College Week 7 Essentials of EBP Discussion

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College Week 7 Essentials of EBP Discussion

College Week 7 Essentials of EBP Discussion

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.

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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.

BY DAY 3 OF WEEK 9

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.College Week 7 Essentials of EBP Discussion

& March 2011 , Volume 111 (3) FEATURE ARTICLES AJN, American Journal of Nursing March 2011, Volume 111 (3), p 54–60 Copyright © 2011 Lippincott Williams & Wilkins, Inc. SUBSCRIBED Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change Gallagher-Ford, Lynn MSN, RN, NE-BC; FineoutOverholt, Ellen PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek PhD, RN, CPNP/PMHNP, FNAP, FAAN; Stillwell, Susan B. DNP, RN, CNE Author Information ! DOI: 10.1097/10.1097/01.NAJ.0000395243.14347.7E ” Email # Cite Reuse $ PDF ISSN: 0002-936X Article PDF Complete Reference Full-featured View % (/ovidredirect/00000446201103000-00031) About the Journal Abstract This is the ninth article in a series from the Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problemsolving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every other month to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we’ve scheduled “Chat with the Authors” calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May’s Evidence-Based Practice, Step by Step. In January’s evidence-based practice (EBP) article, Rebecca R., our hypothetical staff nurse, Carlos A., her hospital’s expert EBP mentor, and Chen M., Rebecca’s nurse colleague, began to develop their plan for implementing a rapid response team (RRT) at their institution. They clearly identified the purpose of their RRT project, the key stakeholders, and the various outcomes to be measured, and they learned their internal review board’s requirements for reviewing their proposal. To determine their next steps, the team consults their EBP Implementation Plan (see Figure 1 in “Following the Evidence: Planning for Sustainable Change,” January). They’ll be working on items in checkpoints six and seven: specifically, engaging the stakeholders, getting administrative support, and preparing for and conducting the stakeholder kick-off meeting. ENGAGING THE STAKEHOLDERS Carlos, Rebecca, and Chen reach out to the Ovid ® key stakeholders to tell them about the RRT Search ( ) ‘ project by meeting with them ! in their offices Advanced or calling them on the phone. Carlos leads the team through a discussion of strategies to promote success in this critical step in the implementation process (see Strategies to Engage Stakeholders). One of the strategies, connect in a collaborative way, seems especially applicable to this project. College Week 7 Essentials of EBP Discussion

Each team member is able to meet with a stakeholder in person, fill them in on the RRT project, describe the purpose of an RRT, discuss their role in the project, and answer any questions. They also tell each stakeholder about the initial project meeting to be held in a few weeks. Box No caption available. In anticipation of the stakeholder kick-off meeting, Carlos and the team discuss the fundamentals of preparing for an important meeting, such as how to set up an agenda, draft key documents, and conduct the meeting. They begin to discuss a time and date for the meeting. Carlos suggests that Rebecca and Chen meet with their nurse manager to update her on the project’s progress and request her help in scheduling the meeting. SECURING ADMINISTRATIVE SUPPORT Journals Help Related articles Implementing NPASS: applying evidencebased practice at the point-of-care (/article/01258363201009000-00193? relatedarticle=y) International Journal of Evidence-Based Healthcare 2010; 8(3): 228. Abstract Nurses’ perspective towards evidencebased practice: a descriptive study (/article/01258363201009000-00234? relatedarticle=y) International Journal of Evidence-Based Healthcare 2010; 8(3): 244. Abstract Improving the Work Environment, Step After Rebecca updates her manager, Pat M., on the RRT project, Pat says she’s impressed by the team’s work to date and offers to help them move the project forward. She suggests that, since they’ve already invited the stakeholders to the upcoming meeting, they use e-mail to communicate the meeting’s time, date, and place. As they draft this email together, Pat shares the following tips to improve its effectiveness: * communicate the essence and importance of the e-mail in the subject line * write an e-mail that’s engaging, but brief and to the point * introduce yourself * explain the project * welcome the recipients to the project and/or team and invite them to the meeting * explain why their attendance is critical * request that they read certain materials prior to the meeting (and attach those documents to the e-mail) * let them know whom to contact with questions * request that they RSVP * thank them for their participation Box No caption available. Before they send the e-mail (see Sample Email to RRT and Stakeholders), the team wants to make sure they don’t miss anyone, so they review and include all of the RRT members and stakeholders. They realize that Environment, Step it’s important to invite the manager of each of the stakeholders and disciplines represented on the RRT and ask them to also bring a staff representative to the meeting. In addition, they copy the administrative directors of the stakeholder departments on the e-mail to ensure that they’re fully aware of the project. PREPARING FOR THE KICK-OFF MEETING The group determines that the draft documents they’ll need to prepare for the stakeholder kick-off meeting are: * an agenda for the meeting * the RRT protocol * an outcomes measurement plan College Week 7 Essentials of EBP Discussion

