DNP Peers’ Posts Needing Responses
FridayJan 27 at 4:51am
How do the EBP models promote quality care in the clinical practice setting?
Evidence-based practice (EBP) is the conscientious use of current best evidence to make decisions about patient care. EBP is a lifelong problem-solving approach to care delivery, integrating the best evidence from high-quality studies with a clinician’s expertise, patient preferences, and values (Melnyk, 2020).
I used the Johns Hopkins Nursing Evidence-Based Practice Model, which promotes quality care in the clinical practice setting. The model allows clinicians to focus and provide interventions from current research and best practices to solve issues. It provides easy access to the EBP process and cultivates a culture of care based on research. The three steps of the model are practice questions, evidence, and translation. The tools provide clinicians with directions to address clinical inquiries (Wyant, 2017).
The EBP model integrates the best available scientific knowledge with clinical expertise to promote quality care. EBP promotes quality care in clinical settings by providing tools to effectively handle clinical issues and provide patients with the best evidence in dealing with cases.
EBP promotes quality care by allowing practitioners to assess research data critically. It helps guide practice by providing clinical guidelines and other available resources to address clinical problems, apply high-quality interventions, and re-evaluate improvement outcomes (Agency for Healthcare Research and Quality, 2020). For example, due to EBP, catheter-associated urinary tract infections (CAUTIs) that affected as many as 25% of all hospitalized patients are currently reduced because of EBP (Melnyk, 2020).
The evidence-based practice model promotes quality care in the clinical practice setting by providing nurses with scientific research to make well-informed decisions like CAUTIs. EBP allows nurses to stay updated about new medical protocols to improve patient care. Also, it becomes easier for practitioners to search for helpful interventions that fit the profiles of their patients. Hence, allowing nurses to increase their patients’ chances for faster recovery and promoting quality care (Eastern Illinois University, 2021).
EBP enables nurses to evaluate the research and its associated risks and effectiveness in treatment. Applying EBP helps nurses to include patients in their care plan. Also, the EBP model promotes quality care by allowing patients to take a proactive role in their healthcare by voicing their concerns based on research. Patients can share their values and preferences and make suggestions on how they want to proceed (Eastern Illinois University, 2021)
EBP provides safer ways of caring for patients and improves healthcare quality, patient outcomes, and cost-effective care due to EBP application.
Do you think nursing has embraced information technologies?
Nursing has embraced information technology due to its continuous improvement by synthesizing data and information to generate knowledge and wisdom.
American Medical Informatics Association ( AMIA) describes information technology as a science that drives innovation that defines the future approaches to information and knowledge management in biomedical research, clinical care, and the public (Austin & LaFlamme, 2021). A report from IOM indicates that 98,000 people die in hospitals annually due to preventable medical errors (Institute of Medicine, 2000). The report has accelerated the development and implementation of health information technology with evidence of the influence of health information technology to improve patient safety. Also, Health information technology (health IT) is widely used by professionals and patients to store, share, and analyze health information. It has decreased errors, reduced death rates, and improved the quality of care delivery.
Nursing has embraced information technologies because informatics is evolving, and traditional ways of keeping data have faded. Technology continues to expand and grow as national efforts toward consensus use of Healthcare information technology (HIT) in healthcare to reduce errors based on IOM reports. Nowadays, hospitals use computers, wrist bands, and the only option for the nurse is to be computer literate because hospitals do not have paper charting. Hence, the introduction of HIT has transformed lives to varying degrees in healthcare which includes; reducing human errors, improving clinical outcomes, facilitating care coordination to enhance practice efficiencies, tracking data, and reducing the death rate (Alotaibi & Federico, 2017).Below are examples that indicate that nursing has embraced information technology.
Electronic health records (EHRs)
Since the inception of EHRs, doctors can keep better track of health information and set reminders when labs are out of range for immediate intervention. EHR has improved health, reduced errors, and patient records are assessed after the close of office for the continuation of care. Also, EHRs allow doctors to share information with other specialists when needed (The office Of the National Coordinator for Health Information Technology, n.d). This indicates that technology has improved, and nursing has embraced information technology.
Electronic prescribing (E-prescribing)
It has become easier for patients to receive their prescriptions without losing the scripts. It reduces errors and timely delivery of medications because a paper prescription can get lost or misread. E-prescribing allows doctors to communicate directly with the pharmacy, improving care delivery and outcomes (The office Of the National Coordinator for Health Information Technology, n.d). E-prescription has improved medication adherence, increased patient safety, and medication reconciliation.
Agency for Healthcare Research and Quality (2020). Evidence-based Practice. Retrieved from https://www.ahrq.gov/topics/evidence-based-practice.html.
Austin, R., R. & LaFlamme, E., A. (2021). Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care. In M. Zaccagnini & J. Pechacek (Eds.), The doctor of nursing practice essentials: A new model for advanced practice nursing (4th ed., pp. 111-128). Jones & Bartlett Learning.
