NURS 6052 Wk 9 Discussion: Developing a Culture of Evidence-Based Practice

Evidence based practice has multiple benefits when implemented at a facility. Research has shown that EBP can improve patient outcomes, provide a safer environment, and bring better quality healthcare (Melnyk et al 2017).   A challenges with evidence-based practice is finding ways to implement EBP in an organization.  One strategy that I would use to implement evidence-based practice at a facility is to have organizational level presentations given by EBP mentors.  By focusing on EBP at an organizational level, mentors have an opportunity to bring data that can help change policies.  Melynk et al., (2011) explain…..”Measurement of outcomes(internal evidence) plus rigorous research( external evidence) results in the best evidence-based organizational policies to guide the highest quality of care in healthcare institutions”(P.4).

Barriers can exist with implementing evidence-based practice.  These can include lack of mentors, inadequate EBP knowledge, and not valuing EBP (Melynk., el al, 2017).   One strategy that I would use to overcome the challenges as outlined in NURS 6052 Wk 9 Discussion Developing a Culture of Evidence-Based Practice, is to establish dedicated mentors to help bring a change in culture to an organization.  I would also convince management and administration of the importance of how EBP can benefit an organization by having greater job satisfaction and less staff turnover (Melynk et al.,).  Less staff turnover will save the departments money on training.

Another strategy I would use to disseminate EBP is by encouraging the use of peer-reviewed journals that can provide evidence-based practice examples.  However, some employees may not have time to access EBP concepts and time to conduct research.  One strategy that I would use to support EBP at an organization is to place flyers and posters for staff to view.  Flyers and posters would be a reminder of the culture and value that EBP has in healthcare practice.  It would also allow employees to have better access to the changes the organization wants to make based on EBP. 

In NURS 6052 Wk 9 Discussion Developing a Culture of Evidence-Based Practice resources, Melynk and Fineout-Overholt explain that “a multitude of interventions are necessary, including a culture and an environment that supports and sustains EBP”(2018).    Signage and flyers can help reinforce the culture change and be a reminder for using proven techniques.   Change may not happen with flyers and posters.   A solution would be to have training that goes along with the flyers and posters such as modules or hands-on tasks.  Training can help prepare employees to implement the EBP change.

One strategy I would not use is on-site journal clubs.  Melykn and Fineout-Overholt(2018) explain, “Journal clubs provide an opportunity for clinicians to share and learn about evidence-based approaches in their work setting”(P. 565).   From my experience, employees do not want to spend more time at a place of work than they need to.  However, an online journal club would work better to allow for journaling at home and not have to worry about being available for on-site journal club gatherings.  It might be challenging to find an advanced level practitioner to be open to do on-site clubs as well.  Also limiting contact with the organization due to the high numbers of COVID patients.

 References

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Sustaining Evidence-Based Practice Through Organizational Policies and an Innovative Model. AJN American Journal of Nursing, 111(9), 57–60. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NAJ.0000405063.97774.0e

Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A Test of the ARCC© Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews on Evidence-Based Nursing, 14(1), 5–9. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12188

Evidence-based practice focus on essential elements that can help create a highly integrated environment where it is possible to attain better outcomes. The evidence-based practice focuses on a specific problem where the findings can be compared with other results previously obtained. Dissemination of evidence-based practice findings can be evaluated based on different settings, mainly where the practice will be applied.

The work of evidence-based practice (EBP) is a stringent process that requires practitioners to continuously provide evidence in support of their decision-making process and policy/practice changes. Healthcare workers may use the EBP model to initiate and implement policy changes that will improve patient care. During the procedure, practitioners must present their appeals to the lawmakers, providing evidence of why the changes happen. There are several ways of disseminating the evidence. Melnyk and Fineout-Overholt (2018) define dissemination as “the process of distributing or circulating information widely.”

Two dissemination strategies that I would be most inclined to use

The best dissemination strategies that I would consider are unit-level presentations and local dissemination (Harvey & Kitson, 2015). Unit-level dissemination is only successful, especially in ensuring where the issue has been considered to improve the underlying problem within the unit. Different units with a given setting can have a varied assessment of the operational environment. This means that there is a need to take into consideration the context under which the evidence-based practice. Therefore, ensuring that the engagement is strategic help ensure that based on the results, the intervention that is put in place is unit-based (Brownson et al., 2018). Organizations strive to implement essential aspects of improving their performance. However, evidence-based practice eliminated the uncertainty risk, which is crucial in attaining better outcomes.

