NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?

Main Post – Evidence-Based Practice

   Introduction  

Evidence-Based practice is the foundation of patient safety.   The Joint Commission (2021) is an accrediting body that directly evaluates hospital functions by “offering unbiased assessment of … quality achievement in patient care and safety,” which assists organizations in reaching goals and receiving reimbursement for care (para. 1).  Since the Affordable Care Act in 2010, an evidence-based practice directly influences hospital requirements and nursing goals to achieve the quadruple aim (Laureate Education, 2018). NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? The Joint Commission places a specific focus each year on a set of National Patient Safety goals that help improve population health, patient experience, lower healthcare costs, and improve healthcare workers’ work-life (Laureate Education, 2018).

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National Patient Safety Goals 

In 2021, there are eleven main safety goals broken down into seven main categories for hospitals. On jointcomission.org, there is a link to a simplified version of the goals and an entire chapter devoted to a detailed description. According to Kim et al. (2016), “the actual implementation of EBP has been inconsistent due to barriers related to nursing workload, lack of organizational support, lack of EBP knowledge and skills, and poor attitudes toward EBP” (p. 340).  The Joint Commission’s (2021a) Goals provide the organizational support required to help achieve objectives designed to accomplish evidence-based practice.  For example, one of the goals is to Prevent Infection. Within this goal, the Joint Commission (2021a) has emphasized using Hand Hygiene. Lenggono et al. (2019) share in their research that “handwashing has a proven benefit in preventing transmission of infection, yet compliance, … especially in intensive care units, ranges between 28% and 74% (p. 268). The evidence states that washing your hands is critical, but hand hygiene is suboptimal and still causing infections. The Joint Commission uses this data to pinpoint a place of potential improvement within hospitals utilizing evidence to promote increased safety.

                                                                                             Conclusion

It is not uncommon for accrediting agencies such as the Joint Commission to have a bad reputation.  Organizations and their employees can feel frustrated about the people exposing errors and expecting perfection.  However, when you understand their role in creating safe environments where evidence-based practice is applied, their job is critical to achieving the best medical care for our patients.   Their dedication to changing the culture within hospitals is enough to change perceptions and promote respect.

References 

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice         implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on

Evidence-Based Nursing, 13(5), 340–348.

Laureate Education (Producer). (2018). Evidence-based Practice and the Quadruple Aim [Video file]. Baltimore, MD: Author.

Lenggono, K., Sholihah, Q., Djati, M. S., Putranto, N., Tangkas, T., Hastuti, A. P., Adi P., D. K., & Aminah, T. (2019). Quality

Audit Analysis of the Implementation of Hand Washing 5 Moments 6 Steps for Doctors and Nurses with the Incidence of

Plebitis in the Hospital. Systematic Reviews in Pharmacy, 11(1), 268–272. https://doi.org/10.5530/srp.2020.1.34

The Joint Commission. (2021). Why The Joint Commission. https://www.jointcommission.org/accreditation-and-certification/why-

the-joint-commission/

The Joint Commission. (2021a). 2021 Hospital National Patient Safety Goals.

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/simplified-2021-hap-

npsg-goals-final-11420.pdf

NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? Sample response post

Very informative! I can see that we are on the same page with the ( TJC) Joint Commission.  I liked the example of handwashing. This has become most relative to Global Health recently. As far as a TJC is concerned, a  3 step Tracer Methodology is used for the accreditation process. This change in process was made in 2014. This will include the delivery of care ( patient tracer), the process utilized ( department /radiology/surgery/ed), and finally, the system ( x-ray, stroke protocol, time out).  The observations of compliance are then used as feedback for a visit. This is where EBP is essential. Hand hygiene must be done correctly, or an infection can be initiated to the patient inadvertently. Any observation by surveyors of individual failure to perform hand hygiene in the process of direct patient care will be cited as a deficiency resulting in a Requirement for Improvement (RFI) under Infection Prevention and Control (IC) Standard IC.02.01.01, EP 2: “The [organization] uses standard precautions, including the use of personal protective equipment, to reduce the risk of infection.” Surveyors also will continue surveying an organization’s hand hygiene program to National Patient Safety Goal NPSG.07.01.01. (see also the December 2017 issue of the Perspectives Newsletter). https://jointcommission.org

My understanding is, it took a Global Pandemic for the General Public to trust in the hospital process.  EBP does get push back from Nurses lacking the understanding that EBP was the direct pathway to achieving quality and safety. The misconception is there is no support. NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? As knowledgeable clinicians, it is important to question, apply and grow our peers. To keep free from judgment zone work environment will expedite the application of EBP to achieve quality patient outcomes.

