NURS 561 Unit Two Objectives as Well as Barriers To safe Practice DQ

Want create site? With Free visual composer you can do it easy.

NURS 561 Unit Two Objectives as Well as Barriers To safe Practice DQ

NURS 561 Unit Two Objectives as Well as Barriers To safe Practice DQ

 

 

Being prepared as a Nurse Practitioner when entering the
clinic setting is a win-win for the student, the preceptor and most of all the
patient. Safe, effective delivery of patient care requires that the nurse
practitioner student understand the complexity of healthcare systems, the
limits of human factors, safety design principles, characteristics of high
reliability organizations, and patient safety resources. These components are
critical to the preparation of safe clinicians and essential for 21stCentury
healthcare delivery.

Discuss how you met the Unit Two Objectives as well as
barriers to safe practice that can occur if you come to the clinic setting
unprepared. Support your discussion with evidence based practice and
recommendations for improvement of safe patient care in the primary care setting.

Overcoming Barriers to Implementing
Evidence-Based Practice
A Collaboration Between Academics and Practice
Pamela Rockmeal, MS, RN, ACNS-BC ƒ Joyce Simmons, MS, Edda, RN
This article describestwo collaborative paired student preceptor
efforts. One project resulted in the implementation of a
hospital-wide oral care protocol, and the second enhanced
the admission assessment process for adult patients at risk
for respiratory compromise after sedation and/or receipt of
narcotic analgesia. Recommendations for staff development
are addressed
The benefits of implementing evidence-based
practice (EBP) are numerous. Increases in patient safety, reduction in variations of care, and
increases in positive patient outcomes have all been reported as positive outcomes of EBP (Fink, Thompson, &
Bonnes, 2005; Leasure, Stirlen, & Thompson, 2008; Nay,
2003). The literature reveals that implementing EBP has
proven to decrease the length of time between discovery
of effective interventions through clinical research and
the application of these discoveries at the bedside (Corrigan, Greiner, & Erickson, 2003). The excitement that
accompanies both sound decision making and confidence gained by applying ‘‘best practice’’ by nursing
colleagues has strengthened the level of professional
nursing practice (Gennaro, Hodnett, & Kearney, 2001).
The literature also shows that implementation of EBP is
hard work and requires more than desire and excitement. Successful implementation of EBP requires
commitment by practitioners and support from administrators and nurse educators.
Evidence-based practice has been described as ‘‘the integration of best evidence with clinical experience and
patient values’’ (Sackett, Strauss, Richardson, Rosenberg,
Pamela Rickbeil, MS, RN, ACNS-BC, is Clinical Nurse Specialist, Department of Education and Professional Development, Saint Cloud
Hospital, Minnesota.
Joyce Simones, MS, EdD, RN, is Professor, Department of Nursing
Science, Saint Cloud State University, Minnesota.
The authors have disclosed that they have no significant relationship with,
or financial interest in, any commercial companies pertaining to this article.
ADDRESS FOR CORRESPONDENCE: Pamela Rickbeil, MS, RN,
ACNS-BC, Saint Cloud Hospital, 1406 6th Ave. N., Saint Cloud, MN
56303 (e-mail: rickbeilp@centracare.com).
DOI: 10.1097/NND.0b013e31824b4141
Journal For Nurses in Staff Development
& Haynes, 2001, p. 1). Best evidence is not limited to clinical and experimental research studies but also includes
expert opinion and clinical expertise. Each patient brings
a different perspective and value system, which must
be included in the healthcare decision-making process (Pape, 2003). The literature demonstrates that
despite best intentions, successful implementation of EBP
is doomed to fail unless the organizational culture is prepared to change through strengthening facilitators and
reducing barriers.
Facilitators are identified as factors that support and
encourage the development and implementation of
EBP (Parahoo & McCaughan, 2001). Significant facilitators have been identified as manager support, time,
guidance, and institutional support of nurse educators.
Barriers are identified as obstacles that discourage the
development and implementation of EBP. Barriers to
successful implementation of EBP (Parahoo, 2000) most
commonly cited by nurses include lack of time, lack of
interest of nursing staff, lack of knowledge of the EBP
process and change theory, and lack of support from
others. Many nurses indicate that they do not understand
the research process and are incapable of evaluating the
quality of research and statistical analyses. Nurses believe
that they lack the necessary skills and authority to change
patient care procedures within the institution. Another barrier isthe perception that the work culture is unwelcoming
to new ideas and suggestions (Pravikoff, Tanner, & Pierce,
2005).
Research has provided recommendations to enhance
facilitators and diminish barriers. Recent recommendations that enhance EBP efforts include enhancing staff
nurse skill in critically analyzing research studies, building
practice policies and procedures that cite EBP references,
and developing staff nurse expertise in using computers,
databases, and search engines. These are all responsibilities and talents of the staff development specialist
