Evidence-Based Practice Proposal: Section G: Evaluation of Process.

In 500-750 words (not including the title page and reference page), develop an evaluation plan to be included in your final evidence-based practice project. Provide the following criteria in the evaluation, making sure it is comprehensive and concise: Evidence-Based Practice Proposal: Section G: Evaluation of Process.

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Describe the rationale for the methods used in collecting the outcome data.
Describe the ways in which the outcome measures evaluate the extent to which the project objectives are achieved.
Describe how the outcomes will be measured and evaluated based on the evidence. Address validity, reliability, and applicability.
Describe strategies to take if outcomes do not provide positive results.
Describe implications for practice and future research.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Introduction

This paper describes the methods used to evaluate outcomes after implementing BSR to improve patients’ safety, quality of care, and nurse satisfaction in an acute care setting. It provides the rationale for data collection methods, explains how the outcome measures will determine the achievement of project objectives, and highlights outcome evaluation methods. The author will also explain the steps to take if outcomes do not provide the expected outcomes and the implications for practice and future research.  Evaluation forms an integral part of the EBP implementation process as it informs decisions on areas to make adjustments on research for more successful outcomes, and provides influences future initiatives. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

The rationale for Data Collection Methods

The author will collect pre and post-implementation data on nurses’ satisfaction using a satisfaction survey form. According to Ponto (2015), surveys offer an easy way to collect, compile, and analyze data from a huge sample size, which guarantees a more accurate sample to make conclusions. Since the survey will maintain anonymity, participants (nurses) will likely be more candid with the responses, which increases the reliability of findings. The outcomes of the nurse satisfaction survey will help to improve performance in practice, as it will help to identify areas that need improvement. The author will also use morbidity and mortality forms, incident report forms, and patient experience questionnaire to collect data on mortalities, morbidities, medication errors and related adverse events, and patient experiences. Apart from being affordable and practical, a researcher can use quantitative data collected using questionnaires to test hypotheses or create new theories (Young, 2016). In this EBP, data collected using questionnaires will help to determine the quality of care and safety of patients. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

How Outcome Measures Evaluate the Extent of Attaining Objectives

The primary purpose of this EBP project, which also describes the outcome measure, is increased nurse satisfaction, patient safety, and quality of care.  The author will use quantitative measures to evaluate the extent of achievement of objectives. This will primarily involve making comparisons and correlations between pre and post-implementation data using statistical tests. The correlations will particularly be between nurse satisfaction, patient safety, and quality of care before and after implementing BSR.

Measuring and Evaluating Outcomes

The author will use ANOVA   to determine the validity and reliability of the outcomes of this EBP project. The major variables being tested in this EBP project are patient safety, nurse satisfaction, and quality of care. Post-implementation, the author anticipates that there will be an increase in patient safety, nurse satisfaction, and quality of care. According to Boisgontier & Cheval (2016), ANOVA statistical is easier to use when analyzing the variations present in different group samples. In this EBP, it will be easier to use ANOVA   to assess the correlations and confirm the reliability, applicability, and validity of findings in clinical practice. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Strategies If Outcomes Do Not Provide Positive Results

If the outcomes fail to provide the expected outcomes,   it will be important to identify the specific areas where gaps exist and determine whether the gaps had a significant impact on the outcomes. The author will then proceed to make relevant recommendations on how to improve the research or how to conduct further research. This implies that other researchers can conduct the same research using a different approach but incorporating the proposed recommendations. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Implications for Practice and Future Research

Nurses should implement BSR over traditional reporting to increase the quality of care, patient safety, nurse, and patient satisfaction in clinical practice. However, nurses must understand that implementing BSR is time-consuming and requires a thorough examination of the current environment, organization culture, and human resources (Natafgi et al., 2017). To increase implementation success, nurses should follow the five-step approach with nurses who possess innovation characteristics as the frontline staff. Nurse leadership must have a perfect understanding of mentorship, process management, and relationship-building skills, and a well-organized and executed implementation process (Dorvil, 2018). Further studies should focus on strategies to improve BSR given its comprehensive nature and coordination-related challenges during shift handover. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Conclusion

