Developing and Evaluating New Practice Approaches Summary of the Practice Issue and Proposed EBP Strategies It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care (White, Dudley-Brown & Terharr, 2016). One of the issues that affects nursing practice is long intensive care unit (ICU) admission of critical care patients. Extended stay in intensive care is a significant practice problem in health care. There are many risks that face patients who are admitted in ICU for an extended period of time. Longer hospital admission in the ICU has been associated with negative patient outcomes and experiences. The longer patients are admitted in intensive care, the higher the chances of mortality and hospital readmission (Denehy, Lanphere & Needham, 2017). Patients’ personal experiences in care are also more negative when they stay in ICU for a long period of time. Therefore, it is important to use EBP solutions to improve the experiences and outcomes of these patients. The proposed solution for this practice issue is the mobilization of patients. Research shows that early mobilization of critical care patients can have a positive effect on their healthcare experiences and outcomes. Therefore, it is recommended that nurses increase their frequency of mobilizing patients from time to time to speed up their recovery. The theoretical foundation for this solution is the theory of planned behavior. This is a psychological theory arguing that people’s perceptions and beliefs influence their behavioral reactions to certain phenomena. Mobilizing the patients will help them to have a positive view of their recovery; hence, this will enhance their attitudes towards their health and help to speed up their recovery process. The Potential Economic Impact of the Suggested Strategies The main economic impact of the recommended EBP strategies for improving ICU experiences and outcomes is the need for new personnel. According to Lord et al. (2013), early mobilization of the critical care patients may generate substantial clinical improvements in ICU patients and reduce costs to hospitals, payers, and capitated health care delivery systems. Even when the expected clinical effectiveness of an early mobilized program is reduced by 20% the estimated net present value was positive by the second year of the program. The ICU I work for has 32 beds which equals 32 patients who do require early mobilization to improve their health outcomes. This procedure, on the other hand, will require the nurses to spend a lot of time with the patients to help them. This, on top of the low nurse to patient ratio in many hospitals as well as my unit, means that nurses will experience more burnout or be unable to perform the procedures effectively, especially the minimum of three times a day per patient per twelve-hour shift. Therefore, for my hospital to implement the procedures will need to invest in more personnel, which will mean that more financial resources will be spent on managing the workforce. How can the new Strategies Improve Healthcare Quality? However, the new strategy of mobilization has the potential to improve the quality of care for intensive care patients. First, mobilization helps to reduce muscle fatigue. The patients who are critically ill spend a lot of their time in bed, which increased their muscle atrophy (Denehy et al., 2017). Early mobilization of the critical care patient will also help with the reduction in airway, pulmonary, and vascular complications; their early mobility can also significantly reduce certain complications such as re-intubation rates, pneumonia, pneumothorax, and DVT (Denehy et al., 2017). Most importantly, the early mobilization of patients has the potential to reduce the rates of mortality and hospital readmissions (Denehy et al., 2017). Longer hospital stays have been associated with these two factors. Therefore, if the mobilization is done, patients will have a chance to experience positive outcomes. Generally, these strategies will help to enhance the experiences of patients admitted in intensive care. References Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten reasons why ICU patients should be mobilized early. Intensive care medicine, 43(1), 86-90. Lord, R. K., Mayhew, C. R., Korupolu, R., Mantheiy, E. C., Friedman, M. A., Palmer, J. B., & Needham, D. M. (2013). ICU early physical rehabilitation programs: financial modeling of cost savings. Critical care medicine, 41(3), 717-724. White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

Advocating for New Practice Approaches Through Policy

 

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.”
—Florence Nightingale

Through the policy process, nurses can put their feelings—as well as their experiences and expertise—into actions that create results. In this course, you have been honing your skills for critically assessing evidence with the purpose of improving practice and developing new practice approaches. As a DNP-prepared nurse, you can influence health care outcomes at the population or aggregate level. Leading policy development to address health care concerns is a vital way to achieve this.

 

For the past several weeks, you have been focusing on a health care issue of interest to you for your EBP Project. For this Discussion, consider how you could lead policy development in support of a proposed evidence-based practice approach that addresses that issue and is designed to promote quality.

 

Reference: Nursing Schools. (2012). 100 entertaining and inspiring quotes for nurses. Retrieved from http://www.nursingschools.net/blog/2010/06/100-entertaining-inspiring-quotes-for-nurses/

 

 

To prepare:

Select one of the new practices approaches you developed for the Week 6 Discussion (See attached file)
Review the Ridenour and Trautman (2009) and Stokowski et al. (2010) articles listed in the Learning Resources. Assess the strategies for engaging in the policy process.
Consider the barriers to using evidence to affect changes in health care policy discussed in the course text.
Brainstorm ideas for leading policy development related to your suggested practice approach, as well as ideas for addressing those barriers.
By tomorrow Wednesday 10/10/18 at 12 pm, write a minimum of 550 words essays in APA format with at least 3 references (see attached file) from the list of REQUIRED READINGS below. Include the level one headers as numbered below:

 

Post a cohesive response that addresses the following:

 

1) Identify your proposed practice approach in the first line of your posting (See my PIICOT question below).

 

2) How would you lead policy development for your selected issue?

 

3) What strategies could you use to overcome barriers you may encounter while engaging policy makers? (Select three or more strategies to focus on in your posting.)

 

 

Required Readings

 

 

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

Chapter 4, “Translation of Evidence to Improve Clinical Outcomes”
Chapter 5, “Translation of Evidence for Improving Safety and Quality”
Chapter 7, “Translation of Evidence for Health Policy” (See attached file)

Andermann, A., Pang, T., Newton, J.T., Davis, A., & Panisset, U. (2016). Evidence for health II: Overcoming barriers to using evidence in policy and practice. Health Research Policy and Systems, 14 (17) doi 10.1186/s12961-016-0086-3. (see attached file).

 

 

Catallo, C. & Sidani, S. The self-assessment for organizational capacity instrument for evidence-informed health policy: Preliminary reliability and validity of an instrument (2014). Worldviews on Evidence-Based Nursing, 11(1), 35–45. (see attached file).

 

 

Malterud, K., Bjelland, K., & Elvbakken, K.T. (Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and Systems, 14 (15) doi 10.1186/s12961-016-0088-1 (see attached file).

 

 

Rehfuess, E.A., Durao, S., Kyamanywa, P., Meerpohl, J. J., Young, T., & Rohwer, A. (2016). An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries, Policy & Practice, 94, 297–305 doi: http://dx.doi.org/10.2471/BLT.15.162966 (see attached file).

 

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

 

P: Adult patients

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

 

 

Due tomorrow 10/10/18 by 12:00 pm noon. Thanks!

identify a problem or concern in your community, organization