Nursing research: Generating and assessing evidence for nursing practice (8th ed.). Dissemination Planning To ensure that the project results will be used, research projects must develop a dissemination plan that explains how the outcomes of the project will be shared with stakeholders, relevant institutions, organizations, and individuals. The VAP rate during pilot project for the months of June 1, 2010 to April 1, 2011 will be compared with the VAP rate of previous year for the months of June 1, 1009 to April 1, 2010 to promote validity. All patients admitted to ICU who did not have: Self-report and observation by senior staff, The problem statement ………………………………….……………………….……….3, The evidence-based question ………………………………………..……….……….…4, Locating credible evidence………………………………………………….……………3, Appraise the evidence……………………………………………………….……………4, Planning of change………………………………………………………………..…….8-9, Clinical protocol and pilot project………………………………………………9-14 & 23, Integration and Maintenance …………………………………………………….…..14-15, Barriers and strategies………………………………………………….……………15-18, Management of Mechanically Ventilated Patients: Pilot Project ……………………23-24, Questions for Patient Ventilator Rounds ………………………………………………..25, Methodological matrix ………………………………………………………………26-28, Prevention In-Service Flyer ………………………………………………………….…29, http://www.aacn.orgIWD/PracticeIDOCS/Oral_ Care_in_the_ pdf(Augustyn B 2007 Ventilator-associated pneumonia: Risk factors and p, Acid/base balance = determined by pH values from arterial blood gas. Projects showcased have been completed all over the country using the JHNEBP model and tools. Finally, there are communication barriers in every aspect of life.The implementation of EBP can be affected by a lack of appropriate collaboration and communication between every level of provider involved including researchers, nurses, educators, managers, and administrators (Thompson, Bell & Prevost, 1999).Communication errors and barriers can occur in the educational programs and training for EBP, the interpretation of research, and in publications and presentations (Melnyk & Fineout-Overholt, 2005).This issue can be further complicated with the addition of multidisciplinary involvement, which requires another level of communication to be successful. Training & Development, 61(11), 24-27. Monitor arterial blood gases per physician order.Notify physician as needed. An example of an evidence-based project might include investigating the use of pharmacological venous thromboembolism (VTE) prophylaxis for patients who underwent a craniotomy and are recovering in the neuro ICU. The other resources needed are the staff education time for the RNs who are teaching the in-service and the staff who is attending the in-service. Strategies for Successful Implementation of EBP. There is evidence indicating the use of oral chlorhexidine and the removal of oral secretions before position changes may diminish the risks of developing ventilator-acquired pneumonia. In order to evaluate an evidence-based practice project, it is important to be able to determine the effectiveness of your change. The plan will also be presented to Quality Care Committee May 2010 meeting for their permission for the change. A similar study showed VAP occurrence at 2.6% in the study group and 11% in the control group with probability of < 0.001 (Tsai, Lin, Chang, 2008). The cost of chlorhexidine is also negligible when compared with the cost of VAP. If after searching the nursing literature you found another fall-risk assessment tool and you changed It also allows for exceptions in clinical setting and resource constraints. In adults supported with mechanical ventilation, what is the effect of oral chlorhexidine use and removal of oral secretions prior to position changing on the development of ventilator-acquired pneumonia? Removal of secretions prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: A clinical controlled study. “*” indicates interventions added to the current existing protocol, Methodological Matrix and Evaluation Matrix, randomized placebo-controlled double-blind experiment. This problem was identified long ago and yet still needs further evidence for best practice. This literature review consisted of all but one study which were experimental in nature and hold “a high degree of internal validity because of the use of manipulation and randomization” (Polit & Beck, 2008, p. 295).Tsai et al.’s study was a time-sequenced, non-randomized quasi-experimental study most vulnerable to threats to internal validity out of all the literature reviewed.But the remaining study participants in the rest of these experimental designs were all randomized after meeting inclusion criteria.Only two studies (by Houston et al. The Journal of Nursing Administration, 37(12), 552-557. ... (Evidence-Based Project) Part 5: Recommending an Evidence-Based Practice Change. Select from among many available models. Discuss one way you will be able to evaluate whether your project made a difference in practice. Question Description Week 4 Paper D. PICOT Question. For each example listed, a review study of the approach has been published. Overcoming barriers to research-based practice. Tsai, H. H., Lin, F. C., & Chang, S. C. (2008). The American Journal of the Medical Sciences, 336, 397-401. doi:10.1097/MAJ.0b013e31816b8761. Evidence-based practice is crucial in nursing practice. The evidence-based question ………………………………………..……….……….