References

Melnyk, B. (2019). Evidence-Based Practice in Nursing And Healthcare A Guide to Best Practice (Fourth ed.). Wolters Kluwer https://jointcommission.org

NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? Peer Response 2

Your discussion post on patient safety through evidence-based practice indicates that the Joint Commission utilizes EBP. The utilization of EBP is supported by the existence of a spirit of inquiry among nurses. According to Melnyk and Fineout-Overholt, (2018), a spirit of inquiry among nurses is the critical step towards attaining the use of EBP. However, the spirit of inquiry cannot be functional in an organization that lacks a supportive culture for EBP. Joint Commission has taken the initial step of supporting evidence-based practice by creating a supportive culture through patient safety goals. The use of EBP is critical towards achieving patient safety. For example, patient safety is supported by an emphasis on preventing infection (The Joint Commission, 2021) NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?. The goals of patient safety enhance the health outcomes, which the EBP supports. Your discussion post provides a clear explanation of the goals of patient safety supported by EBP.

The availability of the EBP culture within the Joint Commission shows that the Joint Commission has a strong EBP belief. According to Kim et al., 2016, a strong belief system of EBP leads to the implementation of EBP. Therefore, the organization can easily implement EBP within its setting through the goals that show specific steps towards patient safety. EBP is an essential contributor towards attaining the quadruple aim of care, cost, and meaning in work (Sikka et al., 2015). Healthcare providers working within the Joint Commission framework implement the EBP, which leads to the achievement of the quadruple aim. Implementing EBP by the Joint Commission has been essential in boosting patient outcomes within the healthcare system.

References

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=2&sid=560b8646-a181-49b0-937e-4026d53e80a0%40sdc-v-sessmgr03&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=000388307700002&db=edswsc

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?.

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608–610. https://www-proquest-com.ezp.waldenulibrary.org/docview/1778837907?accountid=14872

The Joint Commission. (2021). Why The Joint Commission. https://www.jointcommission.org/accreditation-and-certification/why-the-joint-commission/

NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? sample response 3

What an interesting post about the importance of safety through hand washing in patient care. When providing care in the field of medicine, it only makes sense to practice based on evidence-base practice.  Although often times, when looking into the reasons behind various methods for assessing, diagnosing, and treating, there is no science to back it up.  Many providers in the field of dermatology practice using the same treatment options for specific diagnoses as they have used for years, without making the necessary changes based on current research and data available.  As medicine is ever growing and changing and research is advancing, the way that care is provided must grow and change as well.  By using evidence-based medicine and staying current on best practices, optimal care can be given.  While skills like examination and taking a comprehensive history are essential to giving the best care, maintaining relevant and up-to-date knowledge through evidence-based practice is also vital (Williams,2014).  Providing medical care without adapting to current best practices is doing patients a disservice.

Dermatology like all specialties in medicine possesses its own “gold standards” of care.  When a patient is diagnosed with melanoma, many factors play into determining the optimal methods for treatment.  Various skin conditions can be treated in a variety of ways through the utilization of surgical excisions, medications, radiation, chemotherapy, light therapy, etc.

NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? The type of skin cancer melanoma is graded based on its Breslow depth, mitotic rate, size, and overall degree of severity.  These factors play a role along with patient age and history in determining the best possible method of treatment for the best patient outcome.  The purpose of specifically sampling from sentinel lymph nodes is that they are the first group of lymph nodes to receive lymphatic drainage from a tumor to a particular area (Prieto & Curry, 2017).  This makes them a reliable indicator of determining whether the melanoma has spread or not.  Patients with positive sentinel lymph nodes have a poorer prognosis than if they are negative.  Early diagnosis of melanoma and the presence of metastases is key to reducing morbidity and mortality rates (Wiesner & Zbyszewski, 2018).  In contrast, some recent studies have come out showing that sentinel lymph node biopsies are unnecessary and not an accurate predictor of metastases and survival rates. This is why evidence-based practice in science is important.

