Assignment: Role of EBL to Facilitate Organization Change to New Paradigm

Assignment: Role of EBL to Facilitate Organization Change to New Paradigm ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Role of EBL to Facilitate Organization Change to New Paradigm Describe how the unique role of evidence-based leadership (EBL) can facilitate an organization change to the new paradigm of EBP. Assignment: Role of EBL to Facilitate Organization Change to New Paradigm Chapter 19 describes the similarities of the EBP and evidenced-informed health policy (EIHP) processes. Provide a summary of a policy problem and formulate the policy problem into a policy PICOT question. attachment_1 attachment_2 Original Article An Integrative Review of Interventions for Enhancing Leadership in the Implementation of Evidence-­Based Nursing Tarja Välimäki, PhD, RN ? Pirjo Partanen, PhD, RN ? Arja Häggman-Laitila, PhD, RN ABSTRACT Key words evidence-based practice, administration/ management/ leadership/ organization, evidence-based nursing, research utilization, intervention research, nursing practice, policy development/ policymaking Background: The most common barriers to evidence-­based nursing (EBN) are related to nurse leadership and to organizational characteristics. Scientific evidence is needed regarding interventions that support nurse leadership. Aims: The aim was to gather, assess, and synthesize the current empirical evidence regarding interventions for enhancing nursing leadership in EBN implementation. Methods: We conducted an integrative review of interventions that enhance the roles of nurse leaders in EBN implementation using reporting guidance according to the PRISMA statement. Results: The search identified five studies, which described two intervention types: interventions improving nurse leaders’ capabilities for EBN implementation and supporting the activities for EBN implementing. The interventions focused on strategic, teamwork, and individual levels. All interventions produced positive outcomes on primary outcomes, however all not statistically significant. Linking Evidence to Action: The studies mainly had descriptive designs and short follow-­up times, so it was not possible to propose evidence-­based recommendations for effective interventions. The certainty of evidence was very low due to the study designs and the risk of bias. Structured clinical education might promote new innovations in evidence-­based leadership in nursing. Conclusions about the impact of the interventions must be drawn with caution. They might be useful for promoting the abilities of nurse leaders to implement EBN, but further studies are needed to provide more reliable recommendations. INTRODUCTION Evidence-­based health care improves healthcare quality and safety as well as patient outcomes, and it reduces costs and enhances nurses’ professional satisfaction. However, despite all these benefits, nurses and nurse leaders do not consistently implement evidence-­based practices (EBP; Melnyk, Fineout-­Overholt, Gallagher, & Kaplan, 2012). According to a recent survey study (Melnyk et al., 2016), nurse leaders’ (CNOs, CNEs) own implementation of EBP in their organizations remained relatively low. Although the CNEs and CNOs stated that their highest priorities were quality and safety, EBP was not listed as a top priority, and the budget allocations were low for implementing and sustaining evidence-­based care. According to the systematic review of Carlson and Plonczynski (2008), the most common barriers to evidence-­ based nursing (EBN) are related to the characteristics of the organization. Specifically, nurses do not have enough time to read and implement research knowledge, they lack the authority to change patient care procedures, and they lack support from physicians, managers, and other staff 424 (Melnyk et al., 2012). Assignment: Role of EBL to Facilitate Organization Change to New Paradigm One recently identified barrier to EBP is resistance to EBP by nurse leaders and managers (Melnyk et al., 2012). According to systematic reviews including studies published approximately a decade ago (1995–2007) in various target groups, there were few reports on the roles of nurse leaders or on interventions aiming to support nurse leaders and healthcare infrastructure (Flodgren, Roja-­ Reyes, Cole, & Foxcroft, 2012; Gifford, Davies, Edwards, Griffin, & Lybanon, 2007; Halm, 2010; Sandström, Borglin, Nilsson, & Willman, 2011). Taken together, these reviews emphasize that the role of leadership is poorly defined in EBP leadership (Sandström et al., 2011), with only two studies explicitly focusing on leadership-­related EBP behaviors (Gifford et al., 2007; Halm, 2010). Leadership is defined according to Gifford et al. (2007) as multidimensional process of influence to enable nurses to use research evidence in clinical practice. Melnyk et al. (2012) pointed out that compared to nurses in non-­magnet institutions, nurses in magnet institutions report more consistent implementation of EBP by their healthcare system, greater availability of EBP experts, Worldviews on Evidence-Based Nursing, 2018; 15:6, 424–431. © 2018 Sigma Theta Tau International Original Article an