Evaluation forms an integral part of the EBP implementation process as it informs decisions on areas to make adjustments on research for more successful outcomes, and provides influences future initiatives. The author will collect pre and post-implementation data on nurses’ satisfaction using a satisfaction survey form, and morbidity and mortality forms, incident report forms, and patient experience questionnaires to collect mortalities, morbidities, medication errors, and related adverse events, and patient experiences data. Post-implementation, the author anticipates that there will be an increase in patient safety, nurse satisfaction, and quality of care and will use ANOVA statistical test to make correlations between pre and post-implementation data on the aforementioned variables. If the outcomes do not provide the expected results, the author will proceed to make relevant recommendations on how to improve the research and how to conduct further research. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Evidence-Based Practice Proposal – Section F: Implementation Plan

Setting and Access

The author will implement this EBP project in a regional-based healthcare organization that provides inpatient care to an ethnically diverse population comprising of adults, children, and elderly patients. According to Doody & Noonan (2016), this will encourage close continuous monitoring and evaluation of outcomes. The healthcare staff involved in the project will comprise of nurses, physicians, and ward clerks working in multidisciplinary teams, but nurses will comprise the majority in the implementation teams. Since bedside shift reporting may impact a patient’s privacy, each patient will sign a consent form to demonstrate that they agree with the proposed evidence-based idea. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Project Timeline

The implementation of this EBP project will take 12 weeks bearing in mind that the project does not have numerous facets to consider. In the initial week will be a pre-assessment to determine the knowledge of staff members on bedside shift reports. The outcomes of the initial training will inform the training needs based on identified knowledge gaps. In the second week, there will be staff training and a post-assessment to determine the grasp of relevant content. In the third week, staff will progress to form a multidisciplinary team that will oversee the implementation process within the organization. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

The team will comprise of nurses, physicians, physiotherapists, radiographers, and dieticians. Each member will have specific roles and responsibilities for clear communication. In week four to week six, the members of the multidisciplinary team will search for literature that supports the proposed evidence-based idea, conduct a critical appraisal and synthesis. Week seven to week eight will be a pilot change of the proposed evidence-based idea in the pediatric and med-surge units. The pilot test will help to determine the need for any modifications before the actual implementation. Week nine to week ten will be the actual implementation of the proposed EBP change. In week ten, the multidisciplinary implementation team will develop clinical practice guidelines and policies on bedside shift reports that all staff must adhere to during sift handover. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Resources

Several resources are integral for the success of the proposed evidence-based project. A key facet of this component is human resources comprising of competent nurses, physicians, dieticians, radiographers and physiotherapists to ensure the implementation of the proposed evidence-based idea in the best way for successful outcomes (Dorvil, 2018). There will also be a need for materials on bedside shift reports for both patients and healthcare providers. Implementation will further require an EMR (Electronic Medical Record) and Whiteboards which are already available.

Methods and Instruments

The author will use a survey to conduct the pre and post-assessment of staff to determine knowledge gaps on bedside shift report. Surveys are affordable, easy to build, and implement compared to other instruments for collecting data (Ponto, 2015). The organization will hire an external quality improvement trainer to conduct training based on the identified knowledge gaps. Post-implementation, the author will collect data using incident report forms, patient and nurse satisfaction survey forms. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Delivering the Intervention

The author will deliver the intervention through a one-week training of healthcare staff, and posters. There will be four training sessions each session lasting forty-five minutes. The training will comprise of content on bedside shift report as documented in the clinical practice guidelines. On the other hand, there will be staff-specific and patient-specific posters. The latter will contain details on the roles of patients, advantages, and expectations of bedside shift report while the former will contain staff roles, expectations, requirements, and the process of bedside shift report. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Data Collection Plan

