Reflection in Action

Creating and Sustaining an Evidence-Based Nursing Environment

In this course, it has become apparent that I need to be concerned with creating an environment that supports EBP. This is because new evidence continues to surface in the medical and nursing fields. Hence as a nurse leader, I must incorporate the significant increase in new knowledge into the daily routines for evidence-based practice. However, there is a well-documented delay in the implementation of new knowledge in practice environments. The Agency has cited seventeen years for Healthcare Research and Quality as the mean time for new evidence to be generated to the time it is implemented into practice (Dang & Dearholt, 2017). In addition, for healthcare professionals to remain relevant to the practice, they need to keep up with journals in the field, and this would call for one to read 17 articles in a single day, every day of the year. The US’s competitive and dynamic healthcare environment requires that practitioners provide effective and efficient care. This kind of environment also expects care processes and outcomes’ continuous improvement is made. Healthcare providers like me can create an environment within an organization that can inhibit or facilitate evidence uptake. EBP calls for creating an environment that allows for lifelong learning to enhance the use of evidence within the practice. Due to the emphasis on safety and quality, most healthcare organizations have EBP strategic initiatives. At the moment, initiatives for pay-for-performance, either mandatory or voluntary, provide to hospital reimbursements as well as to practitioners for the implementation of healthcare practices backed by evidence. The pressure from consumers and expectations by patients place an increased emphasis on true EBP being necessary (Dang & Dearholt, 2017). Additionally, the study by McGlynn et al., 2003 reminds me that I need to implement EBP for my patients; the study cited that approximately 50 percent of Americans receive evidence-based healthcare. Hence even with EBP emphasized, most practitioners and hospitals fail to implement the available guidelines and evidence in their practice. This is suggestive of a greater imperative for building infrastructure that supports EBP as well as penetrates the same in practice environments.

Asking Compelling, Clinical Questions

In this course, I have learned that a clinical question ought to be directly relevant to the problem or the patient and also phrased in a manner that allows for the answer to be searched. The PICO process simplifies this as it helps to formulate the strategy for searching by identifying the main concepts that are needed in an article and that can satisfactorily answer the said question (Fineout-Overholt & Stillwell, 2011). That said, I will ensure that at each stage of a patient’s treatment, I will ask precise and appropriate questions for enhanced patient outcomes.

The primary question types include therapy, diagnostic tests, prognosis, and harm/etiology. Therapy involves selecting treatments offered to patients that do not harm them more than they do good to them and are also worth the costs and effort of utilizing them. Diagnostic tests involve selection and interpretation so as to exclude or confirm a diagnosis based on the consideration of safety, expense, acceptability, accuracy, and precision, among other parameters. Prognosis deals with the manner in which estimates are made on the probable clinical cause over time because of factors besides interventions. The harm/etiology refers to how the causes of the disease are identified and include the iatrogenic disease forms.

Other types of questions include clinical findings, clinical manifestations, differential diagnosis, prevention, and qualitative. Clinical findings involve how to gather findings and properly interpret the same from the history and physical examination of a patient. The clinical manifestation of diseases is knowing the frequency and timing of a disease in causing clinical manifestations and how this knowledge can be used to classify the patient’s illness. Differential diagnosis is where questions are asked when considering the different possible causes of the illness and then selecting those that are responsive to treatment, serious, and likely to be the illness. Prevention involves reducing the chances of disease by asking questions that identify and modify the risk factors and through early diagnosis via screening. Lastly, the qualitative aspect of asking questions involves empathizing with the patient and appreciating the patient’s meaning in the experience and consequently understanding how this meaning impacts the healing influences (Fineout-Overholt & Stillwell, 2011).

Protecting Human Subjects in Quality Improvement or Evidence-Based Practice Projects

As a nurse leader, I will participate in research or facilitate research done by staff at my place of work. One of the major aspects of the research which I will need to enforce to ensure validity is the protection of human subjects in EBP or QI. The HHS has published guidance that differentiates QI and research involving human subjects. One of the main advantages of an endeavor in meeting the definition of QI is that the activities do not need the review of the Institutional Review Board, nor are they subject to Federal regulations concerning human subject protection. Some of the QI activities are designed in a way to answer the question being researched as well as improve the care quality or delivery of healthcare. In such a case, the activity may be seen as a research protocol subject to the HSS Common Regulations, and the researcher should then consult with personnel at the DHA Human Research Protection Program Office at the research design phase of such activities. Doing so will help the researcher avoid non-compliance to the DoD or Common Rule policy provisions. Additionally, the HHS has availed guidance on whether a specific QI activity is subject to regulations of the Common Rule. Essentially, two basic questions need to be answered by the researcher: whether the activity involves research and, if so, whether the research involves human activity. The DHA then assists the researcher in answering these questions, after which it assembles a package that the researcher can present to the IRB for review.

References

Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.

DHA (2013). DHA Human Research Protection Program

Fineout-Overholt, E., & Stillwell, S. B. (2011). Asking compelling, clinical questions. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins, 25-39.

McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 2635–2645.

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