Evidence-Based Practice Proposal.

PICO Question

In an acute care hospital (Population), does bedside shift report (Intervention) compared to traditional report at the nurses’ station (Comparison) improve quality of care, safety and nursing satisfaction (Outcome)?Evidence-Based Practice Proposal.

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Proposed solution:

Implementing bedside shift report during shift handoff on patients.

References

American Nurses Association.(2015). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Bressan, V., Cadorin, L., Stevanin, S., &Palese, A. (2019).Patients experiences of bedside handover: findings from a meta‐synthesis. Scandinavian Journal of Caring Sciences, 33(3), 556–568.doi: 10.1111/scs.12673

Bressan, V., Cadorin, L., Pellegrinet, D., Bulfone, G., Stevanin, S., &Palese, A. (2019). Bedside shift handover implementation quantitative evidence: Findings from a scoping review. Journal of Nursing Management, 27(4), 815–832. doi: 10.1111/jonm.12746

Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing Management , 49(6), 20–25. doi: 10.1097/01.numa.0000533770.12758.44

Malfait, S., Eeckloo, K., Lust, E., Biesen, W. V., &Hecke, A. V. (2016). Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed-method research protocol. Journal of Advanced Nursing, 73(2), 482–494. doi: 10.1111/jan.13154

Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, S. R., Donnelly, J., …Riesenberg, L. A. (2016). Bedside Shift-to-Shift Handoffs. Journal of Nursing Care Quality, 31(1), 54–60. doi: 10.1097/ncq.0000000000000142

Schmidt, N., Brown, J. M. Evidence-Based Practice for Nurses. [Western Governors University]. Retrieved from https://wgu.vitalsource.com/#/books/9781284155471/

Boshart, B., Knowlton, M., & Whichello, R. (2016).Re-implementing bedside shift report at a community hospital. Nursing Management (Springhouse),47(12), 52-55. doi:10.1097/01.numa.0000508265.42099.cc

Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing Management (Springhouse),49(6), 20-25. doi:10.1097/01.numa.0000533770.12758.44

Lincoln, N., MS, RN, APRN-BC, CCRN. (2016, July 13). Hardwiring Standardized Nursing Bedside Handoff to Improve Patient Safety and Satisfaction[Scholarly project]. In Virginia Henderson Global Nursing E-Repository. Retrieved June 13, 2019, from https://sigma.nursingrepository.org/handle/10755/616293

Natafgi, N., Zhu, X., Baloh, J., Vellinga, K., Vaughn, T., & Ward, M. M. (2017).Critical Access Hospital Use of TeamSTEPPS to Implement Shift-Change Handoff Communication. Journal of Nursing Care Quality,32(1), 77-86. doi:10.1097/ncq.0000000000000203

Sand-Jecklin, K., & Sherman, J. (2014).A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing,23(19-20), 2854-2863. doi:10.1111/jocn.12575

Walsh, J., Messmer, P. R., Hetzler, K., Obrien, D. J., &Winningham, B. A. (2018).Standardizing the Bedside Report to Promote Nurse Accountability and Work Effectiveness. The Journal of Continuing Education in Nursing,49(10), 460-466. doi:10.3928/00220124-20180918-06

Williams, C. L. (2018). A Comparison of the Risks and Benefits of Nursing Bedside Shift Report vs. Traditional Shift Report: A Systematic Review of the Literature. International Journal of Studies in Nursing,3(2), 40-43. doi:10.20849/ijsn.v3i2.382

Selected Evidence-Based Practice Model

There are numerous theoretical and conceptual models used to implement EBP findings in clinical settings within healthcare organizations. To improve the chances of successful outcomes, a researcher must choose a suitable change model that aligns with the recommended EBP change. Change models represent the methodology of implementing an EBP idea by breaking the whole procedure into smaller and simpler steps. According to Nilsen (2015), apart from increasing the chances of a successful implementation, change models ensure the implementation process is complete, and provide a method to evaluate outcomes.Evidence-Based Practice Proposal.

Selected Change Model

The most appropriate change model selected by the author to guide the implementation of this EBP is the Iowa model of EBP as it is easy to comprehend and has proven to be effective in guiding the implementation of EBP in education settings and different healthcare organizations (Michele Farrington, Laffoon & Kealey, 2015). It is also worth mentioning that the Iowa model lays emphasis on interprofessional collaboration, incorporates inputs from an implementation team and an institution’s organizational culture. Before the actual implementation of an EBP, Iowa mode allows an implementation team to conduct a pilot test of the proposed evidence-based project. According to Buckwalter et al. (2017), the outcomes help to determine modifications and this decreases the chances of failure significantly post-implementation.

Applying the Iowa Model to The Implementation Plan

Iowa model of EBP has three points for making decisions. The first point is an organization determining if it should prioritize a proposed change. A problem or knowledge can trigger change (Buckwalter et al., 2017). In this healthcare organization, the problem of the reduced patient and staff satisfaction (nurses), and an increase in medical errors that decreased patient safety and the quality of care triggered the need for change. Reduced staff and patient satisfaction and a decrease in the quality of care and patient safety had a negative impact on the organization’s financial performance.Evidence-Based Practice Proposal.

According to Buckwalter et al. (2017), the next step is forming an interprofessional team comprising members from different health professionals who are directly and indirectly involved inpatient care. However, nurses will be the frontline champions of the proposed change since they spend more time with patients, are directly involved in patient care, and communicate with all members of interprofessional healthcare teams. To facilitate the implementation of this EBP project, the multidisciplinary implementation team will comprise of nurses, ward clerks, physician associates, and physicians.

This multidisciplinary implementation team will start by searching for current evidence using specific keywords in scientific databases on bedside shift handover. After ascertaining that the evidence collected is adequate, the team will proceed to critique and synthesize the evidence collected (Michele Farrington, Laffoon & Kealey, 2015). This implies that each member of the team should have the required evidence-based research skills to be able to search for literature, assess the level of evidence and quality of each study obtained. The process will also include identifying potential gaps that exist in the literature.

Based on the evidence obtained, the team will have to decide if it is adequate to support the implementation of the proposed evidence-based idea. If the team finds that the evidence is sufficient, it will spearhead the implementation of a pilot change in the organization. However, if the evidence will be inadequate, the team will consider using other available scientific evidence or proceed to conduct the lacking research.Evidence-Based Practice Proposal.

Should the interprofessional team implement the proposed change idea, the first step to follow will be to determine outcomes. This EBP purposes to increase patient safety, quality of care, and nurse satisfaction by implementing bedside shift handover. Therefore, the expected outcomes will be; increased patient and nurse satisfaction, increased patient safety, increased quality of care, and decreased medical errors.

The next step will be to develop policies and guidelines that describe how the bed-shift handover process will occur, the stakeholders involved, with their clear roles and responsibilities (Buckwalter et al., 2017). The guidelines and policies developed will include aspects such as the process and items of identifying patients, identification of clinical alerts, how to apply the ISBAR format to the handover process, and documentation in the EMR. The last step will be to evaluate outcomes to determine if the EBP has attained the desired outcomes with appropriate adjustments.

Conclusion

Research recommends the need to utilize change models when implementing evidence-based practice change in healthcare organizations to increase implementation success. Change models ensure the implementation process is complete, and provide a method to evaluate outcomes. Iowa model of EBP was the selected change model to guide the implementation of this EBP to increase nurse satisfaction, improve the quality of care, and safety of patients.Evidence-Based Practice Proposal.