The EBP process is accomplished to the fullest when the recommendations and the evidence are utilized to cause a change within the organization. The EBP process is the interplay between research, education and practice and therefore forms a core for the implementation and adoption of change within an organization. It is the process that offers a viable plan to accomplish a change in respect to a particular research question or problem that has been identified within the setting (Dearholt & Dang, 2012). EBP is concerned about the specific interventions to a specific situation based on tangible evidence and data as opposed to generalizations and assumptions. Thus, before evidence is transferred to a specific situation, the researchers and those involved have to carefully examine the quality if research, the relevance of the findings within the clinical or practice setting as well as the benefits to the patients and whether they could in some way or another outweigh the adverse effects (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010).
The ability and success of EBP within a facility is based on three major factors; on one hand the culture within the facility has to have a believe that EBP will achieve optimal patient outcomes; secondly the presence of a leadership that supports EBP through allocation of resources as necessary and required and thirdly the ability by each facility to develop clear expectations in regard to EBP by integration them in job descriptions and the standards of practice (Dearholt & Dang, 2012). This paper will seek to develop a change proposal formula for the implementation of EBP based on the earlier develop research question that focused on the determination of the viability of hourly rounding compared to a less frequent monitoring (two hour monitoring). This design will be accomplished in line with the 18 steps of the EBP process
Change plan; practice question
The EBP process begins at the point where the research or PICOT question has been develop to address a particular problem. In this case, the practice problem was the prevalence of falls and their frequency of occurrence in the group of hospitalized elderly patients. The stated PICOT question was as follows; “For hospitalized elderly patients how does hourly rounding compared to two hour monitoring help in reducing the occurrence of falls and their subsequent injuries?” The role of the nurse in the prevention of falls remains a pertinent issue that needs be addressed as they are at the actual point of care where they can interact with the patients and significantly influence their health status including the risk to falls. Nurses and the nurse managers will take the lead role in the accomplishment and designing of schedules to ensure appropriate staffing levels at all times (Deitrick, Baker, Paxton, Flores & Swavely, 2012).
On the other hand, the staff nurses will actualize the monitoring and ensure documentation within the wards to provide reliable data for evaluation in the future to determine how effective or otherwise the intervention resolves the existing problem. The nurse educators within the setting will schedule workshop sessions that will be used to train the nurse son their roles in the accomplishment of the intervention. The Management and administration within the facility will monitor the need for integration of nurse educators within the wards to guide the nurses while in practice and therefore make decision on increased hiring and recruitment (Dearholt & Dang, 2012). The informatics department will play a major role as they will be tasked with developing automated systems that will help collect all the desired evidence and data for future evaluation of the intervention. The Informatics department will also provide the nurses in the wards with support tools based on the identified areas of conflict or difficulty within the EBP implementation process (Dearholt & Dang, 2012).
Change plan; evidence
A key aspect of EBP is the availability of evidence that is reliable, strong and valid as well as one that can actually be utilized to answer the question or solve the problem under investigation. The role of the informatics department will be the key in this phase. The informatics department carries the database for clinical evidence as well the infrastructure that can connect to outside sources that can be utilized in seeking for evidence to support the clinical question (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010). Each member of the team that is accomplishing this EBP project will be assigned to present at least five sources analyzed with the use of Research Evidence Appraisal or the Non-Research Evidence Appraisal to determine the strength and quality of evidence. In order to ensure that all the members participant in the search and appraisal in a timely manner, the Individual Evidence Summary will be utilized as the communication tool that will monitor and track the progress of each member in the assigned role (Dearholt & Dang, 2012). The team will then use the results of the Individual Evidence Summary to make a collective and overall analysis of the evidence so as to determine the weighted strength and quality of each based on that of others within the list. As soon as the strength and quality has been ascertained the members will then develop recommendations as focus groups and thereby combine them to come up with the most desired and agreeable solution (Dearholt & Dang, 2012).
Change plan; translation
This is the third phase in which the recommendations have already been developed and the focus is on the actual implementation. The first step here is to assess the feasibility of translating the recommendations into workable practice setting activities. This includes constant communication with the stakeholders especially those who are tasked with the distribution of resources. Once the support has been acquired and the feasibility has been determined, the next phase is to make changes that will accommodate the intended intervention. For instance, in this case, the policy on the designing of shift schedules for nurses will be based on the patient needs and the level of strain within a particular unit. Other policy changes such as the integration of nurse educators in wards will have to be acquired and recognized within the new policy. Aside from that, the feedback from the various groups that are affected by the change such as patients, staff nurses as well as the changes in the roles of the nurse supervisors will be assessed and used to evaluate the intervention in the future (Dearholt & Dang, 2012).
Once these measures have been put in place to safeguard the elements of the intervention, the team leaders will make verbal and written communication to the affected groups to notify them of the intended change and their new roles. The nurse educators in this case will have to be available at all times to answer the questions that the affected groups may have and therefore eliminate the fear that comes with an intended change. Once this has been done, the next process is to initiate a process for evaluation of outcomes which helps provide the basis for change/alteration/modification of the process (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010). This is based on the assessment to the short term outcomes as well as the response by the various stakeholders such as the patients and the staff nurses. The results of the assessment will then be communicated to the team members who will assess the frequent of falls, the magnitude of the injuries and the attached costs in each case. These results will then be used as the justification for the review of the EBP solution (Deitrick, Baker, Paxton, Flores & Swavely, 2012).
Summary
The success of the EBP is based on the level of collaboration and the presence of communication channels amongst the members of the team. The most important entity that helps the EBP process is the feedback; the team leaders have to provide a channel; for tracking and delivering messages to each of the members as appropriate. The feedback provides a basis for constant modification of the various components of the EBP since there is no single formula that can afford to accomplish EBP without regular reference to the previous steps or phases (Mant, Dunning & Hutchinson, 2012). The nurses have to be involved in this case as they are the actual point of interaction with the patients and have a clue as to the how falls manifest and therefore in a better position to analyze how well the intervention impacts the occurrence of falls and the satisfaction of the nurses and the patients (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010).
References
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd-ed.). Indianapolis, IN: Sigma Theta Tau International.
Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of nursing care quality, 27(1), 13-19.
Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 10(56 Suppl), 63-74.
Mitchell, S. A., Fisher, C. A., Hastings, C. E., Silverman, L. B., & Wallen, G. R. (2010). A thematic analysis of theoretical models for translational science in nursing: Mapping the field. Nursing outlook, 58(6), 287-300.
