comment1

Reading that Evidence based practice (EBP) is currently only at 15% in United States is concerning. EBP is defined as “integration of best research evidence with clinical expertise and patient values. … EBP is aimed at hardwiring current knowledge into common care decisions to improve care processes and patient outcomes” (The Online Journal of Issues in Nursing, 2013). I am sure that if you asked any nurse if they wanted the best for their patients they would say yes. So, why are we only at 15%? The American Association of Colleges of Nursing has listed a few barriers as to why EVB is not being carried out. Two of the barriers listed by the association are: (1) lack of time to locate and synthesize knowledge and (2) negative attitudes towards research and EBP (American Association of Colleges of Nursing, 2013). One can see how lack of time could be a contributing factor as to why our percentage is so low. Most nurses have busy lives outside of work and usually do not have the time to sit and research EBP. One can also see how negative attitudes could affect EBP for example, bedside shift report. From experience, most nurses who have been in practice for a while are against bedside shift report even though it is proven EBP, because they are set in their ways. A suggestion that could help these two examples would be to assign mandatory learning activities to employees. By doing this the nurses would actually have to sit down and review evidence based practice. To make sure nurses are providing EBP after completing the learning modules it requires leadership oversight in order to hold nurses accountable.

comment2

A review of an article found the in American Journal of Nursing (2012) states that there are two major factors which impede the implementation of EBP: “lack of time and an organizational culture that didn’t support” (p. 1). A lack of time makes sense, especially considering the continued increasing nurse-to-patient ratios; this makes it difficult to deviate from current practices which help maintain a routine for nursing staff. Another factor in “lack of time” is that nurses have lives outside of the hospital setting; family and social life takes precedent over spending time in front of a compute, researching new EBP to implement. In regards to decreased organizational cultural support, this comes from the continued increasing numbers of baby boomer nurses who are so set in their ways, that when change comes around, it is almost impossible to convince them to adopt these changes. Though sometimes, these changes are forced and cannot be helped, it is something that we must accommodate and accept. Not only do the older “baby boomer” nurses have issues, but sometimes the culture within the facility itself is not conducive to change. In order to foster an environment where both of these barriers are addressed would be to assign mandatory education activities for nursing staff to participate in. This then requires the nurses to sit down and discuss and become educated on current EBP, while creating an environment that is conducive and positive to the change. The facility I currently work in requires that, after completing an EBP related course, nursing staff complete online education modules to solidify the education provided.

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Comment1

While nurses have high turn-over, it is higher with home health aides. During the research for this assignment, the information I was able to find in regards to HHA and home care setting turnover, information is few and far between. The possible impact that this shortage can have on nursing from my perspective: high turnover is more likely to breed less experienced staff with many fleeing the profession. Shortage of home health aide can affect nursing through home health care agencies lacking the ability to provide services for elderly at home “a lack of skilled aides forces individuals to rely more on family, neighbors and friends, and increases the chance that they will end up in the Emergency Room” (Wexler, 2017).

It also increases the likelihood of frequent hospital admission. Having more admissions adds pressure to the ever mounting healthcare cost for the country, and impacts jobs. Services provided by nurse practitioners in the home care setting would be affected with less people at home living in the community. Homecare is still plagued with the same clinical or staff issues that an acute care setting might come across. and when those type of issues take place, then patients’ care suffer, for inpatient and outpatient activities alike.

comment2

The issue that the organization is currently facing is an increase in hospital acquired pressure injuries (HAPI’s). The hospital started noticing an increase trend in HAPIs in patients, which is a big matter of concern. Currently there is a wound care team that does monthly surveys on wounds and prevalence trends. The organization started several initiatives and investigations to see what is going on and possible solutions. During the investigation’s, management found gaps in turning for high risk patients, gaps in documenting on Braden risk assessment, and gaps in care documentation. In this some causes may be that nurses and nurse aides feel overwhelmed with the amount and high acuity of patients they have to care for. I personally saw where the nurses and nurses’ aides looked very busy and overwhelmed with all the tasks they needed to complete.

