It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care. One of the issues that affect nursing practice is long intensive care unit (ICU) admission of critical care patients.
It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care. One of the issues that affect nursing practice is long intensive care unit (ICU) admission of critical care patients..
Running head: EBP PROJECT 1
EBP PROJECT 2
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Evaluating EBP Projects
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Evaluating EBP Projects
It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care. One of the issues that affect nursing practice is long intensive care unit (ICU) admission of critical care patients. Extended stay in intensive care is a significant practice problem in health care. There are many risks that face patients who are admitted in ICU for an extended period of time. Longer hospital admission in the ICU has been associated with negative patient outcomes and experiences. The longer patients are admitted in intensive care, the higher the chances of mortality and hospital readmission (Schneider et al., 2012). Patients’ personal experiences in care are also more negative when they stay in ICU for a long period of time. Therefore, it is important to use EBP solutions to improve the experiences and outcomes of these patients. The proposed solution for this practice issue is the mobilization of patients. Research shows that early mobilization of critical care patients can have a positive effect on their healthcare experiences and outcomes (Adler and Malone, 2012; Denehy, Lanphere & Needham, 2017; Holdsworth et al., 2015). The purpose of this project is to create a plan for the change to implement this intervention, implement the change, and evaluate the effectiveness of the change to ensure that it has an impact of the improvement of quality and safety of care.
Planning for EBP Change
Even when a new practice approach has been approved for implementation, it may still fail to materialize because of poor management of the change process. It is important to analyze the organization’s readiness for change, deal with the barriers to change, and develop the best framework to implement a given change process (Darling, 2016). The following is an analysis of my organization’s readiness to change and the specific strategies to be used to ensure that the proposed practice change is successful.
Assessing Readiness for Change
There are various factors that either facilitate or limit my organization’s readiness for change. One of the factors that makes the organization ready for change is the great leadership. Leadership plays a big role in facilitating change. Once the leaders believe in the need for change and are willing to motivate the rest of the organization, it is easier to implement the new practice approach and inspire other people to join in (White, Dudley-Brown & Terharr, 2016). Another facilitator of change in the organization is good communication. Communication is an essential component of a successful change process. There needs to be good communication of the need and the benefits of the change process so that all the members of the organization can understand the purpose of the change process and be willing to be a part of it,
A major barrier for the change process in this organization is the financial obligations for implementing the new practice standard. There will be a need to invest in a new workforce to facilitate effective mobilization of the patients. There may be a limitation of financial capabilities that may influence the successful implementation of the project. Another barrier is the possibility of resistance. Changing from one practice approach to another may attract resistance because people may want to stick to the usual ways of operations.
Theory/Framework to Guide Change Efforts
The change process for this project will be facilitated by the Theory of Reasoned Action. This theory believes that people’s actions are rational. Behavior is linked to the beliefs, attitudes, and intentions of people towards a given action (White, Dudley-Brown & Terharr, 2016). Therefore, the organization will facilitate the change by developing a model to reason with the employees to show them that changing to the new practice approach is a reasonable thing to do.
The organization will begin by changing the beliefs and attitudes of the workers by showing them evidence of the poor health quality of the ICU patients in the old models of operations. They will later change the intentions of the workers by showing them a new model of operation that they can use to improve the quality of care they provide to the patients. This will help to change their behaviors when helping intensive care patients, leading to the creation of a new norm in the care of these patients.
Strategies to Address Barriers
The strategy to deal with the resistance to change is to have open communication of details pertaining to the new practice approach. It is important that all workers understand the importance of the change process for them to want to participate. As explained by the theory of reasoned action, people are able to change their behaviors when they have altered their attitudes and beliefs towards the change efforts.
Implementing EBP Change
In the process of implementing the EBP project, there are some macro and micro factors that may influence its success. Identifying the desired outcomes and the factors that might affect successful implementation is vital. This helps in the development of mitigation and management strategies that will enhance chances of success.