Nurses heading each inpatient unit will collect data in two phases; pre and post-implementation phases, since the data will be readily available on whiteboards and EMRs. In both phases, the nurse-in-charge will collect data on adverse events, patient outcomes, and clinical alerts such as precautions on infection control, and allergies from the communication board in each patient’s room. Data collected will also include nurses’ perceptions on the care given to patients, and treatment outcomes will be managed by a data manager and analyzed using ANOVA

Addressing Potential Barriers, Facilitators, and Challenges

Most healthcare staff perceive bedside shift report to be a time-consuming process. Since it is a new change initiative, there are high chances that there will be much resistance from staff. However, to prevent or reduce the impact of resistance from staff, there will be an open and effective communication plan, identification, and addressing the root causes of resistance (Dorvil, 2018). The proposed evidence-based project is highly feasible since currently, the organization has adequate staff, an EMR, and whiteboards. The only resource that will incur costs is hiring an external trainer. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

Maintenance Plan

The implementation team will conduct ongoing quarterly meetings to evaluate whether the project attains the expected outcomes. This team will obtain feedback through questionnaires administered to nurses and patients, and reports tabled during meetings.  The team will use the outcomes to make modifications and improve outcomes.

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: Section G: Evaluation of Process.

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. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

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: Section G: Evaluation of Process.

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. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

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: Section G: Evaluation of Process.

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. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

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: Section G: Evaluation of Process.

Organizational Culture and Readiness Assessment

The organizational readiness assessment used to asses my organization is a question-based survey and prioritized survey.  The survey used is called Ready, Set, Change! The purpose of this tool is to guide you through the process of selecting a valid and reliable readiness assessment measure that is appropriate for your organizational setting (Jones,Amataykul, Kotter,Graham, Fixsen, Bartholomew, . . . J. Ritchie, 2014).  This tool is a multi-phase approach.  Phase one measures the key readiness with systemic review developed for the healthcare setting.  Phase two study investigators and field experts were engaged in a mapping exercise to categorize individual items of included measures according to four key readiness constructs (Jones, 2014).  The categories include individual psychological (IP), individual structural (IS), organizational psychological (OP), and organizational structural (OS).  IP are the beliefs that an individual hold regarding potential change and recognizing an issue.  IS is related to the knowledge, skill, and ability for an individual to implement change.  OP are organizational members beliefs related to the commitment and collected efficacy (Jones, 2014).  OS are Considerations related to human and material resources, communication channels, and formal policy (Jones, 2014).Phase three is the stakeholder panel which includes a variety of disciplines for recommendation of measures and change. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

The results of readiness determine several different things.  The organization readiness for change to implement EBP is lacking in the motivation for change.  This determines that the organization need to define its mission for change and the specific goals.  The organization need to evaluate the performance and improve the communication and skills with staff.  The assessment also suggest that more training is needed in the organization.  Training to implement EBP includes adequate communication and management supervisor reasonability’s.

The background is acute care hospitals before the implementation of nursing EBP initiatives.  Project barriers inside a bias with self-reporting.  Self-reporting raises some issues with giving accurate and honest answers versus not socially desirable responses (Thiel, 2008).  This can affect the survey negatively, with the information not being accurate. Evidence-Based Practice Proposal: Section G: Evaluation of Process.

The objective of the study is to assess registered nurses’ readiness for EBP in acute care hospitals.  The surveys measure contains a total of 118 items, of which 30 items (25%) are designed to assess OrganizationalPsychological priorities (Jones, 2014).  This means that even with the barriers that are lacked the organization can implement EBP in a timely manner without affecting other resources of the organization.  The respondents determine their EBP knowledge as moderate with positive attitudes towards them as well.  The way to integrate clinical inquiry is top support the staff and their questions about the readiness to implement EBP.  Communicate, offer resources, and listen to the question’s nurses have about EBP and the implementation process.

Evidence-Based Practice Proposal: Section G: Evaluation of Process.