organizational culture that is more supportive of EBP, more routine EBP educational offerings, and more routine recognition of EBP efforts. Although studies suggest that nurse leaders should play a key role in EBN (Dale et al., 2015; Higuchi, Downey, Davies, Bajnok, & Waggott, 2012; Matthew-­Maich, Ploeg, Jack, & Dobbins, 2012), the nature of this role has not yet been fully identified (Wilkinson, Nutley, & Davies, 2011). Although accumulating interest on the implementation of EBP, we did not find any recent reviews reporting on interventions aiming to enhance nursing leadership in the implementation of EBP. The aim of this integrative review was to gather, assess, and synthesize current empirical evidence regarding interventions that enhance nursing leadership in the implementation of EBP. Our specific research questions for this review were as follows: (a) What kinds of interventions have been used to improve nurse leadership in the implementation of EBN? (b) What outcomes have been achieved using these interventions? THE REVIEW Design The design involved an integrative review (Whittemore & Knafl, 2005) using reporting guidance according to the PRISMA statement that covers evidence-­based minimum set of items for reporting particularly evaluations of interventions (Moher, Liberates, Tetzlaff, & Altman, 2009). Search Terms Four databases that were searched are as follows: the Cochrane Library, CINAHL, PubMed MEDLINE, and SCOPUS. The search was limited to papers published from January 1, 2008, to August 29, 2017. Table S1 describes the search terms and the search results. An additional manual search was conducted on reference lists from retrieved articles and journals. Data search was completed in August 2017. Assignment: Role of EBL to Facilitate Organization Change to New Paradigm Eligibility Criteria To be included in the review, the full text of the study had to show that the study met the following inclusion criteria: (a) The study describes an intervention for implementation of EBP or EBN; (b) the study describes nurse leaders as a target group; (c) the study was an empirical study; and (d) the study had no methodological restrictions (Table S2). Search Outcome The searches identified 989 studies that were reviewed by three authors based on the criteria. The selection process is described in Figure 1. Five articles were included in the final analysis (Table S3). Publication Quality Appraisal Publication quality (Table S3) was evaluated using the criteria presented by Gifford et al. (2007), and the studies were ranked as excellent (2 points), as having some limitations Worldviews on Evidence-Based Nursing, 2018; 15:6, 424–431. © 2018 Sigma Theta Tau International (1 point), or as having many limitations (0 points). When the study had methodological triangulation, the study quality was graded based on the predominant method in the study. Surveys were evaluated with six criteria. Studies receiving 9–12 points were evaluated as excellent, 5–8 points indicated some limitations, and 0–4 points meant many limitations. Qualitative studies were evaluated with 11 criteria. Studies receiving 16–22 points were evaluated as excellent, 9–15 points as having some limitations, and 0–8 points as containing many limitations. Studies were evaluated as excellent (Hauck, Winsett, & Kuric, 2013; Wallen et al., 2010) or with some limitations (Gifford, Davies, Tourangeau, & Lefebre, 2011; Gifford et al., 2013; Kvist, Tähkä, Ruotsalainen, & Tervo-­Heikkinen, 2014). Assessment of Bias and Certainty of Evidence The risk of bias was evaluated in three studies (Gifford et al., 2011; Hauck et al., 2013; Wallen et al., 2010) according to the study designs using Cochrane Risk of Bias Tool (Effective Practice and Organization of Care, 2017). The authors made final decisions on the level of bias together. One study (Gifford et al., 2013) was excluded from the assessment because it was a qualitative one and one (Kvist et al., 2014) because it did not report statistical differences between measurements at two time points. One randomized controlled trial (RCT) was evaluated with nine criteria, and two interrupted time series (ITS) studies with seven criteria. There was very serious and mixed or unclear risk of bias in all included studies. In the RCT, the baseline measurements were not conducted. In two ITS studies, sample sizes were sufficient to the conducted analysis, but the interventions were not independent of other changes in time. The Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of evidence of the intervention outcomes. The criteria were as follows: study design, risk of bias, indirectness, imprecision, and publication quality. Scores ranged between ?1 and +1 and were added together to total score. Assignment: Role of EBL to Facilitate Organization Change to New Paradigm The score 1 is the lowest, and 4 the highest (Cochrane Effective Practice and Organisation of Care, 2017; Table 1). Data Abstraction and Narrative Summaries All relevant articles were reviewed, and the data were extracted from the empirical studies into a descriptive matrix of the full texts (Table S3). Due to the divergent methodologies of the included studies, a narrative summary