Research is a systemic investigation used to answer questions. For nursing, research uses the scientific process to study nursing questions for nursing practice. “Research promotes accountability, which is one of the hallmarks of the nursing profession and a fundamental concept of the American Nurses Association Code of Nurses,” (Haber, 2018, p.7). An example of this would be exploring how patients rate their pain on a numeric scale. This type of research helps with evaluating the experience patients feel post-operative.   Evidence-based practice (EBP) is the collection and evaluation of valid research, clinical expertise, and patient values to make a clinical decision. “The IOM has issued a challenge to change the way nursing is practiced by bridging the chasm between research knowledge and practice.” (Brower, 2017, p.18). EBP can ensure the best practice of care for patients, along with decreasing mortality rates. An example of EBP would be a nurse gathering research based on how health care clinics bring about lowering hospital-acquired infections, and using that evidence from the research to provide the best possible outcome. Quality improvement (QI) is using data from different outcomes of care and improvement processes to improve the quality of health care. Current nursing knowledge and methods are researched, alongside with outcomes of certain care processes to answer a question in order to make improvements in nursing care for patients. An example of QI would be a nurse conducting research for an outcome of care involving patient injuries. The nurse would use already existing studies on how health care facilities prevent patient injuries, compare this knowledge to the methods the health care facility they work at use with the outcomes presented, and then create a possible new method of care that can be an improvement. 

Brower, J., E., & Nemec, R. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18. 

Haber, J., & Lobiondo-Wood, G. (2018). Nursing research: Methods and critical appraisal for evidence-based practice (9th ed.). St. Louis: Elsevier. 

 

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 Approximately 150-180 words APA format with references and in-text citations. 

Where in the World is Evidence-Based Practice?

            This paper addresses the main discussion post regarding evidence-based practice (EBP).  EBP provides problem-solving to clinical practice that focuses on the best research, clinical expertise, and patient preferences or values (Melnyk & Fineout-Overholt, 2019, p. 8).  It is imperative to implement EBP into clinical practice as it leads to high-quality nursing care and better patient outcomes.  The purpose of this discussion post is to explore a healthcare organization website and determine if they are grounded in EBP.

Description of Healthcare Organization

            The healthcare organization website that I reviewed was the Centers for Medicare & Medicaid Services (CMS).  EBP appears in the quality initiatives section of the CMS website.  This section informs patients that CMS seeks information on how to transform clinician practices by changing practice behavior through evidence-based care to improve patient care and lower healthcare costs (CMS, 2018).  CMS has quality improvement organizations dedicated to improving health quality.  The mission of CMS quality improvement organizations is to improve the effectiveness, efficiency, and quality of services for Medicare patients (CMS, 2018).  CMS has developed Core Measures, which provides EBP information on health care quality that allows physicians, clinicians, and patients to make informed decisions (CMS, 2017).

Healthcare Organization Grounded in EBP

            Throughout the CMS quality initiatives website, there are indications that they are grounded in EBP to improve their patient’s care and outcomes.  In our required reading, it was noted that the most critical reason for implementing EBP is to provide the highest level of care and the best patient outcomes (Melnyk & Fineout-Overholt, 2019, p. 12).  CMS has also focused their aim on providing better care and better health at lower costs (CMS, 2018).  In our required reading, it was also noted that research shows that EBP leads to a reduction in healthcare costs (Melnyk, Fineout-Overholt, Stillwell, &Williamson, 2010, p. 51).

Changed Perception of the Healthcare Organization

            The information that I discovered on the CMS website has changed my perception of the organization by assuring me that they are using EBP to ensure that their patients receive the best possible care which improves patient care and outcomes (CMS, 2018).  For example, both of my parents have Medicare coverage; it is comforting to know that they are receiving care based on evidence that has been shown to improve their care and outcomes.  The aim at CMS is to provide better care at lower costs, which has also changed my perception (CMS, 2018).  For example, both of my parents live on fixed incomes, so it is essential for them to receive quality healthcare coverage as well as prescription drug coverage at a lower cost.

