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NUR 590 Discussion: Barriers to Implementing EBP in Nursing

NUR 590 Discussion Barriers to Implementing EBP in Nursing

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Implementing any change in a healthcare organization or facility entails several aspects that require one to develop an implementation as is the most important part of any evidence-based practice (EBP) project proposal. Implementation entails the actualization of the ideas developed in the proposal EBP projects are broken into several identifiable steps (Boehm et al., 2020). The implementation plan will focus on hand hygiene measures in pediatric setting among healthcare workers to reduce hospital acquired infections (HAIs). The implementation plan will consist of the setting where the project will take place, time, resources, methods and instruments, intervention of delivery process, and data collection plan. The plan also includes management of barriers, facilitators and challenges and the feasibility of the plan.

Setting and Access to Potential Subjects

The implementation framework of any EBP project includes establishment of a motive for change, development of specific goals, attaining leadership support, creating a leadership teams and engagement of clinical support. In this case, the project setting will be a pediatric hospital where nurse practitioners and clinical nurse leaders involved in service delivery to the patient population will be the main subjects taking part in the proposed project. The selected participants should have served in this unit for the last 12 months. The project will select 20 healthcare staff to be involved in the implementation process.

The second component of this project is getting consent or approval from the participants and the institutional review board for the project to take place. Participants’ consent will be essential as it will demonstrate their willingness to be part of the project without any undue influence. The review board will give the project a green light and ensure that ethical provisions are met to protect the subjects. The consent will indicate that the main purpose of the project is to reduce the rate of HAI within six months by enhancing hand hygiene measures, specifically the use of alcohol-hand sanitizers or rubs alongside handwashing using soap and water. The participants will sign the consent form upon getting relevant information about the project and its overall benefits to the population.

Timelines

The implementation timeframe for the EBP project will be six months. Different activities will take place each month to ensure that all components of the proposal are implemented effectively. The timeframe will include creation of a multidisciplinary team in the first two weeks of the program. The last two weeks of the first month will have collection of required resources and expertise for the implementation process. The training of the nursing staff will occur in the second month and will take two to three weeks to ascertain that the participants have sufficient knowledge and skills based on existing resource to implement hand hygiene measures aimed at reducing HAIs.

The first week of the third month will involve identification of any possible barriers that may influence or interfere with the implementation. The duration will also be used to increase stakeholder engagement, participation and collection of their input and views to be incorporated in the final implementation activities (Luciano et al., 2019). The remain three and half months will involve the actual implementation. However, in the fifth month, the project team will review the implementation to ascertain if there will be need to have any modifications to the project. The implication is that the implementation process will be successful if the five months will be used as expected in the timelines proposed for the plan.

Resources

Studies show that success of any evidence-based project primarily rely on the availability of the needed resources (DeNisco, 2019; Luciano et al., 2019). The implementation of this project require human resources that will comprise of competent trainers who will impart the project team with necessary knowledge and skills. The most appropriate resource for this EBP project include nurse practitioners and clinical nurse leaders. Engagement of nurse practitioners and clinical nurse leaders with the requisite skills improves the success of quality improvement projects. In addition to the human resources, the project will also require financial resources to fund the implementation. the financial resources will be deployed to compensate the trainers and buy required stationeries like the training manuals. These resources will also be instrumental in overall implementation as they will be used to buy equipment like hand-rubs for demonstration. The resources will also include travel expenses for the project manager and the team. Changes needed in the implementation of the solution will include more education and awareness among caregivers since most of the pediatric patients may not comprehend the protocols that will be proposed to reduce hospital acquired infections.

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Qualitative or Quantitative Design in Data Collection and Effectiveness

The selected design to collect data for the evidence-based practice project proposal is qualitative. The qualitative approach is deployed

NUR 590 Discussion Barriers to Implementing EBP in Nursing

NUR 590 Discussion Barriers to Implementing EBP in Nursing

to understand thoughts, concepts, and experiences of participants through techniques like interviews, focus groups, observations, and a review of existing literature (Rebekah & Ravindran, 2018). The qualitative research design will be effective in the project proposal since it will entail getting opinions through deployment of different methods from healthcare workers about the need to enhance hand hygiene measures to prevent and reduce the occurrence of hospital acquired infections, especially in pediatric settings (Vandermause et al., 2017). The evidence-based practice project proposal on hand hygiene measures among healthcare workers to reduce and prevent hospital acquired infections (HAIs) in pediatric settings will inform stakeholders about the importance of handwashing protocols. The EBP project proposal is effective as it will ensure that healthcare workers in the selected settings adhere to hand hygiene measures for effective care delivery and minimize the prevalence of infections that negatively impact patient outcomes and quality care delivery.

