Design For Change Proposal : Implementing Hourly Rounding

Within this essay Evidence based Practice will be identified and the significant effect it has on the nursing profession, barriers will also be explored in the implementation of Evidence Based Practice.

There was in increase in falls over the first quarter of the year so the question was why and how to decrease the number of falls on the unit? After reviewing the data and conducting research on falls a quality improvement team decided on a plan, which was to hourly round on the patients. In essence, education was provided to the patient and family about what hourly rounding and why it is occurring. Overall, hourly rounding did decrease the fall rates on the unit and improved patient safety. Another issue identified on the unit was an increase in percutaneous endoscopic gastrostomy tube (PEG) being pulled out by patients. Therefore, a plan was put into place for patients with PEG tube to wear an abdominal binder and have a stat lock place

The Johns Hopkins Nursing Evidence-Based Practice(JHNEBP) model had been used as a framework for this EBP project. This model focuses on the transfer of knowledge into practice by providing guidelines for nurses and other clinicians based on the best available evidence. There are three main elements in the JHNEBP process are practice, research and education. Each component has prescriptive steps that are a total of 18 subcategories. During the practice stage, five steps need to be done such as identifying an EBP question, defining the scope of practice question, assigning responsibility for leadership, recruiting a multidisciplinary team and also scheduling a team conference. The next component is the evidence/ research stage. Searching

The broad purpose of the evaluation is to improve the effectiveness of the current hourly rounding process. By conducting an evaluation, information was gathered about potential obstacles to performing hourly rounding. Another purpose of the evaluation is to determine if patient satisfaction, the rate of falls, and call bell usage were impacted by the purposeful hourly rounding initiative. The evaluation may suggest a revision to the current hourly rounding tool that is being utilized on the medical unit.

From the attributes mentioned above, the clinical question can be stated as “For patients on a medical, surgical pulmonary unit; how the implementation of hourly rounding compares to the current patient monitoring plan help improve HCAHPs scores and reduce call bells within a month of hospitalization?”

According to Long and Harrison (1997), (as cited by Nursing and Health Sciences, 2003), evidenced base nursing is the process of systemically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Nurses carry out a variety of activities to obtain, recover, and develop the patient’s health and well being. Evidence-based practice helps nurses provide high quality patient care based on research and knowledge rather than because “this is the way we have always done it,” or based on traditions, myths, hunches, or most commonly based on the advice of co-workers. The challenge for nurses is to implement the best intervention and practice informed care by the evidence. Evidence-based practice positions nurses to be a significant influence on health care decisions and a partner in improving quality care. Nursing interventions and processes informed by the best evidence are critical to realizing health-care improvements and cost savings.

Rosswurm, M. A. and Larrabee, J. H. (1999), A Model for Change to Evidence-Based Practice. The Journal of Nursing Scholarship, 31: 317–322.

Evidence-based practice is a problem-solving approach that integrates systematic search for, and critical appraisal of, relevant evidence to answer a burning clinical, educational or administrative question. In today’s Magnet Monday, I will further explain this approach, why it is important to us at Parkview and how our clinical nurses are making great strides to improve clinical outcomes through evidence-based practice.

The learning process during this course (Advanced Nursing Research: NURS 5301) has been quite a lot. We dealt with the importance of research and evidence-based practice (EBP) in nursing and it has being quite revealing and extensive in contents. The course contents and assignments were in-depth and time-consuming, mostly the literature review paper nevertheless they were informative and educative. The course promotes critical thinking and judgment, more so, the materials and assignments were based on how clinicians will be able to identify a need for change in the current practice and ask the right questions, which in turn generate research that will lead to EBP.

Continuing education is important for nurses to remain competent and facilitate quality care. Education based on research is crucial in making practice changes and research based on tried and true evidence will influence these changes. The Johns Hopkins Nursing Evidence-Based Practice Process is evidence-based and consists of eighteen steps that are performed in three phases. The phases are practice question, evidence, and translation. (Dearholt & Dang, 2012) and it came about through collaboration between clinical nurses and nursing faculty. “The strength of the Johns Hopkins model is its reliance on a strong academic-collaboration as a foundation for mutual benefit.” (Houser, 2015, p. 465). A Magnet designated institution has a responsibility to contribute to the education of nurses using research based evidence to make practice guidelines.

During my associate degree program and my bachelor degree in nursing, I have read several evidence-based practice articles and research. However, I still feel I need to strengthened more this area of nursing. According to Balis & Hayes (2016), “Nurses in clinical practice identify the problems in need of investigation and collaborate with researchers from nursing and other disciplines, who design studies to address the identified problems and collect and analyzed the data” (p. 194). I am committed to seek more knowledge through reading more evidence-based practice nursing articles and studies in order to make the best decision and judgment for my patients and

Filling the gaps between research and practice is very important. This issue has always existed and this is one of biggest challenges facing nursing students. The availability of information is increasing. However, it is difficult to find evidence and apply it to nursing practice. The results of research should be feasible and a higher level of evidence should be provided to bridge the research-practice gap. It will require two-way communication between researchers and practitioners, or education for both researchers and practitioners. Through communication or education, researchers can develop more feasible interventions and provide more scientific evidence. Providers should be able to identify the best

With healthcare continually changing, does one ever stop to think why changes are being made, or if changes made are necessity? Wouldn’t it be easier to continue nursing the way everyone is used to? The answer is, no! Changes in health care are brought upon with the idea of implementing safer, more efficient, and patient friendly techniques. This is all due to research that is done and then introduced into clinical practice. Where does the research come from? The answer is, through research utilization. This process consists of five steps before reaching the final step of introing the new research into clinical practice. (Zerwekh & Garneau, 2015).

I believe that nursing should be based on a continuum which includes; research, practice, and theory. As the professional nurse role has evolved each of these concepts collectively define the profession. “New knowledge is generated and effective interventions are developed through nursing science, new avenues for implementation, dissemination, and sustainability must also be considered” (Grady & Gough, 2015, p.518). Theory provides the foundation on which nursing as a profession is built. The ability to generate and apply theory defines the legitimacy of the profession (McCrae, 2012, p.222). Practice provides specific examination and experience that is important to the role of the nurse. Research is imperative to the advancement of care and

The nursing practice is directed to provide qualified and safe care, and remarkable is the fact that the skills and abilities of the nurses have their foundational basis in strong scientific knowledge as a standard for the purposes of care of the patients. Nurses are committed to the best care and responding to the challenges of the actual healthcare system, “Nurses are increasingly engaged in evidence-based practice (EBP) processes to answer significant questions and guide nursing practice” (Lee, 2013).