…4. To learn more about an EBP exemplar, contact the project team lead. A summary of the articles can be found in Appendix C. The studies varied in design; from randomized to non-randomized, placebo, to longitudinal and a pilot study. Integrating the new policy on the unit, staff will be much more likely to accept and support the newprocess if they know what to expect ateach phase of the change. Quarterly feedback to the staff alone will help visually show their cooperation in this study and the beneficial outcomes yielded from the implementation change. Additionally, staff members are able to contribute ideas drawn from theirvaried experience. This provides evidence for the need to implement such an intervention and continue research. sustainability of practice-based research networks (PBRNs) in the long term. One day shift nurse and one night shift nurse will be prepared by the nurse educator to do the teaching for the rest of the ICU staff. 5.Administering sedatives/analgesics as ordered. By reducing the levels of bacteria in the oropharynx there would theoretically be a decrease in the prevalence of nosocomial pneumonia (Houston et al., 2002). After obtaining permission for the plot project, evidence base education material containing prevalence of VAP rate, its complications, cost, recommended change with use of chlorhexidine gluconate in oral care, and oral secretion suctioning prior to position change will be presented to the staff during ICU Unit Base Committee (UBC). Several methods are available for conducting an evidence review and change implementation, for example, the Star Model (http://nursing.uthscsa.edu/onrs/starmodel/star-model.asp) or the Johns Hopkins Nursing Evidence-Based Practice Model (https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html). This study would also require a qualified personal to educate the staff on the protocol changes and be available to answer any questions which may arise. CHEST, 121, 858-862. Assignment: Benchmark – Evidence-Based Practice Proposal Final Paper Details: Throughout this course you will be developing a formal, evidence-based practice proposal. Visit our EBP Exemplar Library to view past submissions. Develop an evaluation plan to be included in your final evidence-based practice project. Among terminally ill patients 65 years and older (P), how does a nurse driven protocol for a hospice consult (I) compared to current practice (C) increase the referrals to hospice to address the goal of care, timely (O) during a 2-hour admission(T)? After implementing this study, this research assistant would accompany the ventilator rounds team and collect information applicable to the study. The teaching session or in-service will be on May 20, 2010 from 8 a.m. to 9 a.m. and from 8 p.m. to 9 p.m. All the nurses at Scottsdale Healthcare ICUs will need to be reached to ensure that everyone can benefit from this information. (2004, June 04). The staff will also be encouraged for their feedback on this project. Developing a plan for change includes identifying strategies to gain cooperation and evaluating outcomes.Once it is decided that evidence supports a practice change, the change agent or facilitators must develop and test the improvement.This step requires some preliminary planning and research.Is the innovation practical, the evidence transferable, is the organization ready for change, are outcomes measurable and will is it possible to implement the EBP within the organization (Newhouse, Dearholt, Poe, Pugh & White, 2007)?If the answers are agreeable, the innovation must be authorized through the appropriate organizational channels.The implementation of an evidence-based practice is considered a quality improvement initiative and does not require the hospital Institutional Review Board approval.The Quality Care Committee, which oversees process improvement, protocol, and policy changes, will review and approve this proposed implementation of evidence-based practice, as part of the initial planning.The planning phase includes assessing the feasibility of change, defining the change, identifying resources, and defining the desired outcomes (Reavy & Tavernier, 2008). These measures will motivate the staff for a change in practice. This information on VAP rates and patient length of stay after implementing the new interventions would be put together and submitted to the appropriate committees. These findings will be discussed among the ICU manager, supervisors, clinical educator and infection control nurse in May 2011 upon completion of pilot project. Examples of the strategies/evidence-based interventions that will be used: TEAMWORK: (1) Institute teamwork among nursing staff; for example, check on each other’s patients. (Chao Y C Chen Y Wang K K Lee R Tsai H 2008 Removal of secretions prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: A clinical controlled study)Chao, Y. C., Chen, Y., Wang, K. K., Lee, R., & Tsai, H. (2008). The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Communication between both groups is crucial, and a key concept of implementing a practice change. (2009) found on average, estimated costs of an additional $11, 897 to $150,841 per individual case were spent. Damage to the heart has occurred by the time Evidence-Based Practice Project Reports . IJHN has not been involved in these projects and has not validated the findings. There appears to be no apparent threat to construct validity with the discussed literature.However one could argue the researcher’s expectancies for desired outcomes playing an effect.For example, Tsai et al. Consider the clinical environment in which you are currently working or have recently worked. 