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Eastern Illinois University (2021). Why Is Evidence-Based Practice In Nursing So Important? Retrieved from https://learnonline.eiu.edu/articles/rnbsn/evidence-based-practice- important.aspx
Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US).
Melnyk, B., M., (2020). Improving healthcare quality, patient outcomes, and costs with evidence- based practice. Retrieved from Improving healthcare quality, patient outcomes, and costs with evidence-based practice (sigmanursing.org)
Speroni, K., G., McLaughlin, M., K., & Friesen , M., A., (2020). Use of Evidence-based Practice Models and Research Findings in Magnet-Designated Hospitals Across the United States: National Survey Results. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32246749/.
The office Of the National Coordinator for Health Information Technology (n.d). Health IT: Advancing America’s Health Care. Retrieved from https://www.healthit.gov/sites/default/files/pdf/health-information- technology-fact- sheet.pdf.
Wyant, T. (2017). Adopt an Evidence-Based Practice Model to Facilitate Practice Change . Retrieved from https://voice.ons.org/news-and-views/adopt-an-evidence-based-practice- model-to-facilitate-practice-change
MondayJan 30 at 11:58pm
What is the role of the DNP graduate in Clinical Scholarship?
Doctoral-educated nurses still need to be more prevalent in clinical settings. However, potential careers in clinical settings, the demands, difficulties associated with developing clinical academic roles, the results, and recommended courses of action have begun in the last ten years. To create career roles that give doctoral-educated nurses a chance to participate in clinical practice and impact its quality and performance, academic nursing organizations are urged to work with professional organizations and healthcare institutions at various levels (Dobrowolska et al., 2021). This could improve the standard of research.
There are numerous ways to shape how nurses develop a clinical practice with doctoral degrees. One of these is the ANP certification, which is significant for both DNP and Ph.D. nurses. Employers classify DNP-prepared nurses as predominantly delivering direct patient care, typically as Advanced Practice Registered Nurses. Additionally, 60% of the nurses questioned by Udlis and Mancuso (2015) said that the DNP is a starting point for advanced practice. Hlge-Hazelton et al. (2016) found that ANP nurses with Ph.Ds demonstrated competencies relevant to clinical research and practice change (Dobrowolska et al., 2021).
DNP path leaves room for uncertainty and confusion regarding the duties of doctoral educated nurses. In contrast to the current, well-established culture of an academic career for physicians, a comparable culture for doctoral-educated nurses has yet to be developed. The primary goal of doctoral education for nurses is to advance clinical practice and leadership. In contrast, a Ph.D. entails having a full-time academic research position or a joint clinical and academic job. Both pathways aim to develop analytical and conceptual skills to strengthen the theoretical underpinnings of nursing care and the application of research in practice using scientific techniques.
Doctoral-educated nurses who work in a clinical setting have identified specific challenges and needs, including the need for research funding accessibility, support in juggling clinical and research responsibilities, and the need to be acknowledged and valued by peers, nurse managers, and other researchers. These difficulties could also be considered obstacles that need to be adequately overcome to develop a clinical career pathway for doctoral-prepared nurses (Dobrowolska et al., 2021).
It may be prudent to provide a clear funding plan available to both academic and non-academic nurses. Nurse leaders should effectively integrate doctorate-educated nurses into the team. Additionally, healthcare organizations that give positions to doctoral-prepared nurses to advance their clinical academic careers must consider some crucial factors, such as handling the competitive demands and assisting grant applications (Dobrowolska et al., 2021).
Research priorities should be established to advance nursing practice and draw more doctoral-educated nurses into clinical settings. However, from a scientific standpoint, doctoral programs should include more clinically oriented research projects. Additionally, the clinical work environment—which has already been emphasized as a crucial component supporting nursing practice—should consist of elements that will make it easier to keep doctorally prepared nurses on staff, which might improve the environment overall (Dobrowolska et al., 2021)
How do you currently utilize information technologies in your nursing practice?
Information technology has been effectively utilized in nursing practice at the Cincinnati VA Medical center in diverse ways to improve and provide quality care for veterans. Alerts have been generated using telehealth to capture unusual incidences such as elevated blood pressure, hyper and hypoglycemia, and falls. Patients with the chronic obstructive pulmonary disease also benefit from using peak flow meters that deliver data straight to the provider. When given to their community nurses, they are synced into their charts, directing their treatment (Johnson, 2018). However, these technologies need to be utilized effectively, and all outcomes and results should be seen relative to one another rather than as absolutes. For instance, an alert that goes off because a patient’s heart rate is outside of the normal range may not always be because the patient is in danger, thus inducing an unnecessary panic in the nursing staff. The veteran can manage their health provided the gadget also gives them feedback, but clinical measures may be necessary if the abnormal findings continue (Johnson, 2018).