References

Centers for Medicare & Medicaid Services. (2017, July 28). Core measures. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html

Centers for Medicare & Medicaid Services. (2018, April 19). Quality initiatives – general information. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/index.html

Centers for Medicare & Medicaid Services. (2018, September 18). Quality improvement organizations. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. Retrieved from https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-3.33.0b/ovidweb.cgi?WebLinkFrameset=1&S=CGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23%257c0%257c00000446-201001000-00030%26S%3dCGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&directlink=https%3a%2f%2fovidsp.tx.ovid.com%2fovftpdfs%2fFPDDNCLBKDNJMM00%2ffs046%2fovft%2flive%2fgv023%2f00000446%2f00000446-201001000-00030.pdf&filename=Evidence-Based+Practice%3a+Step+by+Step%3a+The+Seven+Steps+of+Evidence-Based+Practice.&pdf_key=FPDDNCLBKDNJMM00&pdf_index=/fs046/ovft/live/gv023/00000446/00000446-201001000-00030

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

 

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150-180 words APA format with references and in-text citations. 

Health literacy, along with health numeracy skills, can influence the quality of care delivery across the spectrum of settings and is vital to maintaining patients’ engagement in their own health. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness” (Health Resources and Services Administration [HRSA], 2015).  

The ineffectiveness of healthcare literacy in the current health care climate is not a new issue, however it is as relevant as ever. People need information they can understand and use to make the best decisions for their health. When organizations or people create and give others health information that is too difficult for them to understand, we create a health literacy problem. When we expect them to figure out health services with many unfamiliar, confusing or even conflicting steps, we also create a health literacy problem (Brach, C., Keller, D., Hernandez, L. M., Baur, C., Dreyer, B., Parker, R., … Schillinger, D., 2012).

 Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease (Marshall, E., & Broome, M., 2017).  Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.

Despite the growing interest in health literacy, little research has been done around health professionals’ knowledge of health literacy or understandings of the barriers to health literacy that patients face when navigating the health care system.  Improving both the healthcare workers knowledge and those of their patients decreases the barriers that prevent patients from seeking and receiving proper care (Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A., 2017).

Health literacy may cover choosing and comparing different health plans, prescription drug premiums, copays, and deductibles. As medical science is continuously evolving and progressing, it is easy to understand how health information can confuse and even overwhelm the average healthcare consumer. Improving health literacy is the responsibility of health organizations, healthcare systems, and healthcare professionals worldwide. It is critical for patients to develop health literacy so that they can take a more proactive role in their health. When patients are actively engaged, they are able to make more informed decisions which increases patient satisfaction, adherence, and can ultimately improve outcomes(Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., & Smylie, J., 2015).  Patient empowerment, engagement, activation, and maximized health outcomes will not be achieved unless assurance of health literacy is applied universally for every patient, every time, in every health care encounter, and across all environments of care (Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A., 2017).

References

Brach, C., Keller, D., Hernandez, L. M., Baur, C., Dreyer, B., Parker, R., … Schillinger,

  D. (2012). Ten attributes of health literate health care organizations. Washington, DC:

    Institute of Medicine. Retrieved from http://www.ahealthyunderstanding.org/

         Portals/Documents1/IOM Ten Attributes Paper.pdf

Health Resources and Services Administration. (2015). Health literacy. Washington, DC:

     Author. Retrieved from http://www.hrsa.gov/publichealth/healthliteracy/

Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., & Smylie, J. (2015). Health

   literacy: Health professionals’ understandings and their perceptions of barriers that

     Indigenous patients encounter. Biomed Central Health Services Research,14.

      doi:10.1186/s12913-014-0614-1

Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A. (2017). Call for

   action: Nurses must play a critical role to enhance health literacy. The Journal of the

     American Academy of Nuring,66(11), 97-100. doi:10.1016/j.11003

Marshall, E., & Broome, M. (2017). Transformational Leadership in Nursing (2nd ed.).  

