Academy for Practical Nursing and Health Occupations Evidence-Based Approach

1——-Two barriers that can affect the long-term outcomes of an evidence-based project are (1) the lack of ongoing training and monitoring of the new practice change, and (2) not setting goals or rewarding staff for meeting time lines for the practice change. In order to overcome these barriers, the change agent needs to have clear policies and procedures in place for the new practice change. Ongoing training, especially for new staff, will be needed until the change becomes part of the normal workflow. This is often seen at Indian Health Council, when there are changes to workflows in the electronic health record. Staff can go back to the old way of doing things if they are not monitored, because they tend to be more comfortable with the old way of doing things. The change agent needs to be present to answer questions, and to make changes if the new practice project needs to be changed in any way. According to Cherry (2017), the person who is leading the change needs to be “…available to help, support, and encourage others through the process” (p. 311).

Setting clear goals allows staff to know what they are working to achieve. Small rewards can be given, for example, an ice cream or pizza party, or certificates with balloons can help staff feel recognized for their hard work. “Leadership strategies of positive feedback, encouragement, and constructive criticism reinforce new behavior” (Garon, 2014, p. 41). Once goals are met, then the new practice should still be monitored to make sure staff are compliant with the new changes. Sometimes events or changes happen in a department, and these changes may affect the evidence-based practice, so policies and procedures may need to be revised. According to Cherry (2017), the person who is making the changes should evaluate “… the change, and make modifications if necessary” (p. 311). Sometimes performing a pilot project over a few months can help the change agent fine tune a new procedure or protocol before it is rolled out to the whole department. This can alleviate stress, and help support a change, especially if the project is making improvements in patient care or the department.

When looking at this nurse’s evidence-based project, it will be important to train on screening tools, and when to call for a brief intervention, which may include training nurses on providing a brief intervention if the provider or behavioral health counselor is not available. For SBIRT (screening, brief intervention, and referral to treatment) to be effective, staff must screen accurately and provide a brief intervention. Goals should be set to increase the number of SBIRT interventions by at least 50% within the next six months. The nurse can monitor the number of positive screenings and see how many brief interventions are completed over the next six months. Staff need to be updated every month, so they can meet their goals and know how the department is doing. Once the goal is reached, then a new and higher goal can be set. The staff should be rewarded once they reach their goals, so that they take ownership of the project and continue to support the practice change.

2—-Sustaining change can be one of the most challenging topics related to the long term success of any project. It’s an unfortunate truth that up to 33% of quality improvement projects are not sustained after the first year of completion (Silver, et al,2016) Through my capstone project, I feel I have incorporated blood, sweat, and tears and thus I have a very personal interest in the project’s success. The reality of this is that I can’t be the only one that makes this project successful; rather, it must be a team effort. Therefore, I recognize that I must demonstrate a good understanding of why the project is needed in order to create a vested interest in its long term success. This brings me to my first barrier, which is sustainability after the initial enthusiasm or rationale of the work has dissipated. I plan on overcoming this by maintaining focus on our objective; to keep patients healthy. I plan on doing this by reporting out monthly data on how many patients our department made contact with and of those, how many remained out of the hospital following 30-day post discharge. With this effort, I hope to continue to spotlight the work we are achieving and why the extra effort is needed.

Another anticipated barrier is how to incorporate standardization across the department. Mate (2016) identifies that incorporating clear guidelines and accountability will work to support sustained improvement. I plan on overcoming this barrier by creating standardized guidelines and expectations of the workflow. My intention for this effort would be to clearly acknowledge the goals of the project and what each team member is responsible for in order to achieve our collective goal. Furthermore, this guide would help ensure that new staff are also aware of the project and what is expected of them and why.

I know that with continued effort this project has a great potential to positively influence patients’ lives. This post recognizes that just because we are nearing the completion of our capstone project doesn’t mean that the work is done. We will need to maintain communication and continue to overcome barriers in order to ensure it’s continued success.

3——–Different barriers hinder the implementation of change proposal in a health care facility. The two potential barriers which might prevent EBP from changing proposal which in turn leads to less desired results as compared to results six months from now on include;

Access to information and organizational support
Unavailability of necessary equipment in the hospital for patient monitoring and care to prevent unforeseen cases of the pressure of ulcers.
According to a new national survey of more than 1,000 RNs suggests that resistance from nursing leaders and lack of organizational support prevent nurses from implementing evidence-based practices that improve patient outcomes (LoBiondo-Wood, & Haber, 2014). Pressure ulcers remain the chief complications of prolonged hospitalization, specifically in situations of poor nutrition, increased moisture on the skin (e.g., incontinence), prolonged pressure, and compromised sensory stimuli. Pressure ulcers increase the cost of hospitalization, increase patient morbidity and mortality, and play a significant role in the spread of infection in the clinical area. Although there is measure to prevent the prevalent cases of the pressure of ulcers, the major problem with the implementation of the change proposal is lack of organizational support and access to information and necessary equipment. Organizational support plays a major role in the implementation process, in fact, leaders and managers are important sources of communication. Their expressed support for improving pressure ulcer prevention will reinforce its importance and thus increase the impetus among staff to adhere to the new practices. However, when this support from the leaders is lacking, it becomes difficult to adhere to the practices that are supposed to prevent the pressure of ulcers. This is a barrier I have experienced, and I have heard colleagues complain about (Mwebaza et al., 2014).

To overcome the barriers, clarifying the roles of the implementation team as well as unit champions for the implementation period is very crucial. Also, communication with the managers and updating of the progress of the change proposal keeps them informed, in fact, engaging them can make them feel like part of the change proposal hence contributing ideas necessary to facilitate the implementation of the EBP. Finally, management engagement can similarly help to realize any equipment, tools, or machines that are necessary yet lacking in the implementation of the change proposal. Although these strategies can help overcome the barriers stated above, personal efforts in addressing the barriers and follow-up are equally important in accelerating the implementation of the change proposal.

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