom‐reduction model as the organizing principle for mental health care: time for change?. World Psychiatry, 18(1), 88-96.  https://doi.org/10.1002/wps.20609

Evidence-based practice (EBP) is implemented in order to ultimately impact patient care and gain positive patient outcomes based on the most recent evidence and research. EBP has demonstrated improvements in the quality of healthcare and costs. Melnyk et.al. (2016) discusses four aims of EBP, (1) improving the patient experience of care, (2) improving the health of the population, (3) reducing the cost of healthcare, and (4) improving work-life and decreasing burnout in healthcare workers. There are healthcare institutions who do not utilize EBP as a standard in practice due to barriers such as inadequate knowledge and skills, lack of culture that supports EBP, outdated policies and protocols, resistance, and inadequate EBP mentors (Melnyk et.al., 2016). EBP implementation can be promoted through educational services. Koota, Kaariainen, & Melender (2018), describes multiple education interventions to promote EBP practices found through a systematic review. Education interventions included educational materials such as lecture notes and PowerPoint presentations, posters or leaflets, activity sheets, theory-based lectures or tutorials, self-directed learning packages, workshops, face-to-face sessions, in-service training, and e-learning models.  Education was provided by a variety of professionals, such as researchers, nurse educators, and experienced nurses (Koota, Kaariainen & Melender, 2018). Within the organization this DNP learner works in, EBP promotion began with hiring a research team and a Magnet team. Thereafter, educational techniques were utilized to reach all levels of leadership front-line staff. Most of the educational interventions included staff meeting in-services, handouts and electronic learning through the hospital’s educational portal.  Furthermore, each department created a professional governance team to lead EBP projects and create ideas based on unit processes in order to improve the efficiency of process, protocols, and improve overall patient care. The culture of EBP continues with departmental leadership, especially when suggestions are brought forward by bedside staff. EBP is reviewed at a departmental level and at an organizational level based on benchmarks such as falls with injury, CAUTI’s, BSI’s, CLABSI’s, C. DIFF, and ED metrics such as length of stay, patients, leaving against medical advice, patients leaving without being seen, door-to-EKG time, Sepsis interventions within 90 minutes of arrival, and Stroke measures.

Koota, E., Kääriäinen, M., & Melender, H.-L. (2018). Educational interventions promoting evidence-based practice among emergency nurses: A systematic review. International Emergency Nursing, 41, 51–58. https://doi.org/10.1016/j.ienj.2018.06.004

Melnyk, B. M., Gallagher-Ford, L., & Fineout-Overholt, E. (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Reflections on Nursing Leadership, 42(3), 1-8.

REPLY

I concur with you that most healthcare organizations implement evidence-based practice (EBP) to impact patient care and safety. EBP is a guided healthcare routine. Factual information obtained from research improve the quality of EBP. Similarly, factual information in EBP improves the quality and accuracy of clinical decisions. EBP has demonstrated improvements in the quality of healthcare and costs (Shelton et al., 2018). Therefore, most healthcare facilities have directed their efforts towards implementing EBP. Unfortunately, other organizations have experienced different challenges ranging from inadequate support and incompetent workforce (Wood et al., 2020). However, healthcare facilities have developed criteria aiming at addressing these barriers. Regrettably, some healthcare institutions have opted not to implement evidence-based practices due to various setbacks. EBP implementation can be promoted through educational services. Introducing training programs will create room for healthcare professionals to learn and appreciate the role of EBP in providing quality healthcare services. The culture of EBP continues with departmental leadership, especially when suggestions are brought forward by bedside staff.

References

Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual review of public health.  https://doi.org/10.1146/annurev-publhealth-040617-014731

Wood, K., Giannopoulos, V., Louie, E., Baillie, A., Uribe, G., Lee, K. S., … & Morley, K. C. (2020). The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review. Implementation Research and Practice, 1, 2633489520959072. https://doi.org/10.1177/2633489520959072

Evidence-based practice is a proven method to deliver safe and quality-driven care based on proven outcomes supported by current research. By translating research into practice, healthcare clinicians provide care that improves the care for the patients and, additionally, can improve the work environment for the clinician, increase care efficiency, and results in cost savings for healthcare organizations (Melnyk, 2018). The evidence-based practice strives to enhance clinician knowledge and skills but considers the unique attributes of the patient (AbuBaker et al., 2021).