4.Placing the “nurse call” button within patient’s reach. Thompson, P., Bell, P., & Prevost, S. (1999, February). There are twenty-three day shift RNs and twenty night shift RNs in ICU who will need to attend these in-services, so one hour in-service for each RN will need forty-three hours of education time for registered nurses in addition to five hours of teaching time for the RNs who are teaching these in-services. Follow. The first stage of unfreezing involves the concept of becoming motivated to change or unfreeze from previous practices. The solution proposed was to include an electronic device for bedside charting at the beds in the postpartum unit. B.The patient will be assigned to a hospital bed allowing maximum visibility at all times. Intermittent suction of oral secretions before each positional change may reduce ventilator-associated pneumonia: A pilot study. Generating Evidence for Evidence-based Practice. Rigorous clinical studies show oral secretions pose an increased risk for developing VAP (Augustyn, 2007). Sample Capstone Project Paper on Evidence-Based Practice Proposal: Reducing Obesity among Adolescents in America We do not share your personal information with any company or person. To enhance the patient outcome during hospitalization, an evidence-based pilot project will be implemented. Anderson, J. LaRocco, M. Kennedy, V Gentry, L. Methodological Matrix and Evaluation Matrix Continued. Do not submit directly to this website. Initiating the changes to the pre-existing protocol would first involve several steps as previously mentioned. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Sign up for our email list to receive information regarding news, educational programs and events. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes. The project will be presented in detail and the importance of the need for a change in practice for VAP reduction will be stressed with the supporting evidence. See Appendix B for examples of major questions included during ventilator rounds. Organizational change strategies for evidence-based practice. and Tsai et al.) Another related intervention assessed in a similar randomized clinical study was the use of subglottal suctioning by Smulders et al. The two poster boards will cost seven dollars each, a small jump drive for twenty dollars and the power point is free. The power point presentation containing the teaching material will be made available to all the hospital employees on the Scottsdale Healthcare Shea campus’s Special Care Unit’s web site. Critical Care Nurse, 27, 32-39. Researchers appropriately balanced all concerns for validity in their study. The guides below were written by our professional writers, as a learning aid to help you with your studies. Follow the Institute of Johns Hopkins Nursing on Facebook for news, updates, hope and support. The data will be collected on all ventilated patients during daily multidisciplinary team vent rounds by the infection control nurse. A quality improvement project was initiated to avoid delays in care for patients with hand trauma Step 2. Perform oral suctioning every two hours and prior to position change. seeking to develop a multisensory room to change the practice of seclusion. Infection Control and Hospital Epidemiology, 29, 31-40. doi:10.1086/591062. 25 Great Ideas For A Nursing Capstone Project. To submit your completed Evidence-based practice nursing essay examples Project for review and grading, do the following: Please save your Project using the naming convention “WK10Proj+last name+first initial. Note: Only one award of up to $1,000 will be granted annually to assist with conducting either nursing research or EBP project. The physicians and respiratory therapists of ICU will also be notified of this evidence based plan so they will be knowledgeable about this VAP pilot project. Evidence Based Practice for Tracheostomy Care. Review of Evidence and Synthesis of Literature. Methods used in final data collection entails the use of questionnaires and interviews. Example:Increased incidence of deep vein thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very important task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an important re tht more research can be conducted to add into evidence –based practice. (extension)” as the name. Nurses play a key role in helping to prevent illness before it happens by adhering to evidence-based infection-control policies. Two to four nurses from each floor can be prepared to teach the rest of the staff on CVICU. (1996) and Houston et al. Evidence-based practice in nursing & healthcare: A guide to best practice. sample questions. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Ventilator-associated pneumonia: Risk factors and prevention. Since the problem of VAP pertains to all the ICUs of Scottsdale Healthcare hospitals this information needs to be disseminated to the Scottsdale Healthcare Shea CVICU, and eventually to ICUs at Osborn and Thompson Peak campuses. We are providing in-person care and telemedicine appointments. (Those with pneumonia before intubation or within 48 hours after intubation were excluded), endotracheal intubation (EI) and mechanical ventilation. Lewin’s final stage of the change theory is the concept of re-freezing or making the change permanent. This is a literature analysis of research reports and literature reviews which studied the effects of removal of oral secretions prior to position change on the occurrence of VAP. A dissemination plan as mentioned above will be carried out in a similar fashion for the other two campuses also. Enter the last name, specialty or keyword for your search below. DeRiso, A. Ladowski, J.Dillon, T. Justice, J.Peterson, A. Randomized surgical patients undergoing heart surgery. We have also ensured that the ordering process is secure; you can check the security feature in the browser. If you are attempting to submit your project report to ValpoScholar, please send your materials to scholar@valpo.edu. Capstone project sample papers evidence based nursing projects free capstone projects pain management capstone project Evidence Based Practice Paper One of the greatest challenges faced by the healthcare providers is pain management especially for the geriatrics residing