NURS 8114 Translation of Evidence and Application

NURS 8114 Translation of Evidence and Application

NURS 8114 Translation of Evidence and Application

Challenges and Barriers for Practice Change

The practice change to be implemented for the organization is to create guidelines for neonatal pain management. In the literature review, it was identified that poor pain management in neonates could have an impact on neurodevelopment.  This is why it is important for changes in the current standard of care for neonatal pain management. Many procedures are performed on neonates at the bedside where they may receive little to no interventions to manage their pain. It could be related to poor communication between the neonatal team and nursing staff or the surgical staff.  Regardless of who is at fault for the lack of pain management, it is important to have someone responsible for making sure the neonate is comfortable during the procedure.

Challenges for implementing this guideline or providing the base baseline data may be a challenge.  Collecting the data at the lack of pain management may be difficult if the nursing staff or the neonatology team is not documenting or completing a red flag alert.  A challenge could arise with a lack of education or comfort from the nursing staff regarding pain assessment and documentation. The surgical team could be another challenge if they do not want to make changes to their current practice because it works for them and saves them time. Since the facility is a teaching hospital a lack of education regarding pain management for neonatology residents may serve as a challenge.  Nursing refusal to implement the change may be a harder challenge to overcome if they do not support the guidelines.

 

Role of DNP in creating health care culture

The DNP graduate needs to serve as leaders for the organization to implement the necessary changes while working with other health care members (AACN, 2006).  The DNP graduate should be knowledgeable about the current practices within the organization.  It is important to be organized in their approach with practice problems to members of the organization including the nursing staff.

 

Actions and Activities

The DNP needs to help create a health care culture by becoming knowledgeable about the stakeholders for the organization (Dearholt. The DNP is responsible for providing updated evidence-based practice information regarding the problem within the organization. The use of nursing theories would help to explain different concepts in the nursing practice as well as nursing philosophy.  The middle-range theory provides more accurate answers related to questions about certain nursing practice questions (Alligood & Toomey, 2010).

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The Theory of Caring focuses on knowing, being with, doing for, and maintaining belief (Alligood & Toomey). When

NURS 8114 Translation of Evidence and Application
NURS 8114 Translation of Evidence and Application

caring for the neonatal population knowledge is the key to implement successful practice changes. Due to performance gaps, it is important to use evidence-based practice to identify other practices to improve pain management for neonates (Dang & Dearholt, 2018). All research related to pain management in neonates should be evaluated and synthesized to evaluate the success of implementing changes to current practice (Wills & McEwen, 2019). As always it is important during this process to have a team created willing to help review different practices. A neonatal pain committee team consisting of nursing staff, pharmacy, neonatology team & child life would be a great team to assist with identifying and developing new practice guidelines.

 

 

Reference

Alligood, M.R., & Tomey, A.M. (2010). Nursing theorists and their work (7th ed). Mosby Elsevier.

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

 

Dang, D., & Dearholt, S.L., (Eds). (2018). John Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.) Sigma Theta Tau International.

McEwen, M., & Willis, E.M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.

Organizational culture can be quite difficult to change, however it is not impossible. It will take an influential leader, with good communication skills, a clear plan, and attainable goals.  As healthcare organizations become increasingly diverse, changing the culture will be inevitable. As DNP prepared nurses it is important to participate in organizational change, be equipped to face challenges and barriers when implementing new clinical practices. When seeking to make clinical changes we must first start with synthesizing the research to provide evidence-based answers (Westlake, 2012).

The challenge that my organization continues to struggle with is lab specimen errors. We have had multiple issues with unspin tubes sent to the lab, incorrect tube collection, mislabeling, or labs not being sent out at all. Despite multiple in person and computer in-service trainings we fail to maintain accuracy or consistency.  This presents as a problem because patient care is delayed, resources are wasted, and revenue is affected. To address this clinical practice issue, I educate all staff on the importance of proper lab collection and specimen processing adding a relatable example of a personal nature. I would select lab champions on each shift to act as leaders to inspect all lab collection for any issues before packing and shipping. I would also partner the charge nurse with the lab champions to maintain continuity.

