NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Introduction

Health organizations operate with the aim of optimizing outcomes such as safety, quality, and efficiency in addressing the needs of their organizations. Often, health organizations operate in highly dynamic and challenging environments. They experience issues such as competition from other organizations, changing consumer needs and preferences, and emerging health problems. These challenges imply that health organizations must embrace change to respond to their current and emerging needs in their markets.

Change initiatives provide organizations competitive edge over others involved in the same market niche. Healthcare providers, including nurses play a crucial role in the implementation of change initiatives that address organizational needs. They select evidence-based practice interventions to ensure efficiency in the adopted strategies and realization of optimum safety and quality outcomes in service delivery. Therefore, this presentation examines an organizational issue and proposed change to address it.

Organizational Description

The organization I work with is a tertiary hospital. The hospital leads in the region in the provision of specialized and general care to its diverse populations. The hospital has a culture that supports change. First, healthcare providers utilize teamwork in the provision of patient care services. Teamwork aims at ensuring collectivism in the realization of the organizational outcome. The organization also strives to support safety culture. This is achieved by the adoption of evidence-based interventions in the implementation of organizational strategies. Evidence-based strategies optimize outcomes such as safety, quality, and efficiency.

There is also the use of open communication among different stakeholders. Open communication ensures the prioritization of the stakeholder needs, views, and concerns. Open communication has strengthened openness and trust among the organizational employees, hence, enhanced teamwork in the provision of patient care. The organization also recognizes the vital role that rewarding performance plays in contributing to employee productivity. As a result, it undertakes biannual performance appraisals and uses them to reward employees and motivate them to explore additional ways of achieving the desired outcomes. These aspects of the organizational culture make it ready to embrace change.

Description of the Current Problem

The selected nursing problem in my organization is nursing shortage. The hospital currently experiences an acute shortage of nurses, which has affected the provision of patient care services to the patients. Several circumstances surround the issue of nurses shortage in the hospital. One of them is high rate of nurses’ turnover. The rate of nurses leaving their jobs intentionally has risen significantly over the past years. The rise is attributed to organizational issues such as high workload because of the few nurses, burnout, and occupational stressors associated with the challenge of balancing professional and family life demands.

The other factor is unhealthy workplaces. This can be seen from violence targeted at nurses by other nurses and other healthcare providers. Most nurses report experiencing either physical or verbal violence from others, which affect their psychological and physical health, hence, their intention to leave their jobs. The other factor is the low number of nursing students being trained among the American universities. This is attributed to the shortage of faculty staff to train a high number of nurses to address the current shortage. Lastly, more than one million nurses will be retiring in the next decade.

This implies that the problem of nursing shortage will persist if no intervention is embraced (Yahya Muabbar & Zayyan Alsharqi, 2020). The affected stakeholders by the problem include nurses and patients. Nurses suffer from high workload while patients are affected by low quality nursing care being given to them. The risks of implementing change include resistance to change from the adopters, inadequate support from health organizations, and disruption of the existing systems and processes by change.

Change is necessary in the healthcare systems. With the advancement in the operational processes, there is always the need to adjust some of the approaches used in the healthcare. Most organizations often implement changes to ensure efficiency in the healthcare processes and also to increase revenues. With the increased demands of quality in the healthcare delivery, most healthcare institutions are always involved in the continuous change processes to ensure that they meet the ever increasing demands from the clients. Given that healthcare institutions are faced with different challenges that need to be addressed, there is always the need to initiate change processes to address such challenges/problems (Arditi, Nayak, & Damci, 2017).

Different healthcare institutions are associated with different issues that either require changes in people’s behaviors or the processes or approaches in the healthcare system. Some of the challenges may include medication errors, workplace conflicts, inadequate care delivery, high costs of healthcare services, and low nurse to patient ratios. These challenges/issues often require the implementation of appropriate changes in the service delivery to ensure effective operational processes. The purpose of this paper is to examine an issue that may lead to the implementation of change processes in the healthcare system.

Executive Summary of the Issue Impacting Organization/Workplace

One of the main issues affecting my organization/workplace is workplace conflict. In most cases, conflicts among the employees and the management often impact effective operational processes. Usually, workplaces with a lot of issues experience delays in service delivery. Also, the quality of service delivery may go down. With the increasing conflicts within the work environment, people cannot reach consensus on various issues that impact healthcare processes. Workplaces with continuous conflicts often require constant changes to ensure that there is an overall improvement in the operational processes.

