Evidence-Based Practice Change Process

Evidence-Based Practice Change Process

Discovery of the Practice Issue

Advocating for a change in various nursing practices is sometimes met with opposition and may require a lot of assessments and planning efforts. The nursing officer who is driving for the change needs to be well known and involves a lot of evidence to support the change. Examples of evidence include getting information from recommended guidelines such as CDC. Therefore, the recommendation for the change described is based on the evidence summary. An Action Plan must be drafted to carry information and relays it to the staff, should take data worksheet, which coordinates ongoing weekly updates and educates the staff.

One of the practice issues that affect the process of care delivery from the nurses is transitioning of care between different patients and also changing from one nursing officer to the other. Mitchell et al. (2018) acknowledge that the transition of care is likely to increase the risk of infection and also tends to interfere with the privacy of the patient, which is crucial in care provision. When providing nursing care development of evidence-based practice can be fueled by increasing professional demand for accountability, especially when shifting from one patient to another or during a change in shifts.

Evidence Supporting the Change

Transitioning is vital when dealing with immunocompromised patients and another patient whose immunity is at higher risk of contracting infections example, the elderly and infants below five years of age. Below is a PICOT model relevant to a neonatal nurse working in the Neonatal Intensive Care Unit (NICU); P- Among the neonates in the neonatal intensive care unit and newborn Unit. I- (Intervention) infection transmission control of neonates under the skin to skin contact care (kangaroo mother care) in the neonatal intensive care unit compared with performing it elsewhere. C- Comparison of health between those receiving care elsewhere in the institution, for example, in the newborn Unit. O- Targeted outcome to reduce transmission of infections to infants through transitions of care. T- Timeframe would possibly be the length of stay at the neonatal intensive care unit most probably for three months.

Findings and Evidence-Based Solutions

In highly contagious neonatal skin infection, without any intervention like sensitization, there were higher incidences of transmission of disease from one neonate to another. During the total duration of research, a total of 5 infants contacted the skin infection, which approximates to about 8%. With sensitization and educating the mother and all healthcare professionals in contact with the neonates, the number subsided, thus indicating a positive change. Other interventions include setting rules in the NICU, which provides for proper and routine hand washing between patients, investing in increasing the ratio of nurses to infants to enable a nurse to care for a manageable number of infants (Mitchell et al., 2018). This reduces shifting too many neonates, thus lowering the spread of risk.

Action Plan

An action plan must be set up to ensure the right procedures and standards are upheld in mitigating the spread of infections among the babies in the NICU. Butler Hall & Copnell (2016) notes that other than setting up regulations, it is essential to create awareness by ensuring that intervention plans are relayed to all staff and students. Activities surrounding this process includes educating the nurses and nursing student on the importance of handwashing and sanitizing between patients. Other than that, one can liaise with the In-Charge nurse and the management to increase the number of staff to attain a 1:3 ratio of nurses to patients in NICU. I intend to use printed papers and PowerPoint presentations to convey the plan to the stakeholders.

The most important is the identification of stakeholders and team member roles in the clinical area. These include the physician offering care in the neonatal intensive care unit, a member of the finance department who can liaise with the financial department to allocate funds for the project. The unit manager is an integral part of the plan. She has the mandate to call a meeting and can provide the supplies required for the project. It is also essential to include a member of the nursing student’s body under that specific clinical rotation. The student representative has the role of ensuring the students are aware of the processes and newly set rules that govern the department (Butler Hall & Copnell, 2016). My part is acting as the project champion through educating and advocating the need for practice change to ensure zero spread of contact infections among the neonates in the NICU.

Implementation

Before initiating any action, there is a need to get permission from relevant authorities. First, a printed copy is presented to the NICU Unit in Charge. The charge nurse invites opinions from the majority in the Unit. A meeting is held to estimate the financial input to output ratio. If benefits outdo the contributions, the change project is approved, and then a copy of the same is sent to the departmental head. The plan of education is laid to the staff by the change champion and the charge nurse during the daily briefing meeting after handing over the shift (Stevens, 2013). After approval of the project, the Unit’s financial department allocates the necessary fund to cater to supplies. In this case, more hand sanitizers are added to supplies and also electricity bills for PowerPoint presentations.

The long term plan of increasing the number of staff may take a relatively long time to be implemented; thus it would be appropriate to work with available resources. Educating the nursing staff may face challenges such as arrival time and change of shifts. After liaising with the Unit in Charge nurse, an agreement was put across that PowerPoint presentation is to be conducted every day for five minutes a day in each shift during handing over of the shifts (Brownson, Colditz, & Proctor, 2017). The implementation timeline that connects the day and night shift would most appropriately be at 7:30 am to 7:45 daily for a month.

During the time set, the first five minutes involve the PowerPoint presentation of information. This includes diagrammatic representations, flow charts, and short demonstration videos of procedures, as stated in the institutional procedure manual. A short talk to sensitize and drive information home is also present. A change can be measured by gauging if the desired outcome has been met. For instance, in my PICOT desired result, the potential interventions brought a shift in transitional behavior between neonates. This can be proven by a radical reduction in the number of children acquiring nosocomial infection in the NICU. Increasing the number of staff per patient is also evident. The proposed interventions are now put under hospital guidelines and practices.

Evaluation

The change of project success can be evaluated using the desired outcome goal outcome expected from the changes that have been met. Discuss with the Change nurse how the difference can be put down in the Unit’s norms and culture. Staff feedback is essential in gauging the progressive change duration. With the help of the chief nurse can share the change idea with the other units in neonatal health department (Stevens, 2013). Programs for curriculum preparation in the health profession will cater for curriculum revision to focus on this evidence-based quality improvement project.

References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2017). Dissemination and implementation research in health: translating science to practice. Oxford University Press.

Butler, A., Hall, H., & Copnell, B. (2016). A guide to writing a qualitative systematic review protocol to enhance evidence‐based practice in nursing and health care. Worldviews on Evidence‐Based Nursing, 13(3), 241-249

Mitchell, S. E., Laurens, V., Weigel, G. M., Hirschman, K. B., Scott, A. M., Nguyen, H. Q.. & Gass, B. (2018). Care transitions from patient and caregiver perspectives. The Annals of Family Medicine, 16(3), 225-231.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2).