was used to describe the content of the studies at the analysis stage (Whittemore & Knafl, 2005). RESULTS Characteristics of the Included Studies The studies were published between 2010 and 2014. Two were conducted in the United States, one in Finland, and two in Canada. The majority of the studies were conducted in hospital settings, whereas one project, reported in two papers, was conducted in a home and community 425 Identification Nurse Leadership Interventions in EBN Records identified through database searches (n = 989) Screening After duplications removed Abstracts excluded (n = 78) Abstracts screened for inclusion (n = 152) Full-text articles excluded based on criteria (n = 67) Eligibility Full-text articles assessed for eligibility (n = 74) Full-text articles included (n = 8) Included Studies included by manual search Full-text articles excluded based on poor quality (n = 1) or that did not meet inclusion criteria (n = 2) Studies included in analysis) (n = 5) Figure 1. PRISMA flow diagram of the study selection process. [Correction added on October 26, 2018 after first online publication October 15, 2018. In Figure 1, Full Text articles was updated from n=7 to n=8.] [Colour figure can be viewed at] Table 1. Assessment of the Certainty of Evidence (GRADE) No. of studies Design (scores of design) Risk of bias Inconsistency Indirectness Imprecision Publication bias Certainty rating Interventions to support activities of nurse leaders in implementing EB Outcomes: In one study, a primary outcome not set for the intervention (ITS). Leadership and management behaviors (RCT). Implementation of EBP in a clinical research-­intensive environment (ITS) 3 RCT (4) ITS (2) 2 very serious risk of bias: unclear/low risk of bias in RCT. Mixed risk of bias in one ITS 1 serious risk of bias. Inconsistency between the content of the interventions measurements and primary outcomes No serious, follow-­up periods from 12 weeks up to 2 years Sample sizes Excellent in from 99 to 469 two ITS, in two ITS. No some confidence limitations intervals in RCT available in two study (RCT, ITS). Effect size for post-­intervention scores in one ITS Very low (1) Note. RCT = randomized controlled trial; ITS = interrupted time series. 426 Worldviews on Evidence-Based Nursing, 2018; 15:6, 424–431. © 2018 Sigma Theta Tau International Original Article healthcare organization. The study designs were descriptive, one had an experimental design, and two had quasi-­ experimental designs without control groups (Table S3). The sample sizes in the evaluation phase were small, varying from 13 to 159 participants. The interventions were evaluated using questionnaire surveys. Four of the studies used validated scales (Table S4). In addition, qualitative evaluation data were gathered by focus group discussions, interviews, telephone interviews, and open questions in a survey.Assignment: Role of EBL to Facilitate Organization Change to New Paradigm Interventions That Aimed to Improve Nurse Leaders’ Capabilities for EBN Implementation A 9-­month-­long evidence-based nursing leadership (EBNL) training intervention was used in one study (Kvist et al., 2014). The study was a longitudinal descriptive intervention study with pre-­and post-­intervention surveys. The intervention consisted of EBNL lectures given by academic and service sector experts and researchers, and small working groups were given developmental assignments. The intervention used a Web-­based learning environment as well as advanced mentors that supervised the clinical group assignment (Table S3). The intervention outcome in this study had two goals: first, to help nurse leaders identify their roles as leaders in EBP; and second, to increase the nurse leaders’ knowledge of EBL and EBP, to help them promote EBL and EBP in their units, and to train the nurse leaders to utilize research information. The majority of the nurse leaders (59%) agreed that the EBL training helped them understand that healthcare decisions can be justified with research knowledge. Further, the participants reported that the intervention improved their development as EB leaders (91% agreed or totally agreed). After the training, the nurse leaders reported greater recognition of their responsibility to develop EPB (88%– 100% agreement for each item) and reported that they had improved their skills in terms of supporting staff, setting an example in their working unit, and developing collaboration (24%–27% totally agreed). The nurse leaders understood the role that they play in changing the culture and implementing EPB, although acknowledging it takes time and passion to change their leadership style. The strength of evidence was weak due to the study design. Interventions That Were Conducted to Support the Activities of Nurse Leaders in Implementing EBN Four studies had interventions that targeted the activities of nurse managers or leaders as well as various types of nurses, and clinical educators who had leadership roles. The interventions covered both group-­based methods and methods for individuals. Conducted interventions focused on different levels on organizations: strategic level (Hauck et al., 2013), teamwork (Gifford et al., 2011, 