Conflicts within the work environment may be caused by poor communication, lack of common understanding among the workforce, as well as the lack of respect among the employees and the management. Close-mindedness, misunderstandings, as well as passive aggressive behaviors are some the other causes of workplace conflicts in my organization. In my organization, the management has been involved in implementing different change processes to address the issue of workplace conflicts. However, the approaches that have been taken often appear ineffective. For instance, the management has tried to transform communication processes to enhance understandings among the employees and the management; however, the approaches that were taken failed to produce effective outcomes.

Description of the Change Being Proposed: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Changes in the organizational culture and policies is essential in addressing the workplace conflicts. Changing an organizational culture is one of the best approaches in ensuring a reduction in workplace conflicts. However, it is one of the challenging processes for the management as there is always the need to transform the mind-set of employees as well as their behaviors. Also, the organization’s culture often consists of interlocking set of roles, goals, values, processes, attitudes, communication policies, as well as assumptions. Changing an organizational culture is often a large scale undertaking that requires the organization of different resources. For instance, the organizational tools that are required in changing the minds will need to be put in place.

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Changing an organizational culture will involve addressing the communication processes and improving the behaviors of people. In other words, the proposed change, which is the transformation of the organizational culture, will address the issues that often lead to conflicts. For example, the change process will create an environment of mutual respect and effective communication. Changes in the organizational culture may also create an environment where there is teamwork.

In most cases, workplaces where people interact and operate together experience less conflicts. The change or transformation of the organizational culture may lead to strong employee relationships, which can lead to less conflicts. Changing an organizational culture may also lead to changes in policies, objectives, mission, and vision, especially if these factors are attached to the cultural practices.

Justification for the Change: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Addressing the cultural change will have significant impact in the organization/workplace. Cultural change will lead to the creation of a positive environment for all the stakeholders, which will lead to increased quality in service delivery and the general patient outcomes. Organizational culture often contributes significantly to the behaviors of the people as well as the interaction processes. Therefore, whenever there is the need to resolve workplace conflict, transforming culture is necessary. Also, organizational culture often determines the value, principles, and ethical behaviours of the people. Therefore, transforming it would mean improvement on individual’s values, ethical behaviors and the development of positive principles which are necessary in resolving conflicts.

Type and Scope of the Proposed Change

Making changes to the organizational culture should incorporate making adjustments to the standards of behaviors of the people. Also, the whole process involves changes in the values and principles that people ought to adhere to. In other words, cultural change should incorporate changes in the workplace values, policies, skill, practices, attire, language, expectations, aesthetics, and tools.

Cultural change should involves overall changes in behaviors. In other words, the organizational culture change should incorporate a shift in behaviors and in the ways things are supposed to be done as well as how employees are expected to behave under different circumstances (Slack & Singh, 2018). The cultural change should also involve the transformation of policies relating to human resource activities.

Stakeholders Impacted By the Change and the Identification Of The Change Management Team: NURS 6052 Wk 10 Assignment: EBP Part 4: Recommending an Evidence-Based Practice Change

Some of the stakeholders that will be impacted by the cultural change include employees and the management. In the process of change, employees will be required to transform their behaviours, which may go contrary to the normal behaviors of a person. Also, adjusting to the set standards of behaviors may become very difficult for some people. Given that the management often relates directly to the employees, they may also be impacted by the cultural change (Pitafi, Liu, & Cai, 2018). Other stakeholders that may be impacted by the change include clients/patients that often get engaged directly with the organizational employees.

The change management team will involve the management. For instance, human resource managers will be among the change management team. Also, the chief executive officer, lower level managers, nurse leaders, and some employees, especially nurses, will be part of the change management team. The above professionals understand what it takes to transform the organizational culture.

Plan for Communicating the Proposed Change

There is always the need to communicate proposed changes to ensure that everyone understand the procedures and processes required is necessary. Selecting credible leaders to communicate the change process is necessary in ensuring that every aspect of the change process is well understood and addressed by the stakeholder involved in the whole process. Keeping communication all the way to the end of the whole process is necessary in ensuring that all the stakeholders become aware of the change process (Currie et al., 2017). Delivering accurate messages to the people and ensuring that everyone captures the information being communicated is important. While communicating the processes of change, there is the need to ensure that all the messages delivered are consistent to the end.

Conclusion

Change is necessary in the healthcare systems. With the advancement in the operational processes, there is always the need to adjust some of the approaches used in the healthcare processes. Transforming cultural practices is necessary in ensuring that there are improvements in the quality services delivery and that clients can enjoy effective services offered. Addressing the cultural change will have significant impact in the organization/workplace. Cultural change will lead to the creating of a positive environment for all the stakeholders, this will lead to the quality in service delivery and the general patient outcomes.