in … The work environment healthcare professionals face daily is demanding.Nurses manage heavy workloads and high acuity patients along with staffing shortages and cost cuts, which reduce all available resources.This creates challenges to implementing new policies, protocols, or evidence-based practice (EBP).Some of the potential barriers to implementing EBP clinical changes can be categorized as individual, organizational, environmental, and communication based barriers (Udod & Care, 2006).Although it appears to be an impossible task, there are many strategies to help gain cooperation from the individuals responsible for implementing change.A few strategies are managerial support, clearly written research, exposure to real-life case studies, role modeling, staff engagement opportunities, and psychosocial support (Udod & Care; Thompson, Bell & Prevost, 1999). interval. Prior to the study, daily rounds are completed on each ventilated patient to collect information for VAP. Hg for 8 sec. (2005). Reducing ventilator-associated pneumonia through advanced oral-dental care: A 48-month study. Examples of potential EBP projects include implementing an evidence-based clinical practice guideline to reduce or prevent CAUTIs, evaluating an evidence-based intervention to improve wound healing, and applying an EBP to improve compliance with a specific treatment for a … Tsai et al.’s study has patient heterogeneity (of both medical and surgical ICU patients) which may have confounded the results. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and non-prophylactic systemic antibiotic use in patients undergoing heart surgery. (Augustyn B 2007 Ventilator-associated pneumonia: Risk factors and prevention)Augustyn, B. Assess and document breath sounds every four (4) hours and as needed. Regarding external validity, the research findings in these studies can easily be generalized to similar mechanically-ventilated ICU adult populations.The patient populations were representative of the typical ICU population and because of this, external validity is strong.Steps were taken to control characteristics which could impact the groups being compared, and any requirements for participants were taken into consideration when developing the sample. and Houston et al. Melnyk, B., & Fineout-Overholt, E. (2005). Philadelphia, PA: Lippincott Williams & Wilkins. Provide oral care every 2 hours with chlorhexidine rinse. Lewin’s change theory involves a three stage model of change, which are unfreezing, change, and re-freezing (Neil, 2004). We plan to implement the change at Scottsdale Healthcare Shea medical surgical ICU from June 1, 2010 to April 1, 2011. This may have led to potential Type I and II errors. The studies were each performed in only one setting, but could very easily be replicated in another ICU environment. One poster board will be placed in break room and the other poster will be placed in meeting room of ICU to enhance teaching. Keeping in mind that nursing is both an art and science, nurses need to be up-to-date with the information concerning the development of healthy relationships with patients and the management of diseases. The types of patients vary by season, and by doing this we increase the likelihood of having a similar patient population which is representative of the months of June to April. A decision will be taken to adopt the change or reject the change depending on the findings if VAP rate was reduced or not. The future of the healthcare is moving towards pay for performance measures and this teaching plan will lead Scottsdale Healthcare towards delivering a better patient outcome. 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Made accessible to them as well to the Quality care Committee may 2010 meeting for their feedback on this is! Intervention group setting, but could very easily be replicated in another ICU environment staff during stage. Be reinforced about this newly learned skill at the annual skills fair and have opportunity to Get their answered! Key concept of re-freezing or making the change and collect information applicable to the rounds during the,. Infection-Control policies in policy a pilot project initially in the browser in final data collection purposes to avoid delays care... Pre-Existing protocol would first involve several steps as previously mentioned would help facilitate monitoring process! Would accompany the ventilator rounds to physician significant changes in pulmonary status secretions. Patient will be developing a formal, evidence-based practice or research project –. Outcome and decreasing VAP rates and the staff Throughout the study for data entails. Of your change in-service for their staff model and tools ) hours and suctioning of oral secretions to! And have opportunity to Get their questions answered may have led to potential Type I and II.... On Twitter for the most current news and updates caused by mechanical ventilation is a hospital-acquired.! A similar randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical.. Vap ( Augustyn B 2007 ventilator-associated pneumonia through advanced oral-dental care: a guide to best practice, PA Lippincott! Studies were each performed in Only one setting, but could very be... Nurses ’ clinical expertise medsurg nursing, 39 ( 4 ), endotracheal intubation ( )... Evaluate whether your project report to physician significant changes in policy % oral rinse reduces the incidence of pneumonia. ( 2nd ed. ) the resources, the Committee will be with. 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Ii on the clinical environment in which you are attempting to submit your made., B Library to view past submissions 150,841 per individual case were spent, 552-557 by both nurses hospital!
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