The VHA community nurses also assess the severity of the patient’s condition without having to visit the patient by using technology to hold secure online consultations in a triage setting where the patient can see both community nurses and other professionals. This saves time and makes efficient use of resources. Scheduling and caseload management also benefit from this. Additionally, discussions amongst multidisciplinary teams are made possible using information technology, allowing other specialists to assist the patient remotely and comprehensively. VHA nurses support and educate patients on complex challenges using telehealth tools and successfully monitor long-term illnesses, including diabetes and high blood pressure. Real-time patient data recording has increased accuracy and enable community nurses to confirm information right away (Johnson, 2018), making it simpler to navigate the VHA healthcare system and assisting nurses in giving patients important and high-quality information (Dewsbury, 2019). Using technology in triage also increases and improves productivity, offering veterans a better nursing experience.
Effective information and communication technology utilization has helped to enlighten and simplify medical decision-making, and virtual consultations have helped to save time and money. The usage of technology has also made it simpler to navigate the healthcare system. Finally, technology has assisted nurses in giving patients important, high-quality information (Dewsbury, 2019).
Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of doctor of
nursing practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364.
Dewsbury, G. (2019). Use of information and Communication Technology in nursing services. British Journal of Community Nursing, 24(12), 604–607.
Dobrowolska, B., Chruściel, P., Markiewicz, R., & Palese, A. (2021). The role of Doctoral‐educated nurses in the clinical setting: Findings from a scoping review.
Journal of Clinical Nursing, 30(19-20), 2808–2821.
Johnson, M. (2018). Success in Information Technology – what do student nurses think it takes? A quantitative study based on legitimation code theory. Research i
n Learning Technology, 26. https://doi.org/10.25304/rlt.v26.2049
YesterdayJan 31 at 9:59pm
Week Four discussion
How do the EBP models promote quality care in the clinical practice setting?
This week’s discussion discussed how Evidenced Based Practice (EBP) model promotes quality care in the clinical practice setting because different benefits are associated with utilizing evidence-based practice models in the clinical setting as the model supports quality of care in a different version of modalities, EBP models serve as organizing leads to improve outcomes by integrating best evidence with clinical expertise and patient value (Li, Cao, & Zhu, 2019). However, the Stetler Model promotes quality care by enabling healthcare practitioners to evaluate the different methods of implementing research findings and other relevant evidence in clinical practice. From the significant role of promoting the integration of credible evidence into nursing practice, evidence-based models are crucial in promoting (Cullen et al., 2020).
The Academic Center for Evidence-Based Practice (ACE) is another model that improves the quality of care in a clinical setting by integrating the best evidence into practice. The model offers five main stages that illustrate the different forms of knowledge in relative sequence, as this is very crucial in promoting quality of care as it enables researchers to move through the circles to combine with other types of expertise before integration into healthcare practice as it occurs (Stevens, 2011).
However, there is a Johns Hopkins Nursing Evidence-Based Practice Model that promotes quality of care by utilizing problem-solving approaches in the decision-making process in clinical settings, as the model is designed in a three-step process of practice question, evidence, and translation, which is an uncomplicated approach to meeting the EBP needs direct care nurses besides the model’s primary goal is to make sure that the latest research findings and best practices are incorporated easily into patient care. Nurses are expected to be most effective while using hospital policies and protocols to integrate research findings into the nursing practice (Wyant, 2017).
Do you think nursing has embraced information technologies?
In the different facets of healthcare and nursing being the heart of nursing, have should that nursing has fully embraced information technologies (IT), and most health facilities across the globe are implementing various IT technologies to ensure improvement in the quality of care ( Hsiao, King, Hing, & Simon, 2020). However, nurses have embraced portable monitors that allow nurses to check patients even when they are not at close range; some portable monitors enable nurses to monitor vital signs effectively with respiratory rates, ECG, and oxygen saturation from the critical sign monitor devices; different nursing information technologies are being used to transform the provision of care as affirmed by Hsiao et al. (2020).
However, there is also the utilization of different wearable devices in nursing practice which are very important in reducing human error for nurses, and one of the wearable devices that has been extensively implemented in nursing is the Stethoscope IO smartphone; this stethoscope uses a mobile application that allows nurses to examine breathing sounds and heart rates using their smartphone, which is considered less intimidating. (Booth, Strudwick, McBride, O’Connor, & Solano López, 2021).
Hsiao, C.-J., King, J., Hing, E., & Simon, A. (2020, Sept 04). Medical Care Journal. `: doi: 10.1097/MLR.0000000000000276
Booth, R., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. (2021, June 14). BMJ. How the nursing profession should adapt for a digital future: doi: 10.1136/bmj.n1190
Cullen, L., Hanrahan, K., Farrington, M., Anderson, R., Dimmer, E., Miner, R., . . . Rod, E. (2020, Mar 05). Journal Nurses Admission. Evidence-Based Practice Change Champion Program Improves Quality Care: doi: 10.1097/NNA.0000000000000856.