References

Arditi, D., Nayak, S., & Damci, A. (2017). Effect of organizational culture on delay in construction. International journal of project management, 35(2), 136-147. /https://doi.org/abs/pii/S0263786316303052

Currie, D., Gormley, T., Roche, B., & Teague, P. (2017). The management of workplace conflict: Contrasting pathways in the HRM literature. International Journal of Management Reviews, 19(4), 492-509. https://doi.org/10.1111/ijmr.12107

Pitafi, A. H., Liu, H., & Cai, Z. (2018). Investigating the relationship between workplace conflict and employee agility: The role of enterprise social media. Telematics and Informatics, 35(8), 2157-2172. https://doi.org/10.1016/j.tele.2018.08.001

Slack, N. J., & Singh, G. (2018). Diagnosis of organizational culture in public sector undertakings undergoing reforms. Public Organization Review, 18(3), 361-380.: https://doi/org/10.1007/s11115-017-0383-5

I enjoyed reading your post this week! I liked your statement about EBP analysis creating sustainable interventions to improve the care of the patients and that utilizing a variety of decision aids can improve and support patient preferences while assessing patients and developing their expected outcomes. I agree completely. EBP implementation and the use of decision aids allow the patients to be included more in their care. EBP allows medical professionals to educate the patients and use practices that are proven to be beneficial. Clinical expertise is important when educating and providing care for our patients.

Clinical practitioners should be continuing education throughout their time practicing. If clinical practitioners are not continuing to develop skills and enhance their knowledge base, organizations cannot be successful and provide the necessary care that patients require (Melnyk & Fineout-Overholt, 2018). EBP utilization can foster better relationships between providers and patients, as well as allow for intelligent essential conversations that are centered around the patient (Melnyk and Fineout-Overholt, 2018).

By using EBP and decision aids, healthcare professionals can enhance the shared decision-making (SDM) process. When patients feel like they are included and in charge of their healthcare, they feel more in control regarding the outcomes, which can improve the quality of care provided. For example, more than 60% of providers using a decision aid for SDM with screening options for Colorectal Cancer (CRC) patients stated that the care provided was enhanced by the decision aid in conjunction with their regular methods used while enhancing the knowledge of patients, helping patients decipher which treatment option was best for them, enhancing the drive of the patient to be assessed all while saving time (Schroy et al., 2014).

SDM is proven to enhance care on both ends of the spectrum. Providers can provide more accurate information based on the needs of the patient and allow them to be the leader of their healthcare team. Providing the best care for our patients is of the utmost importance. Patients rely on the providers and nurses to provide them with the best options and treatments regarding their care. Teaming up with the patients in making these essential decisions will all-around enhance the outcomes of the care provided.

References

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide

to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal

cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. https://doi.org/10.1111/j.1369-7625.2011.00730.x

Health care organizations should constantly evaluate their performance and intervene appropriately as situations necessitate. One of the highly recommended interventions is evidence-based practice change. Organizations adopt positive change based on current, relevant, and high-level evidence to solve clinical problems through such changes. The purpose of this presentation is to recommend an evidence-based practice change for addressing workplace incivility. It starts with an overview of the organization before describing the problem, the idea for change, and the plan for knowledge transfer. Other vital sections include an analysis of the measurable outcomes and lessons learned.

The success of an evidence-based change project depends on the organizational policies, attitude towards change, and culture, among other factors. The organization is primarily a general health care facility dealing with inpatient and outpatient services. It is highly centralized, with each department dealing with specific functions. Regarding culture, the organization is primarily an adhocracy.

Lepore et al. (2018) defined an adhocracy as a culture where the management supports individual initiatives instead of prescribed rules. Readiness for change can be determined by assessing the organization’s approach to change. It is right to deduce that the organization is highly ready for change since it embraces change. Previous change-driven projects have been a massive success, and the management commits resources to support innovation.

The current problem is workplace incivility. According to Shi et al. (2018), workplace incivility includes rude and discourteous behavior towards colleagues. An uncivil workplace is detrimental to patient care and nurses’ productivity since it hampers workplace relationships and nurses’ wellbeing. It is a leading cause of discomfort and nurse turnover (Shi et al., 2018). Workplace incivility is among the issues that nurse leadership cannot ignore in health care settings.

It adversely affects the nursing staff, patients due to low-quality care and the organization due to reduced performance. Stakeholders involved in change-facilitation and/or affected by the problem include the management as change promoters, patients, the nursing staff, nurse leaders, and human resources experts (for awareness programs). The most significant risks include a change in the workplace culture and resistance.