Evidence-based practice (EBP) is better supported when the culture of the organization and unit support this practice. A culture is a set group of beliefs, attitudes, behaviors, and values ascribed by a group of people (either the organization or unit) (Melynk, 2016). If the culture in a particular unit is accepting of providing care simply because it is the way it has always been done, this can be challenging to overcome. Staff are less likely to be receptive to introducing new methods to deliver care which can contradict the group norm. Culture is an important consideration that must be overcome to successfully implement EBP. It takes time to intertwine EBP into standard practice. Developing a spirit of inquiry is the first step. Leaders and staff need to be inquisitive to seek the best practice. Staff need to be encouraged, promoted, and supported to question practice and seek out the best evidence. Staff needs the tools to research current practices. When surveyed, many chief nurse executives value EBP, however, do not have budgetary considerations for EBP (Melynk, 2016). The words of the executives are not always reflected in their actions, which can be from a multitude of causes.

Falcone et al. (2020) used EBP to increase compliance with influenza vaccinations. Using EBP, influenza vaccine rates increased 597%, reducing influenza-related costs and improving patient outcomes. While financial support is not the sole way to incorporate EBP into practice, staff need financial support to have the resources to use EBP. It is imperative to show the cost-benefit of EBP. Budgets are strapped so allocating money may be limited. Seeing improvement in patient outcomes as well as the return of investment would be beneficial to change the culture. Additionally, a career advancement program or clinical ladder can help to support the spirit of inquiry. While a culture change does not occur overnight, with relentless determination it can be melded into the culture and eventually become the norm.

References

Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F. & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nursing, 20(13). Doi: http://doi.org/10.1186/s12912-020-00522-x.

Falcone, A. L., Vess, J. & Johnson, E. (2020). Evidence-based interventions cause multifold increase of influenza immunization rates in a free clinic. Journal of the American Association of Nurse Practitioners, 32(12), 817-823. Doi: 10.1097/JXX0000000000000302

Melnyk, B. M. (2016). Culture Eats Strategy Every Time: What Works in Building and Sustaining an Evidence-Based Practice Culture in Healthcare Systems. Worldviews on Evidence-Based Nursing, 13(2), 99–101. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12161.

Melynk, B. M. (2018). Why choose evidence-based practice? American Association of Nurse Practitioners. https://www.aanp.org/news-feed/why-choose-evidence-based-practice.

REPLY

it is true that evidence-based practice (EBP) is a proven method to deliver safe and quality-driven care based on proven outcomes supported by current research. Healthcare organizations that have successful implemented EBP have reported positive patient outcomes. Also, EBP helps in promoting patient safety. The practice rely on current research and external evidence (Li et al., 2018). Therefore, healthcare professionals are involved in translating research into practice. The evidence-based practice strives to enhance clinician knowledge and skills. Unfortunately, some healthcare organizations have failed to realize the importance of EBP. Incompetent workforce and resistance from stakeholders have challenged the efforts to implement evidence-based practice (Jordans et al., 2019). Evidence-based practice (EBP) is better supported when the culture of the organization and unit support this practice. Leadership is important in building and maintaining the environment that will guarantee successful implementation of EBP. Leaders and staff need to be inquisitive to seek the best practice. The collaboration between leaders and the staff is critical in the EBP implementation.

References

Jordan, Z., Lockwood, C., Munn, Z., & Aromataris, E. (2019). The updated Joanna Briggs Institute model of evidence-based healthcare. JBI Evidence Implementation, 17(1), 58-71. doi: 10.1097/XEB.0000000000000155

Li, S. A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Systematic reviews, 7(1), 1-19.