Becoming a Leader in the Translation of Evidence to Practice

Application 3: Becoming a Leader in the Translation of Evidence to Practice

Reflect on your growth, professionally and personally, since you embarked on your DNP journey. The AACN believes that one of the benefits of a practice doctorate is that it enhances your leadership skills to “strengthen practice and health care delivery” (2006, p. 5). As you continue to engage in your practicum experience, be cognizant of your growth in these areas.

In Week 6, you were asked to reflect on your leadership skills for this Assignment. This week, you continue your reflection on leadership and how you can lead the translation of evidence to practice through contribution to policy development.

Prepare for this week’s section of Application 3 as follows:

  • Building      on the work you began in Week 6 for this Application, review this week’s      Discussion posting, and consider how you can lead policy development to      address your EBP Project issue.

To complete:

Due tomorrow 10/11/18 before midnight

Write a 2- to 3-page paper in APA format with a minimum of 5 scholarly references less than 5 years old that synthesizes (DO NOT GO OVER THREE PAGES):

  • Your      vision of yourself as a leader—specifically:

1) How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches (see week 6 discussion attached you did for me, except focus on the critics the professor added for me [see bold and underlined professor critique below] which you failed to include in this discussion

2) How translating evidence would enable you to affect or strengthen health care delivery and nursing practice

3) How you would advocate for the use of new evidence-based practice approaches through the policy arena (see week 7 discussion attached you did for me)

Professor Critics in week 6 on the cost and financial impact of the implementation of the project 

Dear student: Thank you for your contribution to this week’s discussion.  You brought forward potential costs associated with increased mobilization of ICU patients….namely the need for more nurse time.  Do you have some hard numbers you can provide on the potential cost of this? Do you have any local or national information on the cost of not mobilizing the patients (longer stays, increased infection, readmission)? Calculating approximate cost associated with the practice change versus the cost of not changing is important. This will help stakeholders see the value in the investment.

Required Readings

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

  • Chapter      6, “Translation of Evidence for Leadership”

Balakas, K., Sparks, L., Steurer, L., & Bryant, T. (2013). An outcome of evidence-based practiced education: Sustained clinical decision-making among bedside nurses. Journal of Pediatric Nursing, 28, 479-485.

 

Brown, D.S. (2012). Interview with quality leaders: Dr. Donna E. Shalala and Dr. Linda Burnes Bolton on the committee on the Robert Wood Johnson Foundation initiative on the future of nursing at the Institute of Medicine. Journal for Healthcare Quality, 24(4), 40-44.

Brandt, B., Lutfiyya, M.N., King, J.A., & Chioresco, C. ( 2014). A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. Journal of Interprofessional Care, 28(5), 393-399.

Grindel, C.G. (2016). Clinical leadership: A call to action. Med-Surg Nursing, 25(1), 9-16.

Mannix, J., Wilkes, L, & Daly, J. (2015). Grace under fire: Aesthetic leadership in clinical nursing, Journal of Clinical Nursing, 24, 2649-2658.

Stetler, C.B., Ritchie, J.A., Rycroft-Malone, J., & Charns, M.P. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4), 219-226.

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

  • Chapter      4, “Translation of Evidence to Improve Clinical Outcomes”
  • Chapter      5, “Translation of Evidence for Improving Safety and Quality”
  • Chapter      7, “Translation of Evidence for Health Policy” (See attached file)

Andermann, A., Pang, T., Newton, J.T., Davis, A., & Panisset, U. (2016). Evidence for health II: Overcoming barriers to using evidence in policy and practice. Health Research Policy and Systems, 14 (17) doi 10.1186/s12961-016-0086-3

Catallo, C. & Sidani, S. The self-assessment for organizational capacity instrument for evidence-informed health policy: Preliminary reliability and validity of an instrument (2014). Worldviews on Evidence-Based Nursing, 11(1), 35–45.

Malterud, K., Bjelland, K., & Elvbakken, K.T. (Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and Systems, 14 (15) doi 10.1186/s12961-016-0088-1

Rehfuess, E.A., Durao, S., Kyamanywa, P., Meerpohl, J. J., Young, T., & Rohwer, A. (2016). An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries, Policy & Practice, 94, 297–305 doi: http://dx.doi.org/10.2471/BLT.15.162966

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209 (see attached file).

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

Developing and Evaluating New Practice Approaches

Summary of the Practice Issue and Proposed EBP Strategies

It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care (White, Dudley-Brown & Terharr, 2016). One of the issues that affects 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 (Denehy, Lanphere & Needham, 2017). 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. Therefore, it is recommended that nurses increase their frequency of mobilizing patients from time to time to speed up their recovery. The theoretical foundation for this solution is the theory of planned behavior. This is a psychological theory arguing that people’s perceptions and beliefs influence their behavioral reactions to certain phenomena. Mobilizing the patients will help them to have a positive view of their recovery; hence, this will enhance their attitudes towards their health and help to speed up their recovery process.

The Potential Economic Impact of the Suggested Strategies

            The main economic impact of the recommended EBP strategies for improving ICU experiences and outcomes is the need for new personnel. According to Lord et al. (2013), early mobilization of the critical care patients may generate substantial clinical improvements in ICU patients and reduce costs to hospitals, payers, and capitated health care delivery systems. Even when the expected clinical effectiveness of an early mobilized program is reduced by 20% the estimated net present value was positive by the second year of the program. The ICU I work for has 32 beds which equals 32 patients who do require early mobilization to improve their health outcomes. This procedure, on the other hand, will require the nurses to spend a lot of time with the patients to help them. This, on top of the low nurse to patient ratio in many hospitals as well as my unit, means that nurses will experience more burnout or be unable to perform the procedures effectively, especially the minimum of three times a day per patient per twelve-hour shift. Therefore, for my hospital to implement the procedures will need to invest in more personnel, which will mean that more financial resources will be spent on managing the workforce.

How can the new Strategies Improve Healthcare Quality?

            However, the new strategy of mobilization has the potential to improve the quality of care for intensive care patients. First, mobilization helps to reduce muscle fatigue. The patients who are critically ill spend a lot of their time in bed, which increased their muscle atrophy (Denehy et al., 2017). Early mobilization of the critical care patient will also help with the reduction in airway, pulmonary, and vascular complications; their early mobility can also significantly reduce certain complications such as re-intubation rates, pneumonia, pneumothorax, and DVT (Denehy et al., 2017). Most importantly, the early mobilization of patients has the potential to reduce the rates of mortality and hospital readmissions (Denehy et al., 2017). Longer hospital stays have been associated with these two factors. Therefore, if the mobilization is done, patients will have a chance to experience positive outcomes. Generally, these strategies will help to enhance the experiences of patients admitted in intensive care.

References

Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten reasons why ICU patients should be mobilized early. Intensive care medicine43(1), 86-90.

Lord, R. K., Mayhew, C. R., Korupolu, R., Mantheiy, E. C., Friedman, M. A., Palmer, J. B., & Needham, D. M. (2013). ICU early physical rehabilitation programs: financial modeling of cost savings. Critical care medicine41(3), 717-724.

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

 

 

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