Immerion Experience: Quality Improvement Project

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

In the past few decades, many nursing practices were relied on state regulation, cost, or insurance policy. However, evidence based practice (EBP) are increasingly recognized and emphasized to change in nursing practice. For many clinical settings, there are thousands of resources available today. Not only most of nursing practice are made based on a pilot study but also implied to bring most benefits of the care.

Technological advances and genetic discoveries have increased the average individual’s life span. Today’s nurses regularly care for an aging population with a higher incidence of chronic illnesses. People are now living longer and the population is becoming more diverse creating a host of new challenges for nurses. The American Association of Colleges of Nursing has created nine essentials that may be incorporated into any university curriculum to prepare nurses to provide high quality patient care. The third essential discusses the importance of scholarship for evidence-based practice. The term scholarship differs from evidence-based practice. Scholarship involves asking thought provoking questions that may have the potential to better patient outcomes, researching these questions or the topic of interest, collaborating with the healthcare team to successfully incorporate interventions, and continually performing evaluations. Evidence-based practice is vital to quality patient outcomes, may take as long as seventeen years or more to integrate into the hospital setting, is based on numerous scientific research studies, and is best fostered through scholarship. Scholarship

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

This paper will describe current quality outcome measures and the significance for improving medical care. Organizational accountability and transparency has improved with the emergence of Hospital Inpatient Quality Reporting (IQR) programs and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs). This article will review the role of the nurse manager in creating a culture for quality care as well as the nurse for meeting organizational and patient expectations. Organizations like The Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and The American Nurses Association (ANA) have been critical in establishing standards for quality. This paper will also report on the most recent hospital statistics and steps taken to improve HCAHP scores and reduce readmission rates at the University of Tennessee Medical Center in Knoxville (UTMCK). Statistics at UTMCK will also be compared to the Tennessee and National averages found on the Medicare website Hospital Compare. The aim of this paper is to explore if healthcare system initiatives are improving quality and enhancing patient outcomes.

Since there is no reported data or analyses to help the nation or specific regions and communities assess veterans’ needs for services by geographic area, and to plan for and coordinate service delivery across community-based, TRICARE, and VHA resources; we purpose several general directions for moving forward (Burnam et. al, 2009). The general directions for moving forward include a need for confidentiality, consumer education, treatment choices, workforce policy, training and certification, QI needs, and technical assistance to the

Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model reaffirm that evidence based, is a reality concept in the clinical and educational setting. This model help the nurses at all levels will find clear explanations of the differences between quality improvement, research and evidence-based practice and, as long as they can establish good multidisciplinary team working, this model will be able to apply in the home health care agency to achieve the goal of my project. Also useful strategies for defining evidence-based practices problems and how to develop and implement a correct care plan. This model helps to develop research evidence, and find the correct

All elements in this domain scored a five. The VHA focuses on diversity and disparities among Veterans. The comprehensive electronic health record captures demographic information, such as race, ethnicity, language on the initial visit to the facility. This information can then be viewed in the first pane of the patient chart. Although English is the primary language, an interpreter can be made available if necessary. Those patients who are hearing impaired are provided with an interpreter fluent in sign language. Multiple programs are available to Veterans who are underserved. A series of questions are reviewed with the patient annually, with the goal of identifying the Veteran’s needs. These questions focus on routine health care, as well

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

In addition, one will conduct literature review to pinpoint evidence-base interventions from the Chronic Care and Transitional Care models. Furthermore, one will evaluate these interventions by executing a comparative analysis of Chronic Care and Transition care models improve post-hospitalization care for Veterans who are admitted into Non-VA

At the end of 16 months, students are given 2 months for preparation for the USMLE step 1 exam. They are then given a transition course that prepares them for the second phase, the application phase. This is an 11 month phase that integrates clerkships around populations, services and location. It emphasizes on the needs of patients in specific settings at different instances and factors, opposed to students being organized into departments and specialties. It is divided into three aspects: The first is Community based longitudinal care, which integrates longitudinal care clinical care experiences. The second is care of specific populations, where students are set in scenarios with patients with neurologic and mental illnesses, and women and children. The third is hospital interventional, and surgical care, where the students now treat/interact with hospitalized adults, and surgical patients. The final phase in the TEC curriculum is the individualization phase. This is a 14-month phase that allows students to

Enhancing veteran care is the top priority for us all, providing opportunities to veterans enabling them to become actively involved with their healthcare will generate an enriching supportive foundation on every level of health care. Utilizing this “multi-disciplinary” structure encompuses and promotes active health care management that heighten their physical/mental well-being.

A newly graduated registered nurse is well prepared to pass NCLEX for licensure; however, being prepared for the acute care setting in a hospital is a completely different issue. Nursing schools develop the foundation of nursing knowledge, creates critical thinking skills, and touches on nursing tasks. All of these are great tools to possess, but they do not prepare the new graduate nurse for safe, acute patient care. At Boulder Community Health (BCH) on the orthopedic neurology unit, new graduate nurses are given five weeks of orientation. Expecting a newly licensed nurse to learn all of a hospitals policies and procedures concerning patient care and how to incorporate the policies into their practice after five weeks is highly risky and leads to unsafe patient care. On the orthopedic neurology unit at BCH the new nurse trains with several nurses during the five week orientation period. This does not allow for the nurse to learn a consistent system to follow or incorporate into their personal practice as each nurse has their own system. This can become frustrating for the novice nurse. This paper will propose a change in the orientation program at BCH. A one year new graduate nurse residency (NGNR) and mentorship program will be presented to the management administration at BCH. The proposal will serve to prove that a residency program will actually save the hospital money by retaining quality nursing staff through

According to Houser (2012), evidence Based Practice Nursing is the application of evidence based findings by nurses to steer the nurse toward integration of clinical expert opinion and experience with an unbiased comprehensive analysis of the best scientific evidence professional nursing care literature can provide while integrating patient principles and preferences. When planning for sustaining evidenced based practice, it is vital to adopt a methodical critical thinking decision making method, directed by deliberately adopting Evidence Based Nursing model pathway that encompasses searching, appraising, synthesizing, adapting, implementing, with a continuous evaluation of outcomes (Houser, 2012). Consequently, in an attempt to create or sustain an evidence-based practice, the plan must be well thought out, assessed, implemented and evaluated for desired outcome. My current area of nursing practice is in a Med-Surge/Orthopedic unit of an acute health care setting. We are specialized in Total Joint replacements, with an occasional spillover of Medsurg cases, who are admitted to the floor due to lack room at the specific units. My plan to create and sustain an evidence-based practice, will be in regards to creating and instituting a required pre-surgical class for patients who have elected to undergo a joint replacement.

Evidence-based practice (EBP) in nursing means making decisions about patient care on the basis of best, current, standardized practice and guidelines. According to an article, written by Dr. Kathleen Stevens, the development of evidence-based practice (EBP) is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care (Stevens, 2013). The author also mentioned in her article that the intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care,