Reflection Paper : Evidence Based Management

Katz, J. N., Wright, E. A., Polaris, J. J., Harris, M. B., & Losina, E. (2014, May 22). Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskeletal Disorders, 15(1), 1-9. http://dx.doi.org/10.1186/1471-2474-15-168Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: else

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

Standard 1.1 outlines that the registered nurse should access and analyse the best available evidence which includes research to ensure they provides safe and quality practice (Nursing and Midwifery Board of Australia, 2016). This was absent in scenario one as a result of a fast verbal medical handover Mary to Nicole. There was no guidance as to which patient was being discussed, and no time to write down all the important medical information required about her patients (Edith Cowan University, 2016). In scenario two Mary provides more guidance to Nicole about which patient she is talking about ensuring all the necessary information is received by Nicole (Edith Cowan University, 2016). Research has proven that handover is often difficult in the health care process, and often results in information being lost, distorted or misinterpreted. Verbal handover has also been described as an incomplete process when compared to information available in patient notes and records (Drach-Zahavy & Hadid, 2015). This is demonstrated in both scenarios with Nicole being given a fast handover with no guidance about where the information she is being given is relevant to. Whilst in scenario two Mary provides prompts and gives Nicole time to write down all the necessary information she requires (Edith Cowan University, 2016).

In this essay, I am going to consider how evidence-based practice can be used to support, justify, legitimate and/or improve clinical practice. I am also going to explore and discuss primary and secondary research evidences about how nursing interventions can potentially improve the quality of life of patients in the community suffering from heart failure. I will gather these evidences using a literature search which I will include an account of. Using a critiquing framework for support, I will appraise both primary and secondary evidences that I have chosen. I will also look at potential non-evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be drawn.

Answer 3: The evidence-based management approach can help the firm smooth its way to success in the expansion of its U.S. stores by always using the best evidence in their decision-making. The area I would suggest to be looked for the expansion is the population in each city and target the larger ones for more sales and business. The

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.

Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills.

Conrad, A., Grotejohann, B., Schmoor, C., Cosic, D., & Dettenkofer, M. (2015). Safety and tolerability of virucidal hand rubs: a randomized, double-blind, cross-over trial with healthy volunteers. Antimicrobial Resistance & Infection Control, 4(1), 1. doi:10.1186/s13756-015-0079-y

Mrs. Pink, aged 75 was admitted to the orthopaedic ward after suffering a fall at home, resulting in an intracapsular fracture of the hip at the femoral neck. Mrs. Pink has a history of cancer and cardiac diseases and has severe rheumatoid arthritis. Due to ageing patients putting a great deal of strain on the health care system, the incidences of hip fractures in the elderly are a major concern and requires careful consideration regarding treatment. Known as a major cause of disability in the elderly, hip fractures and their subsequent need for surgery result in chronic pain and an altered quality of life (Strike, Sieber, Gottschalk & Mears, 2013). Although important to improve a patient’s quality of life and physical independence, pain related to a total hip replacement (THR), also known as hip arthroplasty (HA) can lead to delays in ambulation, longer hospital stays, poor functional outcomes and quality of life. The purpose of this essay is to identify the rationale behind nursing interventions provided to post-operative THR patients as well as the pathology of a femoral neck hip fracture and their procedure for assessment and diagnosis.

Sterile technique is required for insertion of an indwelling urinary catheter in the hospital setting, but clean technique can be used for intermittent catheterization in non-acute settings. By itself, sterile technique on insertion doesn't prevent UTI’s. Prevention of UTI’s depends on knowledge of causes, proper care techniques, and early catheter removal. Nurses are taught early on in school that sterile technique helps to reduce infections. It was drilled in our heads the entire time and now to have the evidence tell us that early catheter removal, along with proper technique good hand hygiene is the key to reduce UTI’s.

In this essay I will evaluate the David Bennett Inquiry Report, which was set up by the North, Suffolk and Cambridgeshire Strategic Health Authority (NSCSHA) to investigate the death of Mr David Bennett. I will define evidence-informed practice (EIP) and summarise the inquiry report. I shall highlight and critically analyse some of the key issues raised in the report in relation to ethnic minority issues. Finally, I will discuss the implications of evidence-informed practice for social work as well as my own future practice.

Research and best-practices are an integral part of evidence-based management(EBM) and allow an organization to successfully implement EBM into their facilities. HSHS-EWD is a group of four hospitals that work with several clinics and healthcare providers to promote the health and well-being of many local communities. Connie Dorn, manager of central scheduling and prior authorization, is located within the revenue department and oversees registration and scheduling of the four different hospitals. During her 10-year tenure with the hospital systems she has seen many changes occur that have been beneficial to the hospitals, patients, and staff. Management meets on a continuous business to discuss areas that need improvement in order to stay on top of the latest advancements in the medical community. Connie currently sits on many boards, teams, and groups within the hospital system and is very experienced in the utilization of research and best-practices in regards to EBM. She recently utilized these skills while seating on a team that was trying to find a solution to denial of claims and poor customer satisfaction due to lack of authorization being in place. During the research phase it was discovered that the authorization team was obtaining authorization, however, physician offices were ordering the test incorrectly causing the radiologist to update the orders. Her team eventually found a solution that is in the process of being rolled out system wide called ACR-Select.

Evidence - Based Nursing, An introduction (2008, p. 285 ) “ The rapidity of change and the reorganization of nursing services within the health care sector presents challenges for the advancement of EBP. Managers and administrators should facilitate the uptake of practice based on current, high-quality research by formalizing the expectation that nurses care be Evidence Based”.

The Nurses of the Future Nursing Core Competency model is composed of ten competencies. Some of these competencies include patient centered care, collaboration, and teamwork. One particular is safety, which I believe to be one of the most important of the competencies. Safety is minimizing the risk of harm to patients and healthcare providers. This is important to nursing because insuring the safety of a patient is a number one priority, without safety is the care of a patient successful? Nurses are the first line of defense when it comes to safety towards patients and providers. In order to ensure safety there must be a plan of action and then set the plan in motion in order to avoid unsafe outcomes.

Mrs Smith, 5 days prior to visiting hospital tripped and fell, her injury’s prevented her from standing up. At hospital she was diagnosed with a left fractured neck of the femur (L NOF) and required an immediate left total hip replacement surgery. Mrs Smith is 85 years old, lives with her husband at home, has no children however has a strong social support network through her church. She is involved in her community and continues to teach piano. Mrs Smith only known medicine issue is urinary incontinence. 10 days’ post-surgery Mrs Smith developed a urinary tract infection increasing her length of stay in the hospital. This led to the diagnosis of delirium, worsening of her continence issues impacting negatively on her mental health. This has resulted in slow progress in mobility and delay of her rehabilitation plan. Mrs Smith’s anxiety levels are heightened as she is fearful of falling again and is concerned whether she will be able to return home as her mother passed away shortly after she broke her hip. This case study will examine if Mrs Smith will be able to return home with an effective management & discharge plan based on a multidisciplinary team using a person centred approach. The treatment plan will endeavour to assist Mrs Smith to return home. A full health, coordination and function analysis is scheduled to assess to identify any underlying medical condition and possible risk factors for further falls.