PLEASE READ RESPOND TO THIS POST ACCORDINGLY USING APA AND REFERENCES AT LEAST 2 ( WHAT DO YOU THINK ABOUT WHAT THIS WRITER DISCUSSED IN THE READING?

 

I selected the Iowa model of evidence-based practice.  Titler and colleagues initially developed the Iowa model of evidence-based practice in 1994 to provides direction

for the development of evidence-based practice in clinical agency were triggers that can be problem-focused evolving from risk management data, process improvement data,

benchmarking data, financial data, clinical problems, knowledge-focused such as new research findings, change in national agencies or organizational standards and guidelines,

an expanded philosophy of care, or questions from institutional standards committee initiate the change; and the focus should always be to make the change based on the best

available evidence (Grove, 2015, p. 483). 

This model should be effective for implementing EBP in any area of practice as long as triggers are evaluated and prioritized based on the needs of the practice to prompt a

focused action from the organization, an action that is guided by the most appropriate evidence-based research practice available. Once the trigger is prioritized, a group is

formed to search for the best evidence to manage the issue and evaluate all factors such as cost, the strength of the evidence, and the impact of such evidence on the triggers.

This group will assemble relevant research and related literature, critique and synthesize the research for use in practice and if there is sufficient research base, it will proceed

and make changes as deemed necessary as the research progresses. Once the research is completed, results are evaluated and decision is made to make the changes as approved

at the organizational level.

Barriers to this implementation can be the lack of research evidence available on the effectiveness of measures to address the particular trigger; the transfer of evidence-

based research to a particular trigger might not produce expected results based on other factors independent from studies that produced the evidence in use. For example, 

patients’ multiple chronic illnesses can affect their response to treatments, not all patients respond the same way to a particular treatment, regardless of the strength of the

evidence. Other barriers include the cost of implementation related to training staff. Effective EBP implementation at the practitioner and organizational levels within a health

care setting is essential to provide safe, effective and patient-centered care; nurses play a pivotal role to sustain the use of EBPs in clinical setting, and the contextual quality

of an organization that facilitate successful implementation should involve an organizational culture that is value-oriented and learning-oriented and receptive to change, and

a transformational leadership style determined by the leadership and practice of management (El-Mallakh at al., 2013, p. 42).

Reference

Grove, S. K., & Burns, N. (2017). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence (8th ed.). St. Louis, Mo: Elsevier Sanders. 483

El-Mallakh, P., Howard, P. B., Rayens, M. K., Roque, A. & Adkins, S. (2013). Organizational fidelity to a medication management evidence-based practice in the treatment of

schizophrenia. Journal of Psychosocial Nursing & Mental Health Services, 51(11), 35-44

 

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Provide a 3-4 sentence response to the discussion question answer that is provided below. The original question will also be provided.

Response: The list of research and practice is 1) Systematic reviews followed by the following,

2) Randomized control trials (RCT’s), 3) Non-randomized controlled studies, 4) Controlled cohort studies, 5) Uncontrolled cohort studies, 6) Case studies and case series, qualitative and descriptive studies, EBP implementation, and QI projects, and 7) Expert opinion (Melnyk & Fineout-Overholt, 2018).

There are many methods of research. One must start out with a review of the literature in their inquiry. One of the reasons is to see what research has been done as to not duplicate unnecessary research. A review will also help to see where to begin a research study or project. If a project is desired, is there enough evidence with reliability, validity, applicability, and replicability? If the evidence is sufficient, and has been applied to quality improvement and/or EBP projects then it can be possibly considered as expert opinion. Whatever you find in the process at least you can then consider if the research has the necessary information available or whether you may want to find another topic for research. It depends on what your reason is for the search.

Original Question: What levels of evidence are present in relation to research and practice, and why it is important regardless of the method you use?

 

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Workflow Assessment for Health IT Toolkit   Workflow can be defined as a term used to describe the action or execution of a series of tasks in a prescribed sequence (McGonigle, & Mastrian, 2015). 

Workflow tools can help make it easier to redesign workflow and aid in the application of health information technology (U.S Department of Health and Human Services, n.d). 

For the purpose of this discussion three workflow tools were selected which include benchmarking interviews and usability evaluation.  Benchmarking  Benchmarking is a process of evaluating metrics or best practices from other organizations (either related or unrelated to your own) and then applying them to your organization (U.S Department of Health and Human Services, n.d). 

Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others. Benchmarking can stimulate healthy competition, as well as help members of a practice reflect more effectively on their own performance. Benchmarking can be done by reaching out to peers at other facilities and finding out what they do and if it works well. My facility has many other sister and we are the bigger where we encounter most of the problem. The common system that all we use is the point click care.  What I going to do is to contact all the leader of the entire facility sister, so we can have a meeting to debate about each system in place in each facility. I would want to physically see how the design of their system works and if the charting works well. Because nurse has to be involve in and informatics technology process, I would bring with me 2 to 3 clinical managers nurses to see the charting, so they could also see the new idea and give feedback on their feelings about it. Based on the information gathered I would plan a process to implement the new ideas into the charting system at our facility.  