    New York, NY: Springer.

 

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To be one of the best organizations the mission statement and values set forth by that organization must show respect and overall care for the employees representing such. Organizations like ones we work for have a duty to provide the highest of quality care for patients while maintaining safety. In order to perform at these levels it starts with great communication methods.  As many know communication is a crucial element at the forefront of all successful businesses.  At times the downfalls of organizations stem from unhealthy communication lines. Many organizations lack healthy work environments due to communication breakdown (Laureate Education, 2018). Individuals must know how to communicate thoroughly and effectively. 

 A healthy working environment is essential to overall staff and patient satisfaction. When staffs are being treated fairly and under the right conditions results are felt through patient satisfaction surveys and such.  Within organizations the culture is created with an attempt to amplify the healing and health of the populations serviced (Marshall  & Broome, 2017). When there are broken lines of communication, disruptive behaviors and such it causes a great deal on incivility amongst staff.  According to Marshall & Broome (2017), incivility can be classified as behaviors of low intensity which is displayed as being impolite, or rude placing strains on the working environment (p.76).  After taking the workplace assessment this week, my organization was determined to be an unhealthy environment. My work place would be classified as uncivil with this score based on such determining factors such as the lines of communication amongst each other, the fact staff feel over worked with patient acuity and workloads, and the issues with retention of staff.

                An incident in my workplace where I was a key witness of incivility was with a nurse leader and nurse manager. She was very demeaning with every word she spoke. She was not that took well to constructive criticism, but would greatly give out with much pleasure. There was a difficult patient on our unit for a lengthy time. He was very rude to all staff, very manipulative, and demanding. As much as we all kept trying to keep the moral from drowning because of his behaviors, this one particular day I must say the patient won. The nurse leader received a phone call from this patient which was discharged a day before. The patient was calling regarding medications he thought he had left and was informed the medication was not with us but was with him at discharge. The patient began to become frustrated with the nurse leader. While this conversation took place, the nurse manager overheard this interaction. She instructed the nurse leader to hang up the phone and tell the patient we did not have anything that belongs to him. The nurse leader was trying to diffuse the situation with the patient, and be very courteous and diligent. The nurse manager was still in front of the nurse leader and instructing her to hang up the phone on the patient. Again the nurse leader is trying her best to ease off the phone, but clearly it was not fast enough for the nurse manager. The manager then hangs up the phone on the patient in mid-sentence. She then in the middle of the nurses’ station scolded the nurse leader about her conversation and her actions of insubordination towards her requests to hang up the phone. Staff all around was very shocked at this interaction and quickly shifted away. Now although this was not towards me, I felt every bit of sympathy for my fellow leader. She felt belittled, incompetent, and disrespected. This was no way a leader above us should act nor treat staff as such. The nurse leader did walk away and had a moment where she broke down and cried to me. I felt helpless at that moment, but I could not allow this behavior manager or not. I later talked to the manager and expressed my concerns regarding her actions. She did mention her frustrations, and that she did get carried away. Her frustrations grew from the patient overall and the difficult times he caused on our unit. The manager did express her feelings of sorrow towards her staff and fellow leader.

                The issue was resolved for the moment, but overall we did lose a great leader because the nurse transferred to another unit. I will say although the issue was addressed, it should have never happened and this is not something I can ever condone. In this profession of nursing we are looked upon as the most “trusted and caring professions” (Clark, Olender, Cardoni, & Kenski, 2011).  With this being said nothing short of those actions would make me feel comfort with a nurse like this and these behaviors. It is never ok to allow workplace violence and knowing that I was a voice for a peer allowed me to feel comfortable as a nurse leader and advocate for not only patient but my fellow staff.

References

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. Journal of Nursing Administration, 41(7/8), 324–330. doi:10.1097/NNA.0b013e31822509c4

Laureate Education (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

 

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