One implication of nursing is for them to involve clinical leadership in a way that leadership can see what the staff goes through and why there are gaps in turning and documentation. One journal article stated that by using positive clinical leadership to support a culture of pressure injury prevention. In the article it states that pressure injury prevention. In the article it states that pressure injury rounds were done by leadership and they looked at trends on equipment being used, how the ward feels about their trend, what the ward would like more help with, and look around the ward including review of the equipment and clinical assessments. The results were that the rounds led to safety huddles focused on skin topics (Sage & Tudor, 2017)>

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Comment2

Nurse Manager always approach nurses to work over time. To resolve the situation of short staffing, an administration should introduce greater flexibility into work environment structure and scheduling programs. There should be also rewards for experienced nurses for serving as mentors and preceptors for new RNs (Strategies to reverse the new Nursing Shortage,2017). By offering great benefits and flexible work schedule with allowing autonomy to nurses, their will be less chances of nurses turnover and shortage of staff. 

comment2

When Nurses work extended hours, they aren’t resting properly and aren’t letting their bodies recover. For example, many Nurses who take extended shifts suffer from chronic back, leg and shoulder pain. Some of them even develop long-term medical conditions, like diabetes and cardiovascular issues (Bettencourt, 2017).  Another clinical problem is adopting a work culture that supports and strengthens the whole teamwork dynamic.  When I was a new grad in my role, it was a huge challenge to learn and adjust into a new clinical role.  In addition to the skills, one also has to learn how to cope with how that hospital functions.  Unfortunately, not all veteran Nurses are willing to take on new nurses with a welcoming attitude.  These attitudes tend to dull the enthusiasm of new Nurses enough to make them question themselves if they made the right career choice. You are all on the same team, strengthen your team by welcoming new Nurses and being a little more patient with them(Bettencourt, 2017).  By staffing correctly, nurses will not be at increase risk to burnout or injury, decrease med errors, increase patient safety and satisfaction.  By working together and fostering one team that works and support each other will also enforce a healthy and happy environment.  Individuals will enjoy coming to work and be with the company longer if they are happy.

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comment1

The first method that is commonly used for evaluating evidence is meta analysis.  Many studies with the same rules used from study to study will yield the results that are then summarized (Study.com, 2018). Advantages include a better estimate of the relation that exists in the population than single studies, the estimates are more precise because there is an increased amount of data and statistical power, hypothesis testing and biases associated with publications can be examined, and it helps resolve inconsistencies in research, and identifies potential moderating or mediating variables (Stone & Rosopa, 2017).  A major disadvantage is inadequate sample size.  On the other hand, another study that is used is systemic review.  For example, A systematic review is a form of analysis that medical researchers carry out to synthesize all the available evidence on a particular question, such as how effective a drug is (Medical News Today, 2016).  This type of review is beneficial in that the study is the same and follows the same guidelines.  By using this method which is reliable it can help to identify the best benefits of a new drug and how implementing it would be successful.

Comment2

Systematic review- provides answers to research questions that are well defined by the collection and summerization of all data collected that fits into the required criteria.  Systematic reviews help in identifying, assessing and summarizing the findings of all individual studies relevant to the medical issue being evaluated.  This type of evaluation requires the reviewing of related liturature including the results of carefully designed and closely monitored controlled trials.  These random controlled trials are considered to be the gold standard for a clinical trial.  Valuable in determining the efficiacy and effectiveness of medical interventions.

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Comment1

Planned change in nursing practice is necessary when focusing on evidence based practice.  Using a change theory improves likelihood of success. When using a change theory the effort looks purposeful, calculated and collaborated (Roussel, 2006). But even with a good implementation, theory, and idea, executing change is more challenging than perceived. For example it is alleged that two thirds of organizational change projects fail (Szabla 2007), others suggest the figure is higher.

In 1951 Kurt Lewin identified 3 stages for change: 1) unfreezing (when change is needed), 2) Moving (when change is initiated), 3) Refreezing (when equilibrium is established). This changed theory is simply written, easy to understand and easy to implement into a personal or organizational change strategy. Lewin discusses forces (his word) or barriers to change, examples (i.e, culture, money, structure, even attitudes).

Lippit’s theory uses nurses jargon, assessment, planning, implementation, and evaluation. Lippit’s theory gives more detailed instruction, allowing for detailed explanation with trying to implement change. Using the nursing jargon will help to deliver the change idea to staff nurses if the change occurs at the bed side.  Lippit’s change theory can also be used with stakeholders, with variation with words.

The idea of using a change theory to introduce needed improvements using EBP whether education, management or organizational appears more organized, strategic, and professional. 

Lippit’s theory will work best for my change project because I will be instructing nursing and secuity staff on how to recognize mental health decompensation.

comment2

C hange   theories  define a social problem and identifies a long-term outcome that would signify the problem has been fixed and build a roadmap that will guide for the realization of the long-term goal.  The two change theories I will  be  focusing on are  Rogers change theory  and  Lippitt ’s  change theory .  Rodger’s theory of change has five steps which include: awareness, interest, evaluation,  implementation, and adoption. Rodger’s theory provides for the awareness and participant interest part which will incorporate all the multidisciplinary team in a healthcare facility before the implementation of the HIT similar to Lippitt’s theory of change which comprises of four elements: assessment, planning, implementation and evaluation (Mitchell,  

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