Desired Outcomes of the EBP Project
There are three main outcomes that will demonstrate a success in this project;
· Improved consistency in patient mobilization
· Reduced lengths of stay
· Reduced patient mortality
· Reduced patient readmissions
After the implementation of this project, it is expected that the mobilization of the patients will be more consistent, with a definite schedule that is understood and used efficiently by the nurses. The effectiveness of the patient mobilization is expected to help reduce the patients’ length of stay in intensive care. The effectiveness of the project will also reduce patient mortality rate and the rates of readmission after being released from the ICU.
Macro or Micro systems Issues inhibiting Implementation
The macro factors that influence the successful implementation of the new practice approach include the unavailability of adequate resources, inadequate staffing, and the lack of knowledge and skills to effectively mobilize the patients as recommended. First, the unavailability of resources could limit the effective implementation of new standards of practice that will help to improve patient safety. Secondly, the standard of mobilizing patients will require more working time for nurses. There is already a limitation of healthcare professionals. Adding more work will increase the problem of burnouts, which reduce the quality of care. Therefore, there may be a need to add more personnel. Lastly, effective mobilization of patients may require training to be done effectively. Patients in the ICU are quite delicate. It is important that the nurses are equipped with the rights skills to manage such responsibilities. These are all macro factors that need to be handled on the organizational level.
The micro factors are issues at the individual level that can affect the implementation of the new practice approach. According to Maclusky and Middleton (2010), transferring knowledge to practice can be challenging because of factors on the individual level such as personal beliefs and attitudes towards the new practice approach. The micro factors that can affect this project include personal beliefs and attitudes, willingness to improve patient safety, and the professionals’ personal beliefs of their capabilities. Nurses’ beliefs and attitudes on early mobilization will affect how effectively they perform the intervention. If nurses believe that they are actually making a difference, then they are more likely to participate in the change. The nurses must naturally be willing to engage in the new practice model for effectiveness to be achieved. It is important that professionals believe in their capabilities to make a difference to the patients. They should understand the ways in which they are improving patient safety by practicing the recommended approaches.
Strategies for Resolving those Issues
The only way to achieve success when implementing new evidence-based practice approaches is to develop strategies that deal with the challenges and barriers. The following are the strategies that can be used to deal with the barriers and challenges to this implementation. The first strategy is involving external stakeholders. Implementing this approach will need support from external stakeholders to help with the funding. There are governmental and non-governmental organizations that can assist in the funding of such a project to enhance patient safety. The second intervention is training and development. Nurses need to be trained to increase understanding and confidence in the practice approach. Training is one of the important strategies required in managing change because employees need to understand the new practice approaches before they can participate. Lastly, open communication is required for the success of this project. There should be open and direct communication of information on the change to increase engagement.
How EBP Project will Improve Quality and Patient Safety
Dealing with the barriers to the implementation of this evidence-based approach will be helpful in improving care for the patients in intensive care. One of the changes that will be enabled is increased consistency in patient mobilization. Once the patients are mobilized more effectively, they will have a faster rate of recovery. Research shows that early mobilization is an effective way of improving the recovery process for the people in intensive care (Denehy, Lanphere & Needham, 2017). There will also be reduced lengths of stay because of the faster recovery processes. In the end, the patients will end up having better outcomes. The rates of readmission will be reduced significantly. Similarly, this practice approach can help to reduce the mortality rates for the ICU patients. Therefore, it is important to ensure that the barriers to the implementation of this project are effectively dealt with for the benefit of the patients in intensive care.
Evaluating EBP Projects
The outcomes that are to be evaluated in this project include the improved consistency of patient mobilization, increased speed of recovery for ICU patients, and better quality of outcomes, including a reduced rate of mortality and patient readmissions. The following section presents the strategies that would be used to ensure the effective achievement of each of these outcomes.