Local dissemination entails significant players at the local level, which is a better aspect that helps provide a strong emphasis on institutional development (Hall & Roussel, 2016). However, it is essential to ensure that the dissemination of outcomes is done in an environment where there exist resources and technical ability to attain better results. Skills and knowledge among the population are likely to be a challenge in successfully implementing the developed practice. There is a need to manage the needs of existing stakeholders, which is essential and helps in organizational planning and service delivery. The implementation of evidence-based practice should create a profoundly transformed environment where it is easier to implement positive change. Therefore, training is crucial in empowering stakeholders to implement evidence-based practice (Brownson et al., 2018).

Least Inclined Dissemination Strategies to be used

The least inclined dissemination strategies to be used in communicating EBP are poster presentations and podium presentations. The poster presentations may not give enough information, and the display may not look engaging and exciting, thereby losing the exhibition’s aim. The podium presentation, on the other hand, may encounter a low turnout of participants. There could be poor publicity of the expression leading to low attendance.

Barriers to be Encountered and Overcoming These Barriers

The barrier that could expect from the unit level presentation is the lack of interest from staff. An example is staff resistance when a change is to be implemented that they do not like or want. One way to overcome this barrier is by getting staff involved in the presentation. For instance, they are making a member of the team one of the speakers at the exhibition. In that way, they will be very interested in their presentation. The barrier that could be encountered in using peer-reviewed journals is the lack of access to the journals. An example are journals that mandates a subscription fee, which often puts off many readers. One way to overcome this barrier is by giving such journals free access to online readers.

 References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: translating science to practice. Oxford University Press.

Hall, H. R., & Roussel, L. A. (Eds.). (2016). Evidence-based practice. Jones & Bartlett Publishers.

Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 10, “The Role of Outcomes on Evidence-based Quality Improvement and enhancing and Evaluating Practice Changes” (pp. 293-312)
• Chapter 12, “Leadership Strategies for Creating and Sustaining Evidence-based Practice Organizations” (pp. 328-343)
• Chapter 14, “Models to Guide Implementation and Sustainability of Evidence-based Practice” (pp. 378-427)

Evidence-based practice plays an immense role in contributing to optimum care outcomes in nursing practice. Nurses utilize evidence-based interventions to ensure their patients are assured to receive highest possible safety, quality, and efficiency in the care process. Nurses should be competent in disseminating evidence-based practice data to influence the profession. Therefore, the purpose of this paper is to explore the dissemination strategies that I may use in my practice and potential barriers that may be experienced in the process.

Dissemination Strategies

One of the dissemination strategies that I am most inclined to use in my practice is presenting results of my project in conferences. Often, nurses participate in scientific conferences that aim at increasing the availability of current evidence on nursing practice and healthcare. Nursing conferences provide immense opportunities to interact with other nurses and reach a wider audience with the project. It also offers the opportunity to get feedback on ways of improving the evidence-based practice project and enhancing its generalizability to different populations (Lewis et al., 2021). The impact of sharing the evidence-based practice intervention and results in a conference is significant since I can be offered an opportunity to publish it and lead similar evidence-based initiatives in nursing practice.

The second dissemination strategy that I am most inclined to use in my practice is publishing an article about the project and its outcomes. Publishing an article provides opportunities to reach the global audience and inform them about the need and significance of the project. It also informs future evidence-based practice projects in nursing (Mangold & Arring, 2019). Some of the credible publishers that I may consider to achieve this objective includes PubMed, EMBASE, and CINAHL among others. Publishing will contribute to my local, regional, and global recognition as a nurse scholar.

Least Inclined Dissemination Strategies

I am least inclined to use strategies such as forcefully implementing the evidence-based practice intervention in the organization without informing or involving the other organizational stakeholders. Accordingly, the adopters of the evidence-based intervention should be actively involved in assessing, planning, implementing, monitoring, and evaluating the need and effectiveness of the intervention (Jones, 2019; Tucker & Gallagher-Ford, 2019). Implementing the initiative without their involvement increases the risk of poor outcomes due to resistance to change and their inadequate preparedness to embrace the initiative.