(Gerrish & Clayton, 2004; Krugman, 2003).
The staff development specialist is often identified to
initiate and lead EBP and research utilization projects
within a hospital setting; this role is instrumental to the
success of dissemination of EBP throughout the organization. Omery and Williams (1999) reported ‘‘unless
www.jnsdonline.com
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
53
nursing leadership believes in research utilization and
promotes a culture that supports its activities, research utilization failsto become a lived value’’(p. 55). Paramonczyk
(2005) argued that ‘‘the responsibility to develop strategies
designed to encourage and facilitate nurses’ participation
in research-related activities rested with the organization’’
(p. 12). The staff development specialist needs to be the
‘‘champion’’ in the organization.
Research studies have shown that the most frequent
barrier of EBP implementation has been lack of organizational support and that organizations have the responsibility to develop strategies to promote EBP (Funk,
Champagne, Wiese, & Tornquist, 1991a, 1991b). Funk
et al. (1991b) recommended strategies to confront these
barriers, which include empowering role models and establishing collegial relationships (formal or informal) with
university faculty. Specific responsibilities of the staff development specialist would include (a) coordination of
administrative details such as arranging meetings and
providing copies of materials, (b) identifying practice
concerns, (c) providing access to resources such as the
Cochrane Library, (d) collaborating with research experts
in the agency, and (e) motivating staff to participate in this
relationship (Quinlan, 2006).
Stone and Rowles (2007) reported that when nursing
students provided education to staff nurses on research
pertinent to frequently occurring patient concerns, staff
nurses became engaged in that research and related topics. A benefit frequently cited by staff nurse preceptors
was the positive educational impact the students had on
them. This collaboration resulted in policies and procedure changes to reflect current evidence-based findings.
Students in this study also gained valuable experience in
real-life patient care and unit challenges.
Schoenfleder (2007) stated that when students in a
gerontologic nursing experience were paired with registered nurse preceptors, both nurses and nursing students
benefited. The students were required to create ‘‘tip
sheets’’ based on the current evidence of identified patient
care problems. These tip sheets were then distributed
to areas where the students worked with preceptors.
Frequently, students used evidence-based protocols
developed by the University of Iowa Gerontologic Nursing Interventions Research Center in their tip sheets. By
citing the recommended practice change with the source
of the EBP guidelines, staff nurses grew in their awareness
of EBP and increased their familiarity with EBP tools
such as the Gerontologic Nursing Interventions Research
Center guidelines.
Leisure, Stirling, and Thompson (2008) reported encouraging outcomes as a result of collaborative efforts
between students and staff nurses in the area of expanding EBP efforts to staff nurses. As a final assignment,
students bridge research to clinical practice in their review of agency clinical procedures or protocols. The
students used research or EBP to either support or refute
selected current agency practices. Students then report
the findings of their assignment to the staff nurse. It appears that such assignments develop important skills of
formulating questions, obtaining evidence, critiquing
evidence, and summarizing evidence to make recommendations for practice.
Although this work provides promising evidence of
the benefits of student nurse collaboration, no articles
have looked at the effectiveness of large group student
projects conducted with staff nurses. Therefore, this article reports the outcomes of two collaborative evidence based projects by groups of nursing students and groups
of staff nurses under the facilitation and guidance of the
staff development specialist.
A collaborative EBP project was formed with two academic nursing programs and a hospital. The director of
the intensive care unit (ICU) reported a safety alert related
to oral care in the critically ill population (American Associations of Critical-Care Nurses, 2007). The practice alert
recommended development and implementation of a
comprehensive oral hygiene program for patenting critical
care and acute care settings. The practice alert advised that
an ICU program include specifics on the development
of an oral care protocol.
It was hypothesized that perhaps other patient populations would also benefit by implementation of a similar
oral care protocol. Members of the research committee,
which included nursing directors, staff development specialists, and faculty from two baccalaureate nursing
programs, suggested conducting a literature review and
beginning an EBP project to provide a rich leadership
experience for senior nursing students. It was proposed
that nursing students from the two schools work together
to complete the project, including researching current best
practices regarding oral care, collecting information regarding the current practice of oral care from nursing personnel, and then providing education on best practices of oral