Methods and Instruments for Monitoring

The implementation process will entail various methods and instruments in its monitoring. Firstly, an audit tool and satisfaction survey will be used in the implementation process. The project team will use satisfaction survey to evaluate the effectiveness of the measures executed to decrease high prevalence of hospital acquired infections in the pediatric unit. The audit framework will be deployed to complete the auditing process. The tool will enhance the auditing of gathered data on specific hand hygiene interventions and their outcomes (Vandermause et al., 2017). Additionally, the project will use questionnaires to collect the required data from the participating nurse. questionnaires are effective data collection tools and nurse leaders and practitioners will fill them out to offer information about the effectiveness of hand hygiene measures that can reduce occurrence of HAIs in pediatric patient population. The information will guide the project implementation team during the process for effective outcomes. The auditing tools and satisfaction surveys alongside the questionnaire use will be critical in attaining the expected project goals.

NUR 590 Discussion: Barriers to Implementing EBP in Nursing

Delivery of the Intervention

The delivery process for the intervention will involve project team members that comprise of nurse leaders and practitioners. The nurses and practitioners will develop and execute necessary protocols like setting hand sanitizer stations at different points of the care delivery process (Luciano et al., 2019). These points will include the nursing stations and having points in pediatric wards as well as other key points to enhance hand hygiene measures. The participants will require training to enable them perform their respective duties well. Training will consist of giving information to nurse leaders about the components of the proposed so that they can effectively supervise the nurse practitioners to ensure that they carry out their mandate as expected. The practitioners will also require training to implement the proposed measures as planned to meet the set project goals.

Stakeholders Required to Implement the Plan

Stakeholder support is a critical component of evidence –based practice project proposal as they provide critical resources, input, and implement the recommendations of such programs. In this case, several stakeholders will be needed to implement the project (DeNisco, 2019). The initial stakeholders will include clinical nurse leaders and practitioners who will ensure that the components of EBP project are realized. The second set of stakeholders include the project team and trainers that shall offer direction on the implementation of the EBP intervention. The third stakeholder group needed comprise of organizational leaders and managers who shall provide the requisite resources; especially financial resources, to implement the proposed plan to reduce hospital acquired infections in the target population.

Aspects of the Implementation Plan and Potential barriers, Challenges and Proposed Strategies

The success of the project will depend on how the project team manage different aspects like facilitators, barriers, and develop effective strategies to respond adequately. For instance, organizational leaders and managers will be critical facilitators as they offer necessary support through resource allocation and a buy-in. The management will also support the new project will the aim of improving overall care quality.

Time and resource limitation, insufficient knowledge and skills among healthcare workers would be significant barriers in implementation of the project. Negative attitudes that will fuel resistance will also hamper effective implementation of the project as many will feel that it will be sufficient to assess the overall effectiveness of the intervention (Vandermause et al., 2017). It is essential to mitigate these barriers through effective strategies like sticking to the timeframe for implementation, engaging all stakeholders like leaders and managers, and enhancing communication among all players.

Feasibility

The feasibility of this project will be assessed based on a cost-benefit analysis approach. The cost incurred in the implementation process will be estimated to assess the overall benefits that will accrue to patients and healthcare organization’s unit (Rebekah & Ravindran, 2018). The cost will also include funds to compensate trainers and buy the needed project implementation materials to evaluate the overall feasibility of the plan. the unit should implement the plan since its cost-benefit analysis will be positive to the organization.

Conclusion

The implementation of the project stage is essential as it consists of the real practical application of expected changes and subsequent outcomes. Therefore, it is important to evaluate all aspects of the stage for effective outcomes and project’s sustainability. The highlighted plan will be effective through increased stakeholder engagement and participation.

 

 

References

Boehm, L. M., Stolldorf, D. P., & Jeffery, A. D. (2020). Implementation science training and

resources for nurses and nurse scientists. Journal of Nursing Scholarship, 52(1), 47-54. doi: 10.1111/jnu.12510.

DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:

Essential Knowledge for the Profession. Jones & Bartlett Learning.

Klingbeil, C. & Gibson, C. (2018). The Teach Back Project: A System-wide Evidence Based

Practice Implementation. Journal of Pediatric Nursing, 42:81-85. doi: 10.1016/j.pedn.2018.06.002.

Luciano, M. M., Aloia, T. A. & Brett, J. F. (2019). 4 Ways to Make Evidence-Based Practice the

Norm in Health Care. Harvard Business Review. https://hbr.org/2019/08/4-ways-to-make-evidence-based-practice-the-norm-in-health-care

Rebekah, G., & Ravindran, V. (2018). Statistical analysis in nursing research. Indian Journal of

Continuing Nursing Education, 19(1), 62.

Vandermause, R., Barg, F. K., Esmail, L., Edmundson, L., Girard, S., & Perfetti, A. R. (2017).

Qualitative methods in patient-centered outcomes research. Qualitative health research, 27(3), 434-442. doi: 10.1177/1049732316668298

 

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NUR 590 Topic 4 DQ 1

What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing? Explain how at least one of the obstacles you have described could impact the implementation for your EBP project.

