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Third, lack of attention to evidence-based practice can lead to inconsistent delivery of care services.
Evidence-based practice relates to almost every aspect of health care at every stage of a client's relationship with the institution. For example, evidence-based practice informs the types of questions asked during the diagnostic procedures and might even impact the diagnosis itself (Bennett & Bennett, 2000). Evidence-based practice impacts the methods by which infections are prevented (Cantrell, 2009). Evidence-based practices impact the extent to which nurses are empowered to make sound, safe, and effective decisions (Scott & Pollock 2008). Evidence-based practice has the potential to transform the structure of a health care organization like MMH. This is because evidence-based practice changes the hierarchical structure in the organization due to the increased responsibility of nurses for conducting their own research. Alternatively, evidence-based practice can be an extension of organizational change. Health care organizations reducing the hierarchical nature of health care will be more likely to support evidence-based practice because of the inherent ways the method empowers nurses as opposed to empowering only managers.
The process of implementing evidence-based practice in a health care setting like that of MMH involves a series of steps. Those steps include the following, based on a review of literature. First, the nurse formulates the appropriate question based on the parameters of the scenario (Bennett & Bennett, 2000; Egerod & Hansen, 2005). For example, a nurse might need to know whether it would be appropriate to cut in half the dose of a given antibiotic due to the lower body mass of the patient vs. The norm. Second, the nurse searches the literature for evidence. This is one of the most important steps in the evidence-based practice. The nurse requires access to academic and professional databases of literature. Here is where the administration of the health care organization comes in: management must encourage access to nursing and health care databases. To promote evidence-based practice, the health care organization would have on hand terminals with free access to professional and academic databases. Then, nurses would apply their critical thinking skills regarding the accuracy, relevance, validity, and applicability of any given research study.
The third step in implementing evidence-based practice according to Egerod & Hansen (2005) is to integrate the empirical research evidence with clinical experience. Although this step is not included in Bennett & Bennett's (2000) list, it is implied as the past experiences of the nurse are to be taken seriously. The next step in integrating evidence-based practice is to implement the decision, using the evidence gathered from research in the clinical setting (Bennett & Bennett, 2000; Egerod & Hansen, 2005). The choice of method or technique to implement will be based on the review of literature and also on patient preferences (Egerod & Hansen, 2005; Gambrill, 2005). Finally, the nurse evaluates the outcome as systematically as possible. There are a number of ways a nurse may do this. From a managerial perspective, sharing the results with coworkers in staff meetings may be fruitful. Pipe et al. (2005) point out that "incorporating evidence-based research into an organization's policies and procedures" may be one of the most effective ways of improving patient care (Section 2).
According to Bennett & Bennett (2000), implementing evidence-based practice in a health care organization requires an ongoing commitment by individual nurses, nurse leaders, and administrators. Nurses need to "seek continuing education to develop skills for accessing information resources, understanding research methodologies and summary statistics, and critical appraisal," (Bennett & Bennett 2000). However, management and administration need also to make such opportunities for personal and professional development available and affordable to nurses. Nurses also need to be dedicated to using databases and reliable sources of evidence rather than assuming best practices based on habit or coworker advice. Even the authority of managers and doctors must be continually questioned in a genuine evidence-based practice paradigm. To implement evidence-based practice, nurses do need to participate in the creation of new research and in the development of their area of specialization. In other words, evidence-based practice is a means by which to improve the existing canon of knowledge. It is also up to the individual nurse to reconstruct priorities to account for evidence-based practice. The myth that time prohibits evidence-based practice must be discarded in favor of the truth that evidence-based practice is necessary for providing quality of care and for reducing health care costs. Time constraints are indeed a concern for nurses, though, especially given the current staffing shortage. As Pipe et al. (2005) note, "Evaluating studies for scientific merit can be a large task" calling for intensive organizational support for individual efforts (Section 2).
Evidence-based practice itself has no one theoretical framework. Rather, each evidence-based practice reflects a particular theory in action. The Iowa Consortium for Substance Abuse Research and Evaluation's report (2003) distinguishes between clinical practice guidelines and evidence-based practice as being a reflection of theoretical frameworks. Whereas practice guidelines reflect "a wide variety of research literature, representing an eclectic collection" of best practice concepts, evidence-based practices "are generally based on one theoretical approach and provide detailed descriptions of how to carry out the approach," (Iowa Consortium for Substance Abuse Research and Evaluation 2003).
The theoretical framework for the proposed research is in fact eclectic, but also proven in research. Following the research of Kitson, Harvey & McCormack (1998), the current project will employ the "multidimensional framework for implementing research into practice." The multidimensional framework for implementing research into practice is based on the equation SI = f (E, C, F), "where SI=successful implementation, E=evidence, C=context, F=facilitation, and f=function of," (Kitson, et al., 1998, p. 150). The successful implementation of evidence-based practice in a specific health care institution like MMH is therefore "is a function of the relation between the nature of the evidence, the context in which the proposed change is to be implemented, and the mechanisms by which the change is facilitated," (Kitson et al. 1998, p. 150).
Chapter 3: Design and Methodology
The research will be exploratory in nature, and the research design will be a quasi-experiment. Although not necessarily lauded for their external validity, a quasi-experimental design is a very useful method for measuring social variables," (Shuttleworth, 2008). A quasi-experiment can be an important first step in initiating the type of organizational and individual-level change that this research calls for. After a review of literature outlining the definition of evidence-based practice, its role in a holistic vision of nursing, and its intended application in clinical settings, a quasi-experiment will take place at the Mary Martha Hoffman Healthcare Center (MMH) in Mississippi. One benefit of using a quasi-experimental research design is that it may be "integrated with individual case studies," (Shuttleworth, 2008). Integrating the proposed research with future case studies can be a valuable tool for notifying the administration of a health care organization as to the specific ways of improving quality of care while also cutting costs.
The sample population will come from the entire nursing staff at MMH. A notice will be sent out to all nursing employees at the health care institution. The notice will include a brief outline of the research and a consent form. Participants will be selected based on their willingness and ability to sign the consent form and therefore be a part of the experiment. The sample size will be no larger than 347 individuals, which is the total nursing staff at MMH. Gender and age will be tabulated for exploratory information gathering purposes. For example, future research might want to reveal whether younger nurses are more open to incorporating evidence-based practice into their daily repertoire than senior nurses.
In addition to the main population sample of nurses, a number of managerial participants are required for the current research. The managers of the health care organization will be sent a different form from the one sent to the nursing staff. Nursing managers willing to participate in the study will be assigned roles as mentors. The managerial participants are also entrusted with filling out evaluation and observational data forms for the purposes of data collection and analysis.
The entire participant population will be divided into two groups: an experimental and a control group. The control group will proceed with their nursing duties as normal. The experimental group will receive interventions that correspond with research on evidence-based practice. In particular, the experimental group will:
(a) Be allotted a time slot of 30 minutes per day to be devoted to research in the in-house electronic database system. The time slot may be accumulated to account for the irregularity of needing to perform actual research. In other words, a nurse who does no research for five days has accumulated 150 minutes of allotted research time, which will be used at a later date. Individual participants will log the time spent actually researching data electronically, as their login data will be used.…[continue]
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