care to nursing personnel throughout the hospital.
The director of the ICU was established as the point
person for the technical aspects of this project. Nursing
faculty from the research committee were the contacts
for the two nursing programs. The staff development
specialist coordinated the administrative details because
she had previous experience as the liaison between the
hospital and the nursing programs. Meetings were
planned throughout the semester for all 20 student participants. Students from both nursing programs were
divided into subcommittees, which included literature
review (both for pediatric and adult populations), survey
construction, development of education resources including PowerPoint and posters, and hospital policy
development.
www.jnsdonline.com March/April 2012
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
54
Students found specific evidence-based literature related to benefits of oral care for both adults and pediatric
patients in nearly all patient care areas of the hospital. A
survey was constructed based on the specific needs of
the hospital(e.g., which level of staff provided oral hygiene
most frequently, use of hospital supplies, and current oral
care practices). A random sample of eight registered
nurses, eight licensed practical nurses, and eight nursing
assistants completed the survey. Staff development specialists assisted in the distribution and collection of the
surveys. The completed surveys revealed that although
effective oral care was completed consistently throughout
the hospital, there was need for new products (e.g., softer
toothbrushes). Students who were involved in the development of educational resources worked with the
information technologists and unit staff development specialists in the hospital to develop educational tools.
Information was integrated into a new oral care protocol
that followed the hospital format. Twice, students presented their findings to the hospital clinical nurse practice
committee. At the first meeting, staff nurses provided constructive feedback, and the students then incorporated this
information into the next draft of the protocol. At the second meeting, the protocol was approved and added to the
hospital’s policy and procedure manuals. The productspecialist for the hospital took the lead on refinement of the
oral care protocol. Students taught staff nurses and nursing
personnel about the new oral care protocol as well as the
evidence that supported this practice. New supplies such
as denture tablets, denture brushes, and softer toothbrushes were purchased and supplied for patients on the
nursing units. Students also developed a computer-based
training module on this topic that staff viewed as a component of their annual education.
The next semester, a group of four postbaccalaureate
nursing students initiated another project. A patient
safety alert regarding patients with sleep apnea who received narcotics and sedation had recently been released
(American Society of Anesthesia, 2005). Improving identification of this vulnerable population and reducing
potential adverse events for patients with diagnosed
sleep apnea were chosen as the EBP project. The staff
development specialist was designated as the hospital
point person for this EBP project.
The second EBP project began with an investigation
of best practices with sleep apnea patients receiving narcotics and/or analgesia. Nursing staff were surveyed about
their knowledge of sleep apnea, continuous positive airway pressure, and patient response to sedation and
analgesia. Respiratory care staff and staff development specialists were consulted on current practice, asked their
opinion on staff nurses’ competence with continuous positive airway pressure, and asked their suggestions for
process improvement. After gathering all the evidence, a
draft of a policy was developed. Students presented to
the Nursing Research Committee the evidence collected,
a draft of a potential new policy, and personal experiences
with patients they witnessed experiencing breathing difficulties after sedation and analgesia. In addition to Research Committee members, student preceptors from the
various units and the infection control nurse attended the
student presentation. The policy draft and supplemental
evidence-based data were then forwarded to hospital
nurse leaders from units with this population. This project
resulted in additional questions being added to the Patient
Admission Assessment forms. Upon admission, patients are
now routinely asked if they use a ‘‘breathing machine’’ at
home, which, when answered positively, results in a respiratory care consultation to further assess the patient’s knowledge and skill in managing the equipment. The students
provided staff education to both unit staff and those who attended the research committee meeting. Lastly, a poster was
created for Nurses Week to highlight this vulnerable population and impart the evidence used to improve patient care.
Many lessons were learned by both clinical and academic staff on these two projects:
n Identify one lead person from both the student group
and from the hospital staff to assist in communication
and to coordinate efforts. A staff development specialist is in an ideal position to serve in such a role.
n Flexibility is required in expectations from both academics and practice. A poster at the completion of the