Li , S., Cao, M., & Zhu, X. (2019, Sept 27). Medicine Baltimore. Evidence-based practice: doi: 10.1097/MD.0000000000017209
Stevens, K. (2011, Nov 01). Nurse Outlook Journal. Evidence-Based Practice: Destination or Journey?: doi: 10.1016/j.outlook.2010.09.002
Wyant, T. (2017, Nov 21). ONS Voice. Adopt an Evidence-Based Practice Model to Facilitate Practice Change: https://voice.ons.org/news-and-views/adopt-an-evidence-based-practice-model-to-facilitate-practice-change
YesterdayJan 31 at 11:18pm
1. What are barriers that inhibit your use of evidence in the clinical settings? What strategies might you employ to overcome these barriers?
A study done by Melynk et al. (2016) found while chief nurse executives believed in EBP and believed it improved care, most of them didn’t prioritize it. Barriers to implementation of EBP included knowledge and skills, lack of resources, time constraints, lack of cultural/organizational expectations, and conflicting priorities which take precedence (e.g., patient flow). Another issue they found was related to productivity and EBP often being labeled as “nonproductive” time which often isn’t resourced.
Their findings resonate strongly with my experience. I can say throughout my 30-year career at various hospitals and organizations, when we’re working on a performance improvement project, we’ll often ask the question of what current best practice is, but we rarely dig into the literature to ensure we have the most current, valid, and reliable research. Accessing a librarian to research a PICOT question has been easy at all the organizations for which I’ve worked but having an expert to help increase the acumen of the staff nurses and leaders in assessing the validity and reliability of the research is a missing link. Melynk et al. (2016) recommend providing workshops to increase skill until full competency of the team is achieved. They also stress the importance of setting the expectation that EBP is used for all process improvement and working with the executive team to show them evidence of return on investment related to EBP so that resources can be obtained to promote EBP. I will be working with my team this year to increase our EBP utilization starting with socializing with our leaders and unit practice teams the availability of library resources and the expectation that we use EBP in our process improvement projects. During my early discussions with the team, I learned that I have a nursing director who has taken six, week-long, EBP workshop intensives with Dr Melynk and Dr. Gallagher-Ford at OSU and who is willing to help mentor our teams as we transition to a EBP focus.
2. How do you currently utilize information technologies in your nursing practice?
Information technology is a broad term which encompasses many things including software applications, technologies such as IV pumps and nurse call systems, decision support, and analytics. (Austin & LaFlamme, 2021). We currently use information technology in a plethora of ways in nursing practice at my organization. One technology we use extensively is an electronic health record (EHR) with smart pump integration to provide safety for our patients and our bedside teams with such features as bar-code scanning, best-practice alerts, sepsis alerts, and assessment/documentation reminders. Staff nurses and nursing leaders have access to unit dashboards which give them a quick glance of priority care items and whether there are gaps that need addressed. Nurse managers use electronic scheduling and time and attendance programs to see if our resource utilization is matching our volume of work (i.e., productivity). Some units are trialing workload products in the EHR to help the charge nurses balance assignments as evenly as possible.
A recent Becker’s article of an interview with the chief quality officer of Duke Health, Dr. Richard Shannon, discussed nursing’s current use of EHRs, and how we’ve had a swing from ensuring our teams have time to care for and interact with patients in meaningful ways to focusing on data collection for data collections sake and making our clinicians collect and document redundant data. He reports one-third of the nurse’s day is spent in documentation and asks if all this documentation is value-added. Wouldn’t the time be better spent educating the patient about their illness, consoling the patient, and teaching them about their medications (Dean, 2023)? I think the use of information technologies, especially as they relate to the EHR, is something which needs immediate attention and scrutiny. We need to be intentional in designing documentation in EHRs to help our teams provide great care instead of pulling them away from providing care.
Austin, R. R., & LaFlamme, A. E. (2021). Information systems/technology and patient care technology for the improvement and transformation of health care. In M. Zaccagnini, & J. M. Pechacek (Eds.), The doctor of nursing practice essentials. (4th ed., pp. 349-397). Jones & Bartlett Learning.
Dean, B. F. (2023, January 19). Band-aid solutions won’t bring nurses back to the bedside, Duke Health’s Dr. Richard Shannon says. Becker’s Hospital Review.
Melnyk, B. M., Gallagher-Ford, L., Thomas, B. K., Troseth, M., Wyngarden, K., Szalacha, L. (2016). A study of chief nurse executives indicates low prioritization of evidence-based practice and shortcomings in hospital performance metrics across the United States. Worldviews on Evidence-Based Nursing, 13(1), 6-14.
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