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How to Arrange and Rearrange so the Pieces Fit Barriers to Implementation of Evidenced Based Practice. Vicki Good, RN MSN CCNS CENP Director of Nursing Practice Cox Healthcare System Springfield, MO. Objectives. Define implications of Evidence Based Practice to the Magnet Journey

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slide1

How to Arrange and Rearrange so the Pieces FitBarriers to Implementation of Evidenced Based Practice

Vicki Good, RN MSN CCNS CENP

Director of Nursing Practice

Cox Healthcare System

Springfield, MO

objectives
Objectives
  • Define implications of Evidence Based Practice to the Magnet Journey
  • Identify barriers preventing staff nurse engagement in Evidence Based Practice.
  • Demonstrate processes to overcome actual and perceived barriers to Evidence Based Practice.
the challenge
The Challenge . . .
  • Average period of time between discovery of better treatment and implementation in patient care is 17 years.
  • When staff consult others within their own professional discipline, they used 67 sources of data before changing practice.
  • The barriers to implementing Evidence Based Practice have not changed through the years.
challenge need for information
Challenge: Need for Information

“The findings of the 2006 Evidence-based Practice Research Study suggest that most nurses consistently

need to find, access and provide care based on EBP. Nearly 2 in 3 (64%) indicate that this need arises at least weekly and 9 in 10 (90%) say it happens at least occasionally.”

Compliments of Zynx Care

Source: Sigma Theta Tau International, 2006 EPB Study

ancc 14 forces of magnetism
ANCC 14 Forces of Magnetism
  • Quality of Nursing Leadership
  • Organizational Structure
  • Management Style
  • Personnel Policies & Programs
  • Professional Models of Care
  • Quality of Care
  • Quality Improvement
  • Consultation & Resources
  • Autonomy
  • Community & Healthcare Organization
  • Nurses as Teachers
  • Image of Nursing
  • Interdisciplinary Relationships
  • Professional Development
slide8

Challenge: Time

  • No protected time at work to read, review, or implement Evidence Based Practice.
    • Most productivity standards now include all nursing time whether in direct patient care or in meetings, etc.
  • Home time is “reserved” for non-work related activities, especially with younger worker.
challenge time

Time

  • Analysis
  • Accessibility
Challenge: Time

Why is it difficult for nurses to utilize evidence in their practice?

Compliments of Zynx Care

Source: Sigma Theta Tau International, 2006 EPB Study

empowerment
Empowerment
  • Perception that nursing lacks authority and cooperation of medical staff and/or administration to change practice.
  • Staff nurse participation in approval of policy/procedures, research, etc.
knowledge
Knowledge
  • Interpreting statistical/technical language
    • Skill & confidence
  • Access & knowledge of internet and library resources
    • Study by Wells, et al 2007, 76% never searched the internet; 58% never searched Medline
  • Lack of access to experts in Evidence Based Practice
how to overcome barriers
How to overcome Barriers?

Make Evidence Based Practice a part of every day life of the nurse

shared leadership
Shared Leadership
  • As Shared Leadership councils become more mature, require literature reviews for any change in practice, etc.
  • Empower the Shared Leadership structure to make change in practice.
  • Involve the Shared Leadership structure/council in the approval of changes to policies and procedures for patient care.
research internships
Research Internships
  • 6-9 months in length
  • Partnership between College/University and Hospital
  • Monthly or bi-weekly class with a clinical in research
  • Research project requirement
  • Graduate credit?
accessibility of information
Accessibility of Information

Direct link for staff to access Evidence Based Practice at their finger tips located in one place.

partnerships
Partnerships
  • Universities/Colleges
    • Joint appointments, adjunct faculty, etc
  • Professional Organizations
    • Practice Alerts
  • Industry
    • Vendors – both pharmaceuticals and equipment/supplies
partnership zynxcare
PartnershipZynxCare
  • Zynx and Sigma Theta Tau work collaboratively to support delivery of research and evidence to the bedside
  • Zynx clients can access educational and consulting resources to support the development of an evidence-based nursing culture
  • Partnership represents an endorsement of ZynxCare™ from highest level of professional nursing scholarship and leadership
zynxcare evidence based practice for the interdisciplinary team
ZynxCare: Evidence-Based Practice for the Interdisciplinary Team
  • Evidence-based interdisciplinary plan of care and clinical documentationcontent and content managementdesigned to support organizations in:
    • Implementing evidence based practice at the point of care
    • Standardizing clinical practice between and among disciplines
    • Efficiently deploying evidence-based content in paper, HTML, or EHR system
    • Achieving measurable results
zynxcare plan of care
ZynxCare™ Plan of Care

Blue Ribbons: Quality Measures

Shared language and coded concepts

with ZynxOrder™

Evidence Links

zynx evidence cap interdisciplinary
Zynx Evidence: CAP - Interdisciplinary

Evidence

supporting the interdisciplinary care team

vital signs frequency
Vital Signs Frequency

Performance Measures

supporting the interdisciplinary care team

vital sign frequency
Vital Sign Frequency
  • Patients with uncomplicated community-acquired pneumonia, no between-group difference in length of stay, mortality rate, number of ICU transfers or discharge destination between VS measurement assessed every 4-6 hours as compared to VS assessment ever 8-12 hours
chest physiotherapy
Chest Physiotherapy
  • For patients with pneumonia, who do not have underlying mucociliary clearance, the use of chest physiotherapy is not supported
the challenge1
The Challenge . . .

Fit all pieces together for the optimal outcome of the patient in the most efficient way possible for the Registered Nurse . . .

references
References

Carlson, CL & Plonczynski DJ. (2008) Has the BARRIERS Scale changes nursing practice? An integrative review. Journal of Advanced Nursing. 63(4), 322-333.

Leasure, AR, Stirlen, J, & Thompson, C. (2008) Barriers and facilitators to the use of evidence-based best practices. Dimensions of Critical Care Nursing. 27(2), 74-82.

Thompson, C, et al. (2005) Barriers to evidence-based practice in primary care nursing – why viewing decision-making as context is helpful. Journey of Advanced Nursing. 52(4). 432-444.

Wells, N, et al. (2007) Nursing research internship: Enhancing evidence-based practice among staff nurses. Journal of Nursing Administration. 37(3), 135-143.