References

Prieto, V. G., & Curry, J. A. (2017). Sentinel Lymph Node Biopsy in Melanoma Pathology. Retrieved from https://emedicine.medscape.com/article/1977004-overview

Wiesner, T., & Zbyszewski, A. (2018). Progress in the diagnosis and therapy of melanoma. British Journal of Dermatology, 178(1), 12-14. doi:10.1111/bjd.16110 NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?

Williams, H. C. (2014). Strengths and Limitations of Evidence-Based Dermatology. Indian Journal Of Dermatology, 59(2), 127-133.

Discussion: Where in the World Is Evidence-Based Practice?

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

By Day 3 of Week 1

By Day 6 of Week 1

Introduction

Evidence based practice drives the decisions for how we deliver care to patients in the healthcare setting. This research provides concrete evidence to backup the decisions for why we provide patient care the way that we currently do. Implementation of the data that is supported by evidence-based practice is crucial for direct patient care staff to incorporate into the care that they deliver NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?. “Although leaders influence the organizational culture, they also play an important role in supporting implementation of EBP and other innovative practices” (Kim et al., 2016, p. 341). “The staff nurse is a critical link in bringing evidence-based changes into clinical practice” (Crabtree et al., 2016, p. 172). The healthcare organization that I chose to review for evidence-based practice information is the World Health Organization (WHO).

World Health Organization and EBP

I found that evidence-based practice information is spread throughout the World Health Organization’s website. WHO has fact sheets and official publications for a wide range of health topics that are created using evidence based practice research data that are available on the website under the health topics tab. The website also contains data collection tools that WHO utilizes in order to collect and analyze information on current topics that are affecting global health that can be found in the data tab. WHO appears to be grounded in evidence based practice by utilizing this method to support the data for the health topics covered that are presented on their website. “A core component of WHO’s support to Member States is to strengthen their capacity to collect, compile, manage, analyze and use health data mainly derived from population-based sources and institution-based sources” (Data Collection and Analysis Tools- WHO, n.d., para. 1) NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?.

My Perception on WHO

Reviewing the website for evidence-based practice data has changed my view on the World Health Organization. I did not realize how much research WHO conducted in ordered to support their claims on the health problems that we face globally. Seeing that the website has data to validate the claims they make on certain health topics and participates heavily in data collection for analyzation helps me to gain trust in their website and the work that the World Health Organization does to contribute to the health problems the world faces NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?.

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing

engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2),

172–175. doi:10.1111/wvn.12126

Data Collection and Analysis Tools – WHO. (n.d.). Retrieved March 01, 2021, from

https://www.who.int/data/data-collection-tools

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016).

Predictors of evidence-based practice implementation, job satisfaction, and group cohesion

among regional fellowship program participants. Worldviews on Evidence-Based Nursing,

          13(5), 340–348. doi:10.1111/wvn.12171 NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?

NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice? sample response

I know you have covered a lot in your efforts to explain the EBP of the World Health Organization (WHO). Your research findings have equipped me with a wealth of knowledge, and I thank you for sharing it in an enjoyable way to read. I reviewed the WHO website and am delighted to add what I found interesting.

The world health organization evaluates the global health population. They analyze how people get ill, die and how the health care systems respond. The organization employs a strategy called the International classification, which standardizes health data such as recommendations for EBP in healthcare. Many health officials utilize the international classification, including the government. Researchers also use the tool to collaborate with people worldwide when conducting research (“Classifications,” n.d.) NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?.

The world health organization endorses EBP in healthcare. Research has proved that the WHO supports nurses and midwives to promote evidence-based practice in Europe. WHO hones its foundations in the Region to help health care policymakers and professionals facilitating evidence-based practice in nursing and midwifery (“Facilitating evidence-based practice in nursing and midwifery in the WHO European region (2017),” 2017. NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?)

References

Classifications. (n.d.). WHO | World Health Organization. https://www.who.int/standards/classifications

Facilitating evidence-based practice in nursing and midwifery in the WHO European region (2017). (2017, November 7). WHO/Europe. https://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/publications/2017/facilitating-evidence-based-practice-in-nursing-and-midwifery-in-the-who-european-region-2017  NURS – 6052 week 1 Discussion: Where in the World Is Evidence-Based Practice?