Evaluating the Outcomes
The outcomes of this project will be examined using qualitative and quantitative approaches. Qualitative evaluation strategies are used to describe the conditions in which the translation project takes place (White, Dudley-Brown & Terharr, 2016). In this case, this form of evaluation will be used to examine the nurses’ experiences in relation to the new practice approach. A descriptive evaluation design will be used to examine the attitudes of the nurses towards the new system and their beliefs on the effects of the new practice approach to their jobs. This measurement will help to determine how well the implemented strategies have improved the consistency of patient mobilization. For the other outcomes to be measured, a pre and post-measurement strategy in one cohort will be used. This is a measurement of the outcomes in the period that the intervention had not been implemented in comparison to after the implementation (White, Dudley-Brown & Terharr, 2016). This evaluation strategy will help to identify the changes in the speed of recovery of ICU patients, the rates of readmission, and mortality rates.
New Practice Guidelines
Practice guidelines are created after the evaluation of data regarding a given intervention to an identified practice problem. The translation of new evidence into new practice guidelines is essential for the improvement of care quality because it ensures that concerned stakeholders can apply it to enhance patient care (Erickson et al., 2014). Based on the evaluation of the outcomes above, the following are the practice guidelines that I would recommend. First, I would recommend that patients be mobilized at least once a day in their early stages of recover as long as their fitness has been approved by their physicians. Secondly, I would recommend that patient mobilization be included in the patient treatment records so that it can be easier for the healthcare professionals to track the frequency of the mobilization of the patients. This guideline aims at ensuring that the movement of patients is stable for the achievement of the evaluated outcomes.
New Standards of Care
Standards of care are established criteria that should be met for the patient outcomes to be enhanced. The following are the standards of practice that would be favorable for the enhancement of the care of ICU patients based on the outcomes evaluated. (1) Implementing an early mobility program for the ICU patient with different stages including bed mobility to ambulation, depending on the patient functional ability and as prescribed by the physician (Perme & Chandrashekar, 2009). (2) Team working is essential for the effective implementation of this intervention. It is important that the professionals not only in nursing, but also other areas of work, be cohesive in their approach towards the mobilization of patients. This will reduce the possibility of making errors that can affect the patients’ outcomes (Hopkins & Thomsen, 2007). (3) Another standard of care is to enhance communication. The communication between different professions and the nurses should be of good quality. Specifically, it is recommended that the communication be integrated with the help of electronic health record systems to maximize the efficiency of the performance of the patient mobilization in intensive care (hompson, O’Horo, Pickering & Herasevich, 2015)
Conclusion
Evidence-based practice has become essential in improving patient care safety and quality. However, the successful implementation of new EBP models has been a challenge for many hospitals. This project seeks to implement a new practice approach to deal with the practice problem of extended lengths of stay for ICU patients. Longer admission time has been associated with negative outcomes. The recommended change to achieve better outcomes for ICU patients is early mobilization, which has been tried but has not been successful due to poor implementation. In this project the factors that can affect the implementation on the micro and macro level have been identified and strategies to counter them developed. To increase the possibility of success, there is a strategy for the evaluation of the achievement of identified outcomes. Both qualitative and quantitative strategies will be used to determine the effectiveness of the change. In return, the quality and safety of care will be improved.
References
Adler, J., & Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary physical therapy journal, 23(1), 5. Retrieved from: https://eds-a-ebscohost-com.ezp.waldenulibrary.org
Darling, F. (2016). Practitioners’ views and barriers to implementation of the Keeping Birth Normal tool: A pilot study. British Journal of Midwifery, 24(7), 508-519. DOI: https://doi.org/10.12968/bjom.2016.24.7.508
Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten reasons why ICU patients should be mobilized early. Intensive care medicine, 43(1), 86-90. doi:10.1007/s00134-016-4513-2
Erickson, K., Monsen, K.A., Artleson, I.S., Radosevich, D.M., Oftedahl, G., Neely, C., &; Thorsen, D.R. (2014) Translation of obesity practice guidelines: Measurement and evaluation. Public Health Nursing, 12(3), 222–23. doi: 10.1111/phn.12169.
Holdsworth, C., Haines, K. J., Francis, J. J., Marshall, A., O’connor, D., & Skinner, E. H. (2015). Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior. Journal of critical care, 30(6), 1243-1250. doi: 10.1016/j.jcrc.2015.08.010
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