sleep apnea project was one such expectation. Because the changes had not fully been implemented,
development of a poster at the original assigned time
would have been premature. Instead, a poster was
developed at a later time after implementation of
the practice changes.
n As with any joint project, all participants from both
the hospital and academic programs must be actively involved.
n The project focus should be realistic for the size of
the group of students and time requirements. Faculty need to determine if the scope of the project
is appropriate to be completed during the allotted
time. The project must also meet the student learning outcomes of the course.
n If more than one school is collaborating on a project,
the students from both schools should have the same
guidelines and expectations. An example is joint
completion dates for all components of the project.
n Networking and collaborative work takes time. Student’s from both programs did not know each other
before the project began; it took time for joint committees to form effective work groups.
n An interdisciplinary group that included physicians,
therapists, nurses, and students in this project may
have been beneficial.
Journal For Nurses in Staff Development www.jnsdonline.com
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
55
n More detailed statistical analysis than collected on
surveys would provide stronger evidence to support practice changes.
This article supports the earlier literature that collaboration between academics and practice can successfully
overcome barriers to successful implementation of EBP.
Student nurses provided expertise in searching the literature and offering an unbiased view of research findings.
Hospital staff nurses identified significant problems and
knew hospital processes. Staff development specialists
provided guidance and institutional support to maintain
these changes in practice.
References
American Association of Critical-Care Nurses. (2007). AACN: Oral
care in the critically ill. Aliso Viejo, CA: Author.
American Society of Anesthesia. (2005). Practice parameter:
Practice guidelines for the perioperative management of
patients with obstructive sleep apnea. Park Ridge, IL: Author.
Corrigan, J. M., Greiner, A., & Erickson, S. M. (Eds.) (2003). Fostering
rapid advances in health care: Learning from system demonstration’s. Washington, DC: National Academy Press.
Fink, R., Thompson C. J., & Bonne’s, D. (2005). Overcoming
barriers and promoting the use of research in practice.
Journal of Nursing Administration, 35(3), 121Y129.
Funk, S. G., Champagne, M. T., Wiese R. A., & Tornquist, E. M.
(1991a). Barriers: The barriers to research utilization scale.
Applied Nursing Research, 4, 39Y45.
Funk, S. G., Champagne, M. T., Wiese, R. A., & Torn Quist, E. M.
(1991b). Barriers to using research findings in practice: The
clinician’s perspective. Applied Nursing Research, 4(2), 90Y95.
Gennaro, S., Hornet, E., & Kearney, M. (2001). Making evidence
based practice a reality in your institution: Evaluating the evidence
and using the evidence to change clinical practice. MCN. The
American Journal of Maternal Child Nursing, 26, 236Y244.
Garish K., & Clayton, J. (2004). Promoting evidence-based practice:
An organizational approach. Journal of Nursing Management,
12(2), 114Y123.
Krugman, M. (2003). Evidence-based practice: The role of staff
development. Journal for Nurses in Staff Development, 19(6),
279Y285.
Lea sure, A. R., Stirling, J., & Thompson, C. (2008). Barriers and
facilitators to the use of evidence-based best practices.
Dimensions of Critical Care Nursing, 27(2), 74Y82.
Nay, R. (2003). Evidence-based practice: Does it benefit older
people and gerontic nursing? Geriatric Nursing, 24, 338Y342.
Emery, A.,& Williams, R. P.(1999). An appraisal of research utilization
across the United States. Journal of Nursing Administration,
29(12), 50Y56.
Pape, T. (2003). Evidence-based nursing practice: To infinity and beyond. Journal of Continuing Education in Nursing, 34(4), 154Y161,
189Y190.
Parahoo, K. (2000). Barriers to, and facilitators of, research utilization
among nurses in Northern Ireland. Journal of Advanced Nursing,
31(1), 89Y98.
Parahoo, K., & McCaughey, E. M. (2001). Research utilization among
medical and surgical nurses: A comparison of their self reports
and perceptions of barriers and facilitators. Journal of Nursing
Management, 9(1), 21Y30.
Paramonczyk, A. (2005). Barriers to implementing research in
clinical practice. Canadian Nurse, 101(3), 12Y15.
Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of
U.S. nurses for evidence-based practice. American Journal of
Nursing, 105(9), 40Y52.
Quinlan, P. (2006). Teaching evidence-based practice in a hospital
setting: Bringing it to bedside. In R. F. Levin & H. R. Feldman
(Eds.), Teaching evidence-based practice in nursing (pp.
279Y293). New York, NY: Springer Publishing.
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., &
Haynes, R. B. (2001). Evidence based medicine: How to practice
and teach EBM. London, England: Churchill Livingstone.
Schoenfeld, D. P. (2007). Simply the best: Teaching gerontological
nursing students to teach evidence-based practice. Journal of
Gerontological Nursing, 6Y11.
Stone, C., & Rowles, C. J. (2007). Nursing students can help support
evidence-based practice on clinical nursing units. Journal of
Nursing Management, 15, 367Y370

Did you find apk for android? You can find new Free Android Games and apps.