The evidence-based practice (EBP) approach recommends solving a clinical problem by integrating scientific evidence into clinical practice. As already mentioned, the problem of interest is workplace incivility. After generating evidence, it is crucial to appraise it to get the most relevant evidence for a clinical problem. Policy interventions and incivility awareness emerged as the most practical interventions for addressing workplace incivility.

Such interventions include zero-tolerance policies, a culture of reporting, and education programs on workplace incivility. Cognitive rehearsal can also be integrated into the intervention programs to ensure that nurses are adequately prepared to identify and cope with workplace incivility. The objective is to reduce workplace incivility in the facility within six months.

EBP change projects would not be fruitful if the proposed changes are not implemented and knowledge shared. An effective way of knowledge creation is to continue searching and appraising evidence to ensure that changes are based on scientific evidence. Consultative forums and nursing education programs would also be effective in sharing knowledge and generating new ideas. The best way to adopt and implement changes is to share the EBP results with the management to facilitate appropriate practice changes. Dissemination is vital for ensuring that the EBP results reach a wider nursing audience. A policy brief and posting the results on the organization’s education would ensure that information reaches all the organization’s members. Other strategies can be chosen later to share knowledge externally.

The primary objective of the EBP change project is to reduce workplace incivility. It will lead to better health outcomes, achieved through EBP and shared decision-making (Hoffman et al., 2014). As a result, a combination of incivility awareness programs and policy interventions will promote a more civil workplace in six months. Shi et al. (2018) found workplace incivility a leading cause of anxiety and burnout. The proposed changes will address this problem and others stemming from workplace incivility, like reduced esteem and negative perception of the nursing profession. Reducing workplace incivility is also expected to improve the nurses’ wellbeing and confidence. Doing so will reduce medication errors and improve patient satisfaction since patients will be served better.

Research appraisal is a rigorous process which involves systematically evaluating research evidence to determine its relevance and value (Melnyk & Fineout-Overholt, 2018). After the appraisal, four articles were found relevant to workplace incivility prevention. Shi et al. (2018) recommended the importance of informed and resilient nurses to cope with workplace incivility. Armstrong (2018) recommended the need for improving nurses’ ability to recognize and manage workplace incivility, justifying awareness programs. also advised health care managers to improve nurses’ skills. The last article emphasized the need for awareness. According to Kile et al. (2019), awareness programs should be intensified in health care settings to reduce workplace incivility.

The evaluation analyzes articles about workplace incivility from multiple dimensions. It is tedious to analyze articles from multiple dimensions including research methodology, sample size, design, and outcomes. Also, research evidence should be sourced from credible sources with high-level evidence. Systematic reviews are highly reliable since they comprehensively select, analyze, and appraise evidence from multiple data sources. Also, reading the entire article can be time-consuming when searching for evidence. Therefore, it is crucial to rely on the abstract as the guide. Other vital observations include the importance of searching via keywords and in-depth understanding of research databases and the type of articles found in each.

It is crucial to conclude the presentation by summarizing the key findings. One of the major findings is that EBP change promotes positive change in health care by proposing evidence-based interventions for addressing clinical problems. Workplace incivility can be addressed using the same approach where research is sourced from current and relevant evidence. Suitable interventions for addressing workplace incivility include policy changes to promote a new workplace culture and increased awareness on workplace incivility to enable nurses identify and cope with the problem. It is also crucial to share EBP results with other health care providers and the larger nursing profession hence the need for dissemination.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966 Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106 Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186 Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709 Lepore, L., Metallo, C., Schiavone, F., & Landriani, L. (2018). Cultural orientations and information systems success in public and private hospitals: preliminary evidences from Italy. BMC Health Services Research, 18(1), 1-13. https://doi.org/10.1186/s12913-018-3349-6 Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer. Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461

The evolution of technology allows patients to have more access to information resulting in well-informed, educated patients. While it is great that patients are taking the initiative to play active roles in their healthcare, it comes with challenges. Working in labor and delivery, I have had many experiences with patient involvement in treatment and healthcare decisions. One reoccurring experience that patient involvement helps aid in best practice and incorporates them in healthcare decision-making is birth plans.

Birthing plans set expectations and standards of care couples expect during the laboring process (Hidalgo-Lopezosa et al., 2021). According to a study by Hidalgo-Lopezosa et al. (2021), birth plans in southern Spain resulted in fewer interventions and more natural birthing processes. While the utilization of birth plans creates a clear picture of how the patient wants their delivery to go, they can be challenging, especially when they are unwilling to deviate from the plan. When I first started working labor and deli