My role as a DNP clinician is to analyze the problem and develop a new policy and procedures supported by evidence and research to course correct this clinic practice issue. It is important to change the culture from one of negligence to a culture of safety. I can achieve this by disseminating the research to develop new clinical practices (White, Dudley-Brown, & Terhaar, 2019). I am sure that I will be met with opposition, however I will lead by supporting the team, creating teachable moments, and mentoring.

 

References

 

Westlake, C. (2012). Practical tips for literature synthesis. Clinical Nurse Specialist, 26(5), 244–249.

https://doi.org/10.1097/NUR.0b013e318263d766

 

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.

When contemplating challenges to evidence translation and application for practice change in this student’s facility it is easier to put it in the context of the practice change needed for this student’s quality improvement project. The items needed to implement the project include a cart to house resources for diabetes self-management education (DSME), two iPads loaded with DSME videos, and multi-modal education for staff nurses. Once the resources are in place and the nurses have been trained on DSME, they will be expected to implement the provision of DSME to patients with newly diagnosed or poorly controlled diabetes.

The first anticipated challenge is getting approval from the Chief Financial Officer (CFO) for the financial allocations needed. Direct costs for this project include the purchase of a resource cart and iPads. Indirect costs include paying the staff for attendance at the training and printing costs for resource materials. This will be a challenge because it is difficult to get the CFO to let go of funds. One way this student could address this challenge would be to source the cart from some unused ones currently being stored; thus, eliminating this cost. The videos being loaded on the iPad will be from free sources, so these will not add to the cost of the project. To reduce the cost of training staff, a multi-modal format is planned. Didactic information will be placed in the eLearning system as a curriculum. This will allow staff to complete some of the training while on shift and will not require additional productive time.

A second expected challenge will be changing the culture regarding providing DSME to patients. Currently, staff are not comfortable in the role of DSME provider; therefore, the education does not get done. White et al. (2019) state a culture change requires a paradigm shift in order to eliminate the know-do gap. The authors define this as the difference between those who possess the knowledge of a project or change and those who implement the desired change. This paradigm shift will be addressed by bringing the “doers” in on the knowledge by providing them with education on diabetes content via the eLearning system. Staff will also attend in-person training for role play, simulation, and skills practice. Stoffers and Hatler (2017) identified training and education as a method to increase nurses’ skill and confidence in providing DSME. This student believes once nurses’ confidence and knowledge level are increased, they will be much more willing to complete DSME with patients. A second method to address this challenge will be by using DSME videos on the iPad. The use of videos will allow nursing to ensure DSME is given; however, it will take much less time out of their day than it would if they were providing all of the education in person. Instead of having to remember and present all of the information, they will simply have to teach the patient to use the iPad and direct them to which videos are appropriate for them.

DNP-prepared nurses can support a culture of quality improvement by leading interprofessional teams and promoting collaboration on patient safety and quality initiatives. In this quality improvement project, collaboration can occur between nurses, pharmacists, podiatrists, hospitalists, dieticians, etc.

Using collaboration to increase nurse awareness of the importance of DSME supports social change because of the difference it can make for this patient population. Karimy et al. (2018) identify good self-management activities as a direct link to improved diabetes outcomes and decreased complication rates. This, in turn, will decrease healthcare costs for the patient and increase quality of life.

 

References

Karimy, M., Koohestani, H., & Araban, M. (2018). The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetology and Metabolic Syndrome, 10(86). 1-6. https://doi.org/10.1186/s13098-018-0386-6

Stoffers, P., & Hatler, C. (2017). Increasing nurse confidence in patient teaching using motivational interviewing. Journal for Nurses in Professional Development, 33(4), 189-195. https://doi.org/10.1097/NND.0000000000000370

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.