2013), and mentorship (Wallen et al., 2010). Worldviews on Evidence-Based Nursing, 2018; 15:6, 424–431. © 2018 Sigma Theta Tau International In the study by Hauck et al. (2013), a prospective descriptive comparative design was used to assess nurses’ beliefs regarding the importance of EBP, the frequency of EBP use, and the perception of organization readiness for EBP (Table S3). The Nursing Research/EBP Committee developed and directed a strategic plan that addressed EBP enculturation based on the literature. The actions of nurse leaders to promote EBP included elements of strategic leadership as well as steps to enable education and collaboration. The outcomes were set a priori to meet seven strategy goals. The study reported the achievement of targets that were set for the strategic plan and the comparisons of survey results according to the job or role of the participants. The survey results indicated that the score for having a culture that supported EBP increased significantly from baseline mean score 3.10 (0.96) to 3.70 (0.77); F(1.896) = 128.1; p < .001. There was a statistically significant difference for the total group scores during the follow-­up.Assignment: Role of EBL to Facilitate Organization Change to New Paradigm The mean score increased from 3.61 (1.49) to 6.40 (1.6); F(1.640) = 521.4; p < .001 (a score of 1 indicated not ready for action, and a score of 5 indicated being ready for action). The strategic plan was successful in that it created a culture that supported EBP, and it highlighted that it is important to conduct a careful evaluation of leadership at the first step of the intervention. There is insufficient evidence regarding the effect of enculturation of EBP. The results of Hauck et al. (2013) showed only a small improvement in the director or leader nurse’s group for beliefs in the importance of EBP, because the baseline scores were high. The authors suggest that belief in the importance of EBP, the skills to implement EBP, and the confidence in one’s ability to implement EBP were therefore not affected by the intervention. As a group, the respondents showed a 7% increase in achieving the strategic plan target. However, actual EBP implementation was not improved. Gifford et al. (2011, 2013) described a systematically developed leadership-­focused intervention (Table S3). The aim of the leadership intervention was to facilitate nurses’ use of guideline recommendations for diabetic foot ulcers. First, the pilot study (Gifford et al., 2013) tested the feasibility of conducting a cluster randomized controlled trial to evaluate the influence of a leadership intervention in nurses’ use of guideline recommendations in home care settings. However, leadership and management behaviors were assessed through interviews. Compared to the control group, the experimental group reported more relations-­ oriented leadership behavior and more use of feedback, audit, and reminders as leadership strategies. The conducted intervention (Gifford et al., 2011) validated the importance of teamwork as well as the role of each nurse leader in supporting an EBN implementation. The intervention was rated using a 4-­ point scale that ranged from 1 (not at all relevant or useful) to 4 (extremely useful and relevant). Identification of target indicators had the highest 427 Nurse Leadership Interventions in EBN mean score, 3.7, and the following each had mean scores of 3.5: development of a team leadership action, discussions of barriers and leadership support, and charting audit findings about research or practice gaps. Thus, it seems to be critical to have leaders that support the implementation of EBP guidelines through leadership strategies. Three months after the intervention, all participants perceived that the intervention had influenced them as leaders that implement EBP guidelines (Gifford et al., 2011). Wallen et al.’s (2010) study reported a program to enhance system-­wide EBP implementation and sustainability (Table S3). Further intervention consisted of a structured multifaceted mentorship program that utilized a quasi-­ experimental mixed-­ methods design. The intervention included workshops, lectures, and tutorials. Pre-­and post-­ intervention surveys were completed by participants in the EBP intervention group (n = 94 vs. n = 58, respectively) and comparison group (n = 65 vs. n = 41, respectively). There was a greater increase in the intervention group (77.2–89.5 points) than in the comparison group in perceived organizational culture and readiness for EBP (80.9–82.9 points; F = 5.09; p = .025). The combined EBP culture and readiness score increased in the entire sample (78.7–86.9; F = 9.55; p = .002). In terms of the EBP belief scores, the mentorship program group showed an increase of 7.4 points, whereas the control group showed an increase of 0.2 points (F = 5.09; p = .025) In addition, the qualitative findings suggested the importance of leadership support of a culture of EBP. All interventions produced positive outcomes on primary outcomes. The primary outcomes varied across studies, and different outcom … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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