Decision Making Across Health Care Providers, Patients, Managers, And Policy Makers

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

Many individuals do not like the idea of change, but as health care professionals we know that change is a part of our profession. Evidence-based practice is present and the future of health care practice and needs to be fully supported by every health care team member. The gap between understanding EBP and applying it needs to be a thing of the

The facility my change project has potential impact upon is a teaching hospital which is known for promoting, supporting, and encouraging clinical research and implementing latest evidence-based practice. Erlanger serves as the region's only academic teaching hospital and strives to employ healthcare professionals who are knowledgeable in the latest skill, technique, and evidence based practice (EBP) (Erlanger Health System, 2017). This serves as both a strength and opportunity for the facility. A major strength for the hospital is the support that is has for research and implementation of all change processes. In 2013 the Institute for Clinical Research (EICR), was developed to solidify unity of two objectives, providing patients’ access

Evidence-Based Practice Proposal Final Paper Usha Kizhakkedan Grand Canyon Final Paper of Evidence Based Proposal NUR-699 Dr. Debbie Long June 1, 2016 Table of Contents Part 1: Organizational Culture and Readiness Assessment 4 • Introduction to Evidence-Based Practice 4 • Barriers to Evidence-Based Practice 4 • Facilitators of Evidence-Based Practice 5 • Integration of Clinical Enquiry 5 • The Survey 6 Part 2: Problem Description 7 • Description 7 • Identification of change agents in the Health care system 8 • PICOT question 8 • Purpose and Objectives 9 • Rationale 10 • Literature support 10 • Research Method 10 Part 3: Literature Support 11 • Research Questions 11 • Search Method 12 • Organization of Literature 12 • Framework 12 • Nursing Rounds- Patient and Family Satisfaction: 13 • Communication: 15 • Management of Pain, Use of Call Lights and Cases of Patient falls 15 • Data Collection 16 Part 4: Solution Description 16 • Objectives 17 • Change Methodology 17 • Implementation Plan 18 • Evaluation 19 Part 5: Change Model 19 • Change Model 20 • Implementing Change 21 • Rationale 22 Part 6: Implementation Plan 22 • Staff Education 23 • Client feedback 23 • Timeframe 23 • Hiring Process 24 • Implementation 24 • Data collection and Evaluation 24 • Progression 24 • Resource Management 24 • Budget Plan 25 • Outcomes and its impact 25 • Summary 26 Part 7: Evaluation of Process 26 • Objectives 26 • Methodology 27 • Procedure 27 • Collection and Analysis of data

Evidence based practice is the basis for needed change in practice and function. It is a sound method for scientific, fact-based change. Changes which have no evidence to support them are fragile, unscientific, and subjective. These changes don’t effect real change over time, as they aren’t able to be proven to a more general population.

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

The evidence based interventions we learn can improve patient’s outcomes, help provide quality care, reduce cost and eliminate practices that have become obsolete.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

According to Stevens (2013), the call to develop and implement evidence-based practice (EBP) within all healthcare disciplines is fueled by legislative demands for improvement in standard medical metrics such as mortality and morbidity. However, increasing demands by the public for evidence related to the metrics and outcomes of such concepts as quality of life illustrate what may be more important to the client (Stevens, 2013). This client-directed focus has resulted in patient-centered outcomes research (PCOR) (Stevens, 2013). "The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information

The study conducted in 2013 by Dogherty, Harrison, Graham, Vandyk, & Keeping-Burke aims were to describe the Canadian health system's knowledge of the facilitation process in implementing evidence based practice (EBP) among experience nurses. They identified factors that positively and negatively impacted the facilitation process by bringing together 20 nurses across Canada that possessed various backgrounds and years of experience. Their mission was to explore what was successful and not successful in implementing evidence into practice. The selected nurses underwent reflective exercise under the direction of two international researchers with notable experience in facilitation and knowledge translation. Based upon the analysis of the data

As the nursing field grows, evidence-based practice is becoming more pragmatic. This is because people want to know the when, why, and how of diseases processes. Increasing knowledge on evidence-based practice has shown to improve health outcomes. Research translation models are utilized heavily in nursing to help transform findings into practice (Polit & Beck, 2012). Some models are more clinician oriented, while others are institution oriented. There are various models that are utilized by different entities. For the purpose of this paper, the Stetler Model of Research Utilization will be researched and discussed.

Although knowledge translation is one of the greatest strategies widely used in healthcare organizations, there is some of ambiguities and barriers over its utilization. Many studies explore the complexity of barriers and limitation for KT application into clinical practice, these barriers are broadly divided into three aspects as the person, practice environment, and knowledge translation activities (Metzler & Metz, 2010).

Research shows that it takes approximately 17 long years for just 14 percent of medical research to translate into clinical practices. This means that health care consumers will experience considerable delays or never even have opportunities to experience the new medical benefits or technologies. The driving goal of dissemination and implementation-based science is to create evidence-based interventions that can be successfully applied in real-world settings. Increasing the number of new interventions that translate into clinical practices will positively impact and improve community health by expanding the available approaches and alternatives. Implementation science strives to enhance, generalize and represent intervention research in order to increase the quality of public health levels.

Evidence based practices are important to explore for various diseases so that their efficacy level can be determined and medical staff can be trained accordingly. Particularly speaking in the context of chronic diseases, evidence based practices are to be evaluated with the joint efforts of multiple healthcare institutions so that it can bring benefits to the overall healthcare industry.

The ACE Star Model of Knowledge Transformation is a model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various aspects of EBP. The simple five-point star model depicts various forms of knowledge in a relative sequence; research evidence is moved through several cycles, combined with other knowledge and integrated into practice. The stages of knowledge transformation are: Knowledge discovery, evidence summary, translation into practice recommendations, integration into practice, evaluation .The goal is “knowledge transformation-the conversion of research findings from primary research results, through a series of stages and forms, to impact on health outcomes by way of EBC” (Stevens, 2004). Figure