Barriers

One of the barriers that I may experience in using the above dissemination strategies is time constraints in publishing the intervention. Accordingly, different publishers have requirements that must be met for the project to be published. For example, it may take a long period for the project to be approved and published, affecting its clinical significance and impact. The other challenge is the lack of adequate knowledge and skills among nurses who should adopt the evidence-based intervention. Dissemination of results in scientific conferences may not result in the direct adoption of the intervention in clinical practice. Strategies such as training nurses on the use of the intervention at the organizational level may be needed for its successful adoption (Dang et al., 2021). However, issues such as resource shortages and competing organizational needs may hinder the successful use of the intervention in nursing practice.

Conclusion

In summary, disseminating evidence-based practice project outcomes is important in nursing. I am most likely to adopt dissemination strategies such as publishing an article and presenting results in scientific conferences for my evidence-based practice project. I am least likely to forcefully translate the intervention in my workplace. I will explore anticipatory strategies to overcome barriers to disseminating the evidence-based initiative.

References

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines, Fourth Edition. Sigma Theta Tau.

Jones, S. (2019). Faculty and students find a niche in scholarship: Teaching strategies to disseminate scholarly evidence-based practice projects. ABNF Journal, 30(4), 109–112.

Lewis, C. C., Powell, B. J., Brewer, S. K., Nguyen, A. M., Schriger, S. H., Vejnoska, S. F., Walsh-Bailey, C., Aarons, G. A., Beidas, R. S., Lyon, A. R., Weiner, B., Williams, N., & Mittman, B. (2021). Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: Protocol for generating a research agenda. BMJ Open, 11(10), e053474. https://doi.org/10.1136/bmjopen-2021-053474

Mangold, K., & Arring, N. (2019). Advancing Professional Practice Through a Research and Evidence-based Practice Festival. Nurse Leader, 17(1), 59–64. https://doi.org/10.1016/j.mnl.2018.09.013

Tucker, S. J., & Gallagher-Ford, L. (2019). EBP 2.0: From Strategy to Implementation. AJN The American Journal of Nursing, 119(4), 50. https://doi.org/10.1097/01.NAJ.0000554549.01028.af

Discussion: Developing a Culture of Evidence-Based Practice

Dissemination aims to spread knowledge and related evidence-based strategies. The dissemination strategies I would most likely utilize include presentations in conferences and publications in peer-reviewed journals. Presentations in conferences professional nursing and medical associations would be ideal since I will reach a large audience comprising of target healthcare providers (Conley, 2020). During the conference presentation, I will interact with other healthcare professionals and discuss if the EBP interventions can be implemented in patient care settings. Besides, we can discuss how best to implement the EBP intervention to achieve the desired outcomes. Publication in peer-reviewed journals is preferred since I will reach a large audience, including healthcare professionals and scholars (Solano et al., 2020). The EBP information will reach any person carrying out a literature search on the specific topic.

Dissemination strategies that I would be least inclined to employ include discussing the EBP project and findings on the local radio and publishing the information in a local newspaper. I would not consider discussing the EBP on the local radio because it may not reach the target audience and interact with other healthcare providers (Brownson et al., 2018). Besides, the radio host may not be well-versed with EBP and the focus topic and is thus not an ideal platform. Publishing the EBP findings in a local newspaper will not adequately reach the target audience (Brownson et al., 2018). Most readers may not be conversant with the topic and EBP findings and thus lack interest in the publication.

Barriers to presentations in conferences include a lack of depth when the EBP is compressed into a poster or abstract. Research should be consistent, and the strict word limits imposed on conference abstracts limit a detailed explanation of the EBP methods (Conley, 2020). This can be overcome by later publishing the EBP research in a full-length paper. Potential barriers with publications in peer-reviewed journals include unethical practices by some reviewers, who may intentionally delay publication or reject the work of their competitors (Solano et al., 2020). This can be overcome by masking the authors’ identity or establishing a transparent process where the identities of the authors and reviewers are known to each other.

References

Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Research full report: getting the word out: new approaches for disseminating public health science. Journal of public health management and practice, 24(2), 102. https://doi.org/10.1097/PHH.0000000000000673

Conley, P. (2020). International dissemination of evidence. Nursing2020 Critical Care, 15(1), 45-48. https://doi.org/10.1097/01.CCN.0000612860.71342.d3

Solano, J. L., Richardson, T., Walker, J. M., Bettenhausen, J. L., Platt, M., Riss, R., … & Herrmann, L. E. (2020). Pathways to Publication in Pediatric Hospital Medicine Educational Research. Hospital Pediatrics, 10(11), 992-996. https://doi.org/10.1542/hpeds.2020-0100