Barriers to evidence-based practice research can prevent research from reaching potential. Barriers that involve resource management, interdisciplinary involvement and lack of support are common in evidence-based practice research in varying levels depending on the research setting or question being explored. Building research within a medical center has its benefits as well as its barriers to obtaining research goals for health outcomes. Health related education especially can sometimes take a back seat to patient care interventions in terms of implementation of research (Swindle, Johnson, Davenport, Whiteside-Mansell, Thirunavukarasu, Sadavsin & Curran, 2019)

One barrier that I would predict would interfere with the implementation process deals with interdisciplinary communication for educational purposes. Although using education can be used to disseminate information to health care providers and the public, interdisciplinary information and coordination may make this difficult. This would impact my project because coordinating with nutrition and educational departments will become very important to the research outcomes and the amount of involvement or coordination may revolve around the ability to utilize these connections with other disciplines (Shayan, Kiwanuka & Nakaye, 2019).

References:

 

Swindle, T., Johnson, S. L., Davenport, K., Whiteside-Mansell, L., Thirunavukarasu, T., Sadasavin, G., & Curran, G. M. (2019). A Mixed-Methods Exploration of Barriers and Facilitators to Evidence-Based Practices for Obesity Prevention in Head Start. Journal of Nutrition Education and Behavior51(9), 1067–1079. https://doi-org.lopes.idm.oclc.org/10.1016/j.jneb.2019.06.019

 

Shayan, S. J., Kiwanuka, F., & Nakaye, Z. (2019). Barriers Associated With Evidence‐Based Practice Among Nurses in Low‐ and Middle‐Income Countries: A Systematic Review. Worldviews on Evidence-Based Nursing16(1), 12–20. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12337

Mathieson and Brooke reported “barriers (to EPB) frequently reported include lack of time, staff shortage, heavy patient caseload, family commitments, limited knowledge of EBP and negative beliefs toward it, and limited academic skills” (Mathieson et at., 2019). Staff shortages with heavy caseloads are not new to nursing, but are intensely felt with nurse burnout and ethical conundrums.  As a life-long learner with an ADN, BS Biology, and eventual MSN, I feel intense pressure to continue gaining knowledge and desire to increase nursing knowledge However, lack of time makes a war between my family, work rand educational responsibilities.

Lack of time is a one barrier to implementation of my EBP project. Several members of the EBP team, like the floor nurse and CNAs, have limited time during a shift. While a note in the EHR documentation may only take a moment, it can be hard to find those extra minutes on a busy and understaffed floor. Lack of time may be a barrier for the participants who will be completing educational modules. The participants, informal/family caregivers, may be busy or not give the education priority enough to finish. If team-members and participants don’t have the time to complete their needed responsibilities to the project, the data will be biased.

 

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20http://dx.doi.org.lopes.idm.oclc.org/10.1017/S1463423618000488

There will always be barriers when implementing change. A study written by Mathieson, et al, in 2019 explored the barriers to implementing EBP in nursing. It was found that organizational changes – restructuring and the decentralization of services – had a negative impact upon implementation. I think the biggest barrier to change is timing. If the unit or hospital is not fully invested or there are other priorities then the EBP changes will suffer. The timing of implementation is crucial to the success of a project. For example, for my EBP proposal I think there will be obstacles because of our staffing issues. The lack of proper staff takes priority and it can be difficult to train and implement a new process when there is constant turnover of nurses. I am hopeful with a recent change in leadership, there will be better staffing models and my unit can return to focusing on improving nursing practice instead of staffing shortages.

Reference:

 

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20 doi:http://dx.doi.org.lopes.idm.oclc.org/10.1017/S1463423618000488

The process of evidence-based practice (EBP) begins with a clinical query and then moves on to seeking and critically evaluating the evidence. When implementing evidence-based practice in nursing, there will be obstacles and barriers that will affect health care practices. Barriers can come in various forms on an organizational level or personal level. Examples of organizational level include the lack of human resources, shortage of internet service at work, and high workload were all issues at the organizational level (Khammarnia et al., 2017). Personal barriers examples included a lack of time to study literature, a lack of computer skills, and a poor command of the English language. Resistance is another barrier to healthcare when trying to implement evidence-based practice. Resistance is an obstacle that would impact the evidence-paste project; culture can be seen as a significant challenge on Hospital units (Ginex, 2019). It takes more than one person to alter a practice, which is why establishing a culture that promotes a spirit of inquiry and an evidence-based approach to treatment is crucial. When there is resistance in a unit towards change, it inhibits the progression of quality improvement.

 

 

Ginex, P. (2019). Overcome barriers to applying an evidence-based process for practice change. ONS Voice. https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2017). Barriers to implementation of evidence-based practice in zahedan teaching hospitals, iran, 2016. Nursing Research and Practice2017, 1–5. https://doi.org/10.1155/2015/357140

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