* an education plan * an implementation timeline * a projected budget To expedite completion of the documents, the team divides them up among themselves. Chen volunteers to draft the RRT protocol and outcomes measurement plan. Carlos assures her that he’ll guide her through each step. Rebecca decides to partner with her unit educator to draft the education plan. Carlos agrees to take the lead in drafting the meeting agenda, implementation timeline, and projected budget, but says that since this is a great learning opportunity, he wants Rebecca and Chen to be part of the drafting process. Drafting documents. Carlos tells the team that the purpose of a draft is to initiate discussion and give the stakeholders an opportunity to have input into the final product. All feedback is a positive sign of the stakeholders’ involvement, he says, and shouldn’t be perceived as criticism. Carlos also offers to look for any templates from other EBP projects that may be helpful in drafting the documents. He tells Rebecca and Chen that he’s confident they’ll do a great job and shares his excitement at how the team has progressed in planning an EBP practice change. RRT protocol. Chen starts to draft the RRT protocol using one of the hospital’s protocols as a template for the format, as well as definitions and examples of protocols, policies, and procedures from other organizations and the literature. She returns to the articles from the team’s original literature search (see “Critical Appraisal of the Evidence: Part I,” July 2010) to see if there is information, previously appraised, that will be helpful in this current step in the process. She recalls that the team had set aside some articles because they didn’t directly answer the PICOT question about whether to implement an RRT, but they did have valuable information on how to implement an RRT. In reviewing these articles, Chen selects one that’s a review of the literature, though not a systematic review, that includes many examples of RRT membership rosters and protocols used in other hospitals, and which will be helpful in drafting her RRT protocol document.1 Chen includes this expert opinion article because the information it contains is consistent with the higher-level evidence already being used in the project. Using both higher and lower levels of evidence, when appropriate, allows the team to use the best information available in formulating their RRT protocol. As she writes, Chen discovers that their hospital’s protocols and other practice documents don’t include a section on supporting evidence. Knowing that evidence is critically important to the RRT protocol, she discusses this with the clinical practice council representative from her unit who advises her to add the section to her draft document. He promises to present this issue at the next council meeting and obtain the council’s approval to add an evidence section to all future practice documents. Chen reviews the finished product before she submits it for the team’s review (see RRT Protocol Draft for Review1–10 ).College Week 7 Essentials of EBP Discussion

Box No caption available. Outcomes measurement plan. Based on the appraised evidence and the many discussions Rebecca and Chen have had about it, Chen drafts a document that lists the outcomes the team will measure to demonstrate the success of their project, where they’ll obtain this information, and who will gather it (see Table 1 (https://oceovidcom.ezp.waldenulibrary.org/article/00000446 -201103000-00031? sequence=0&clickthrough=y#context-T1-31) ). In drafting this plan, Chen realizes that they don’t have all the information they need, and she’s concerned that they’re not ready to move forward with the stakeholder kick-off meeting. But when Chen calls Carlos and shares her concern, Carlos reminds her that the document is a draft and that the required information will be addressed at the meeting. Table 1. Plan for Measuring RRT Success (Draft for Discussion) Education plan. Rebecca reaches out to Susan B., the clinical educator on her unit, and requests her help in drafting the education plan. Susan tells Rebecca how much she enjoys the opportunity to work collaboratively with staff nurses on education projects and how happy she is to see an EBP project being implemented. Rebecca shares her RRT project folder (containing all the information relative to the project) with Susan, focusing on the education about the project she thinks the staff will need. Susan commends the team for its efforts, as a good deal of the necessary work is already done. She asks Rebecca to clarify both the ultimate goal of the project and what’s most important to the team about its rollout on the unit. Rebecca thoughtfully responds that the ultimate goal is to ensure that patients receive the best care possible. What’s most important about its rollout is that the staff sees the value of an RRT to the patients and its positive impact on their own workload. She adds that it’s important to her that the project be conducted in a way that feels positive to the staff as they work toward sustainable changes in their practices. Susan and Rebecca discuss which clinicians will need education on the RRT. They plan to use a variety of mechanisms, including in- planning an education program: learner objectives, key content, methodology, faculty, materials, time frame, and room location. Susan fills the template with information Rebecca has given her, adding information she knows already from her experience as an educator. When Rebecca and Susan meet to review the plan, Rebecca is amazed to see how their earlier conversation has been transformed into a comprehensive document (see the Education Plan for RRT Implementation at http://links.lww.com/AJN/A19 (http://links.lww.com/AJN/A19)). Agenda and timeline. The team meets to draft the meeting agenda, implementation timeline, and budget. Carlos explains the purposes of a meeting agenda: to serve as a guide for the participants and to promote productivity and efficiency College Week 7 Essentials of EBP Discussion

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