Interviews provide a means of eliciting information from a group of individuals regarding their opinions, behavior, or knowledge (U.S Department of Health and Human Services, n.d). Here the interview involves 2 to more people and during the interview, data are collected and most of the time, it is the interviewee who provide data Here, I will set up an interview with 2 to 3 leaders form the sister facility where I will ask questions about sensitive issues, to determine users’ needs on the systems and to clarify some of my questions question.  

Usability evaluation  A usability evaluation is conducted to determine the extent to which a system is easy to use or “user friendly.” (U.S Department of Health and Human Services, n.d). Here I will determine if the new system is useful to user and if it is easy for to use it before implementation. Here I will determine the goal of my evaluation, what will be evaluated and how? For that I will choose some main staff from each sister facility who will conduct the survey to the rest of the staff to see how easy it is for them to use the informatics system. Based on the result, I will see what the areas of improvement before the implementation.  The article I will be use the information to improve workflow within your organization is:  Improvement of workflow and processes to ease and enrich meaningful use of health information technology (Singh & al., 2014).  In this article the author develop a self-contained workflow toolkit that uses ‘universal visual language’ and recognizes that most practices lack the required expertise and often need external assistance because the current methods (using esoteric charts or various software packages11 that require long and steep learning curves) are alien to health care workers and are, therefore, perceived to be barriers (Singh & al., 2014). It is a well established fact that, in any setting or industry, better management of work processes leads to improved value. Education and training of stakeholders in this management skill needs appropriate tools. The toolkit particularly addresses the ‘system-based practice’ and ‘practice-based learning and continuing improvement’ (Singh & al., 2014). Base on that, I will educate staff by using that pictorial tool for assessing the current and continuing redesigns of future workflows for achieving staff comfort, efficiency, communication, organization, productivity, effectiveness, safety, and satisfaction of patients and staff, all without having to seek outside help.  According to Caspi (2015), it is clear that informatics nurses will continue to be instrumental players in the analysis, implementation, and optimization of advanced information systems and emerging technologies that aim to improve the quality of patient care, while reducing costs.     

Caspi, H. (2015). The significant impact of nursing informatics on workflow, productivity. Healthcare Dive. Retrieved from https://www.healthcaredive.com/news/the-significant-impact…workflow…/387301  McGonigle,  D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of  knowledge (4th ed.). Burlington, MA: Jones and Bartlett  Learning. Chapter 13, “Workflow and Beyond Meaningful Use”     Singh, R. Singh, A., Singh, R., Singh, R. (2014). Improvement of workflow and processes to ease and enrich meaningful use of health information technology. DOI: 10.2147/AMEP.S53307. Retrieved form Walden library.   U.S department of health and human services (n.d.b). Workflow Assessment for Health IT Toolkit.http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

 

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PLEASE RESPOND TO THIS DISCUSSION WITH REFERENCES. 

The rigor associated with research differs between qualitative and quantitative research. In quantitative research a study is rigorous when it is reliable and valid. The researcher must maintain adherence to the procedure during data collection and analysis (Lohfield, 2018). Reliability is the degree to which a research instrument produces consistent results. There are a few different methods to test reliability. Stability reliability is tested using test-retest, where the same concept is is tested with the same instrument over time to see if it yields the same results. Equivalence reliability is tested by inter-rater reliability, which is when two people judge their equvalence, and alternate forms, which is a comparison of two instruments to determine their equivalence. Internal consistency is mainly used with scales as a meausuring concept.  Validity is how accurate an instrument is at measuring what it is trying to measure. There are four types of validity. Face validity is just looking at the instrument to determine if it looks legitamate. Content validity looks to see if the method has all of the main components ncessary to measure whatever is being measured. Construct validity determines whether the instrument measures the theoretical component it is meant to measure. Criterion related validity is used when a score on a test can be used to predict the persons performance in a different situation.

In qualitative research, maintatining trustworthiness is key to a rigorous study. Trustworthiness is the analogous for rigor in qualitative research (Amankwaa, 2016). Trustowrthiness involves establishing credibility, transferability, dependability, and confirmability. the researcher must also have self awareness, because qualitative research involves interpreting findings, and this may be affected by a researchers biases.

To ensure trustworthiness, I think a researcher having a lot of knowledge of themselves and being aware of this when interpreting data would be key to keep their study rigorous. to increase validity, a researcher should make sure they have a very good research tool. To increase reliability, it is best to use a large sample size in the study.

References

Amankwaa, L. (2016). Creating Protocols for Trustworthiness in Qualitative Research . Journal of Cultural Diversity, 23(3), 121-127

Lohfield, L. (2012). Testing the validity of a scenerio based questionnaire to assess the ethical sensitvity of undergraduate medical students. Medical Teacher, 34(8), 635-642.

 

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