Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion

Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion I’m working on a Health & Medical exercise and need support. I have uploaded the resources one of them I couldn’t find to download here’s the info if you can find it cool if not no worries Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion 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) As your EBP skills grow, you may be called upon to share your expertise with others. While EBP practice is often conducted with unique outcomes in mind, EBP practitioners who share their results can both add to the general body of knowledge and serve as an advocate for the application of EBP. In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry. To Prepare: Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP. This may include: unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals. Reflect on which type of dissemination strategy you might use to communicate EBP. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Module06_Week10_Discussion_Rubric MAIN POSTING — Excellent 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources.Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Good 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth.Supported by at least three credible sources.Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Fair 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed.Is somewhat lacking reflection and critical analysis and synthesis.Somewhat represents knowledge gained from the course readings for the module.Post is cited with two credible sources.Written somewhat concisely; may contain more than two spelling or grammatical errors.Contains some APA formatting errors. Poor 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria.Lacks reflection and critical analysis and synthesis.Does not represent knowledge gained from the course readings for the module.Contains only one or no credible sources.Not written clearly or concisely.Contains more than two spelling or grammatical errors.Does not adhere to current APA manual writing rules and style. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion melnyktestofarcc.pdf melnyk00000446_201109000_00027.pdf melnyk00006216_201204000_00006.pdf rpnewhousebp.pdf evidencebasedpracticestepbystep31.pdf Original Article C Model Improves A Test of the ARCC Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FAANP, FNAP, FAAN • Ellen Fineout-Overholt, RN, PhD, FNAP, FAAN • Martha Giggleman, RN, DNP, NEA-BC • Katie Choy, RN, DNP, CNS, NEA-BC ABSTRACT Keywords ARCC, evidence-based practice, organizational culture, patient outcomes Background: Although several models of evidence-based practice (EBP) exist, there is a paucity of studies that have been conducted to evaluate their implementation in healthcare settings. Aim: The purpose of this study was to examine the impact of the Advancing Research and Clinical practice through close Collaboration (ARCC) Model on organizational culture, clinicians’ EBP beliefs and EBP implementation, and patient outcomes at one healthcare system in the western United States. Design: A pre-test, post-test longitudinal pre-experimental study was conducted with follow-up immediately following full implementation of the ARCC Model. Setting and Sample: The study was conducted at a 341-bed acute care hospital in the western region of the United States. The sample consisted of 58 interprofessional healthcare professionals. Methods: The ARCC Model was implemented in a sequential format over 12 months with the key strategy of preparing a critical mass of EBP mentors for the healthcare system. Healthcare professionals’ EBP beliefs, EBP implementation, and organizational culture were measured with valid and reliable instruments. Patient outcomes were collected in aggregate from the hospital’s medical records. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Results: Findings indicated significant increases in clinicians’ EBP beliefs and EBP implementation along with positive movement toward an organizational EBP culture. Study findings also indicated substantial improvements in several patient outcomes. Linking Evidence to Action: Implementation of the ARCC Model in healthcare systems can enhance clinicians’ beliefs and implementation of evidence-based care, improve patient outcomes, and move organizational culture toward EBP. INTRODUCTION AND BACKGROUND It is well known that evidence-based practice (EBP) improves healthcare quality, safety, and patient outcomes as well as fosters clinicians’ active engagement in their practices. Nurses who use an evidence-based approach to care and practice in cultures that support EBP are more empowered as they are able to make a difference in the care of their patients. Although the positive impact of EBP has been demonstrated through multiple studies, major barriers exist that prevent EBP from becoming the standard of care throughout the world. These barriers include (a) inadequate EBP knowledge and skills of clinicians, (b) misperceptions that EBP takes too much time, (c) organizational culture and politics, (d) lack of support from nurse leaders and managers, and (e) inadequate resources and investment in EBP (Jun, Kovner, & Stimpfel, 2016; Melnyk et al., 2016; Melnyk, Fineout-Overholt, Gallagher-Ford, & KaWorldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. C 2016 Sigma Theta Tau International plan, 2012). Aside from equipping clinicians with the knowledge and skills needed to attain the EBP competencies and consistently implement evidence-based care, findings from studies have indicated that clinician access to EBP mentors can play a key role in their implementation of EBP and the development of organizational cultures that support the delivery of evidencebased care (Fineout-Overholt & Melnyk, 2015; Melnyk, 2007). Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Although several EBP models exist, most are process models that outline the steps of EBP or the sequence of conducting an EBP project. EBP process models include the Johns Hopkins Nursing Evidence-Based Practice Model (Dearholt & Dang, 2012), the Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler et al., 2001), the Model for Evidence-Based Practice Change (Rosswurm & Larabee, 1999), and the ACE Star Model of Knowledge Transformation (Stevens, 2012). Unlike EBP process models, the Advancing Research and 5 C Model Improves Implementation of Evidence-Based Practice A Test of the ARCC Figure 1. The Advancing Research and Clinical Practice Through Close Collaboration (ARCC) Model. Clinical practice through close Collaboration (ARCC) Model is a system-wide model to advance and sustain EBP in healthcare systems (see Figure 1). The first step in implementing the ARCC Model is an organizational assessment of the current EBP culture in order to identify strengths and major barriers to EBP in the healthcare system so that strategies can be implemented to remove those barriers. At the core of the ARCC Model is a critical mass of EBP mentors who, through intentional strategic initiatives, assist point of care clinicians in enhancing their beliefs about the value of EBP and their confidence in implementing it. As a result, ARCC contends that heightened EBP beliefs in clinicians result in greater implementation of evidence-based care, which ultimately leads to higher job satisfaction, less staff turnover, and improved patient outcomes. Several studies now support the relationships among key constructs in the ARCC Model (Levin, Fineout-Overholt, Melnyk, Barnes, & Vetter, 2011; Melnyk, 2012; Melnyk & Fineout-Overholt, 2002; Melnyk et al., 2004; Melnyk, Fineout-Overholt, & Mays, 2008; Melnyk, FineoutOverholt, Giggleman, & Cruz, 2010; Wallen et al., 2010). DESIGN A pre-test, post-test longitudinal pre-experimental study was conducted with follow-up immediately following full implementation of the ARCC Model.Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Institutional Review Board approval was obtained from the authors’ institution as well as the organization’s research subject review board. SETTING AND SAMPLE This study was conducted at Washington Hospital Healthcare System, a 341-bed acute care hospital in the San Francisco bay area. The sample consisted of 58 interprofessional healthcare professionals, with complete follow-up data for 45 participants. Participants were point of care nurses, administrators, nurse managers, clinical nurse specialists, respiratory therapists, occupational therapists, physical therapists, dieticians, social workers, and pharmacists. Although physician champions participated in the projects, they were not part of the data collection. Only the project teams participated in data collection. METHODS AIM The purpose of this study was to examine the impact of the ARCC Model on organizational culture, clinicians’ EBP beliefs and EBP implementation, and patient outcomes at one healthcare system in the western region of the United States. 6 The ARCC Model was implemented in a sequential format over 12 months with the key strategy of preparing a critical mass of EBP mentors for the healthcare system. Intensive EBP workshops were first provided to the 58 participants in order to enhance their knowledge and skills in the seven steps of Worldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. C 2016 Sigma Theta Tau International Original Article Table 1. Examples of PICOT Questions Formulated by the EBP Teams r r In ventilated intensive care unit patients (P), how does early ambulation (I) compared to routinely scheduled ambulation (C) affect length of stay and episodes of ventilator associated pneumonia while in the intensive care unit (T) In congestive heart failure patients (P), how does comprehensive pre-discharge education (I) compared to standard pre-discharge education (C), affect readmission rates to the hospital (O)? EBP. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion In addition, content and skills building in the workshops focused on how to facilitate individual behavior change of clinicians to implement EBP and how to facilitate an EBP organizational culture. The 58 participants were divided into working teams of six to eight members who were to collaborate on an EBP change project to improve patient outcomes within the hospital. Each team was then charged with formulating a PICOT (Patient population, Intervention or Issue of interest, Comparison intervention or issue, Outcome, and Time for the intervention to achieve the outcome if relevant) question about an important clinical issue, systematically searching for the best evidence, and critically appraising and synthesizing the evidence culminating in a recommendation for practice. See Table 1 for examples of PICOT questions developed by the teams. Strategic plans were then developed by the interprofessional EBP mentor teams to implement and evaluate the impact of the EBP changes on clinical outcomes within their organization. After implementation and evaluation of the practice changes were completed, the final step for the teams was to submit their projects for presentation at local, regional, or national conferences to disseminate their successes to others within the healthcare community. dence to change my clinical practice, (c) evaluated the outcomes of a practice change, and (d) shared the outcome data collected with colleagues. The EBPI has established face, content, and construct validity as well as internal consistency reliabilities greater than .85 across multiple studies (Melnyk et al., 2008). The Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP) measured the organization’s culture and its readiness for system-wide EBP (Fineout-Overholt & Melnyk, 2006). Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion This instrument contains 26 Likert scale items that identify a description of the existing support in the current culture for EBP, which offers insight into the strengths and opportunities for fostering evidence-based care within a healthcare system. The OCRSIEP scale has established face and content validity along with excellent internal consistency reliability of greater than .85 across multiple samples (Melnyk & Fineout-Overholt, 2015). Examples of items on the OCRSIEP include the following: (a) To what extent is EBP clearly described as central to the mission and philosophy of your institution? (b) To what extent do you believe that EBP is practiced in your organization? And (c) To what extent is the nursing staff with whom you work committed to EBP? Patient Outcomes Aggregate data were gathered by the teams, including data from the hospital’s medical records (e.g., number of cases of ventilator associated pneumonia, hospital readmission rates) before and after implementation of the ARCC Model to evaluate relevant patient outcomes as results of the EBP projects. Analyses T tests and effect sizes were calculated for study variables to evaluate pre-to-post differences. A p value of .05 was set for statistical significance. OUTCOMES Study variables were measured with the following valid and reliable instruments. The Evidence-Based Practice Beliefs (EBPB) Scale Melnyk & Fineout-Overholt, 2003a) measured clinicians’ beliefs about EBP and their ability to implement it. The 16-item Likert scale has established face, content, and construct validity with internal consistency reliabilities greater than .85 across multiple studies (Melnyk et al., 2008). Responses on the scale range from 1 (strongly disagree) to 5 (strongly agree). Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion Examples of items on the scale include (a) I am clear about the steps in EBP, (b) I am sure that I can implement EBP, and (c) I am sure that evidence-based guidelines can improve care. The Evidence-Based Practice Implementation (EBPI) Scale measured delivery of evidence-based care (Melnyk & FineoutOverholt, 2003b). Participants respond to each of the 18 Likert scale items on the EBPI by answering how often in the last eight weeks they have performed certain EBP activities, such as (a) generated a PICOT question about my practice, (b) used eviWorldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. C 2016 Sigma Theta Tau International RESULTS Findings indicated that the clinicians’ EBP beliefs, EBP implementation, and movement of organizational culture toward EBP significantly increased over the 12-month project. Specifically, clinicians’ EBP beliefs (n = 45) increased significantly from baseline (M = 60.7, SD = 7.6) to follow-up (M = 64.9, SD = 6.7; t = 4.2; p = .00; effect size = .62, which is a medium to large positive effect for ARCC). EBP implementation also significantly increased from baseline (M = 17.8, SD = 10.3) to follow-up (M = 51.9, SD = 16.8; t = 12.9; p = .00; effect size = 2.3, indicating a large positive effect for ARCC). In addition, organizational culture and readiness for EBP increased significantly from baseline (M = 80.9; SD = 90.8) to follow-up (M = 90.8; SD = 14.7; t = 3.9; p = .00; effect size = .70, which is a medium to large positive effect for ARCC). In addition, as a result of implementing the ARCC Model, evidence-based interventions improved key patient outcomes (see Table 2). 7 C Model Improves Implementation of Evidence-Based Practice A Test of the ARCC Table 2. Project Outcomes From Implementation of the EBP Changes r r r r r r Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion A practice change to early ambulation in the ICU led to a 2.7 reduction in ventilator days (11.6–8.9) and no ventilator associated pneumonia. With the implementation of a pressure ulcer prevention nursing standardized procedure on a medical-surgical unit, the acquired pressure ulcer rate was significantly decreased from 6.07% to 0.62% 1 year later. Comprehensive education of congestive heart failure patients led to a 14.7% reduction in hospital readmissions. After implementation of family centered care on the pediatric unit, 75% of parents perceived the overall quality of care as excellent compared to 22% pre-implementation. The percentage of mothers not supplementing their breast milk with formula increased from 61.7% to 71.1% after the evidence-based baby friendly hospital initiative was implemented. After implementation of a nurse-initiated pain protocol in the emergency room (ER), wait time for pain medication decreased from 46 minutes to 13 minutes and length of stay in the ER also decreased from 120 minutes to 91 minutes. DISCUSSION Findings support the positive impact of implementing the ARCC Model on clinicians’ EBP beliefs and a dramatic increase in EBP implementation in those who participated in the project. Organizational culture at the hospital shifted greatly toward system-wide EBP. Most important, as a result of implementing ARCC, there were multiple improvements in patient outcomes. The establishment of a cadre of EBP mentors is central to building an organizational culture of EBP and implementing evidence-based care. The EBP mentors in this study garnered the knowledge and skills needed to successfully implement and evaluate EBP changes within the hospital as well as to work with their colleagues in creating an EBP culture in which to deliver high-quality evidence-based care. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion These findings affirm that culture eats strategy and assists clinicians in making EBP the social norm within a system (Melnyk, 2016b). Without a culture and environment that supports EBP, high-quality evidence-based care will not sustain (Melnyk, 2016a). Numerous healthcare systems and hospitals throughout the United States and globe have implemented the ARCC Model in their efforts to build and sustain an EBP culture and environment in their organizations. As a part of building this culture, position descriptions have been created or changed to include responsibilities as an EBP mentor. For example, at The Ohio State University Wexner Medical Center, the primary responsibility of the clinical nurse specialists throughout the healthcare system is to serve as EBP mentors for point of care staff in improving patient outcomes. Part of this role is ensuring 8 compliance with the EBP competencies for advanced practice nurses (Melnyk, Gallagher-Ford, & Fineout-Overholt, 2016; Melnyk, Gallagher-Ford, Long & Fineout-Overholt, 2015). Research is needed to further confirm the advantages of using particular EBP models in real-world practice settings, including how implementation of these models impact both clinician, leader and patient outcomes (Dang et al., 2015). Comparative effectiveness studies that evaluate the benefits of individual models as well as combining models also are needed. Those hospitals and systems who use an EBP model to guide implementation of evidence-based care should document their experiences and outcomes in order to better understand the model’s usefulness in facilitating EBP and share this important information with others who might use the model (Graham, Tetroe, & KT Theories Research Group, 2007). Return on investment by including cost outcomes also should be evaluated. WVN LINKING EVIDENCE TO ACTION r The ARCC Model is an evidence-based systemwide model for advancing the implementation and sustainability of EBP. Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion r A key strategy in the ARCC model is the development of a critical mass of EBP mentors who assist point of care clinicians in the consistent implementation of evidence-based care. r Use of ARCC EBP mentors enhances the EBP beliefs and EBP implementation of clinicians and strengthens the EBP culture of an organization. r An organizational culture of EBP is central to supporting sustainable high quality evidence-based care. r Implementation of the ARCC Model can substantially improve patient outcomes. Author information Bernadette Mazurek Melnyk, Associate Vice President for Health Promotion, University Chief Wellness Officer, Dean and Professor, College of Nursing, Professor of Pediatrics & Psychiatry, and College of Medicine, The Ohio State University, Columbus, Ohio; Ellen Fineout-Overholt, Mary Coulter Dowdy Distinguished Professor of Nursing, College of Nursing & Health Sciences University of Texas at Tyler, Tyler, Texas; Martha Giggleman, Healthcare Consultant & Advocate Livermore, California; Katie Choy, Senior Director, Nursing Practice and Education, Washington Hospital Healthcare System, Fremont, California Worldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. C 2016 Sigma Theta Tau International Original Article Address correspondence to Dr. Bernadette Mazurek Melnyk,Capella University NURS 6052 Developing a Culture of Evidence Based Practice Discussion The Ohio State University, 145 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210; [email protected] Melnyk, B. M., & Fineout-Overholt, E. (2002). Putting research into practice. Reflections on Nursing Leadership, 28(2), 22–25. Accepted 16 September 2016 C 2017, Sigma Theta Tau International Copyright Melnyk, B. M., & Fineout-Overholt, E. (2003b). Evidence-based practice implementation scale (3rd ed.). Gilbert, AZ: ARCC Publishing. References Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Lippincott, Williams & Wilkins. Dang, D., Melnyk, B. M., Fineout-Overholt, E., Ciliska, D., DiCenso, A., Cullen, L., . . . & Stevens, R. K. (2015). Models to guide implementation and sustainability of evidence-based practice. In B. M. Melnyk & E. Fineout-Overholt (Eds.) Evidence-based practice in nursing & healthcare. A guide to best practice (3rd ed., pp. 274–315). Philadelphia, PA: Wolters Kluwer. Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidencebased practice model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Fineout-Overholt, E., & Melnyk, B. M. (2015). ARCC evidencebased practice mentors: The key to sustaining evidence-based practice. In B. M. Melnyk & E. Fineout-Overholt (Eds.) Evidencebased practice in nursing & healthcare. A guide to best practice (3rd ed., pp. 376–385). Philadelphia, PA: Wolters Kluwer. Fineout-Overholt, E., & Melnyk, B. M. (2006). Organizational culture and readiness scale for system-wide integration of evidence-based practice. Gilbert, AZ: ARCC, llc. Graham, I. D., & Tetroe, J. & the KT Theories Research Group. (2007). Some theoretical underpinnings of knowledge translation. Academic Emergency Medicine, 14(11), 936–941. Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and f … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10