Feb 23, 2024 NURS 8114 Module 3 Exploring EBP Quality Improvement Essay
Exploring EBP Quality Improvement
It is a critical obligation of nurses to provide excellent patient care while improving care quality and patient outcomes. In order to support decision-making and improve patient care, evidence-based practice, or EBP, integrates the most trustworthy data from research with clinical knowledge (Keen et al., 2023). This paper examines healthcare sites for quality improvement (QI) projects related to evidence-based practice (EBP). It will focus on three practice problems and discuss why each problem is suitable for an EBP QI project. Additionally, it will identify the key stakeholders involved in approving the project’s initiation, compare their requirements across different sites, and propose a healthcare setting to implement an EBP QI project.
Proposed Sites for an EBP QI Project
Three potential sites for evidence-based practice quality improvement initiatives are acute care inpatient hospitals, long-term care facilities, and hospice care centers. When people have serious but short-lived health issues, they often seek treatment in acute-care inpatient hospitals. Comprehensive medical services and specialized departments, including critical care, surgery, and diagnostic imaging, are available at the hospital (Kesten & Echevarria, 2021). Acute care inpatient hospitals typically accommodate patients who necessitate more extensive medical intervention or observation than what can be achieved in an outpatient environment. Patients who have undergone surgery, sustained significant injuries, are afflicted with severe illnesses (e.g., pneumonia or myocardial infarction), or have complex medical conditions necessitating close monitoring are admitted to the hospital. The hospital aims to provide all its patients with the best possible patient-centered care regardless of their circumstances or background. It combines the most outstanding medical knowledge, professionalism, and compassion with a never-ending pursuit of service advancement. It is a significant hospital and a public health institution known as an acute care hospital.
The long-term care institution offers continuous personal and medical care to those who need it because of a disability, chronic sickness, or other medical issues. The facility is intended to offer a supportive and pleasant atmosphere for those who need assistance with everyday chores, including washing, clothing, and medication management. In addition to medical treatment and rehabilitation therapy, the institution offers social and recreational events, food, and other amenities (Moore et al., 2020). The long-term care institution’s objective is to give our patients the finest level of care and assistance while encouraging independence and dignity. Our mission is to foster an inclusive and supportive environment that prioritizes the well-being of every individual, addressing their specific needs and preferences. As a public health organization that offers long-term care to community members, the establishment is an integral component of the state healthcare system.
The third site for the EBP QI project is a hospice care center. The center offers palliative treatment for terminally sick or incurable patients. Hospice care differs from traditional medical treatment in that its primary objective is not to treat the patient’s condition but to provide solace and support to the patient and their family during this trying period. According to Kesten and Echevarria (2021), the center offers grief counseling, symptom control, pain treatment, and spiritual and emotional support. Caring for the mental, emotional, and spiritual well-being of terminally ill patients and their loved ones is the center’s primary goal. The center aims to assist people and families in dealing with advanced illness and loss with decency, respect, and understanding.
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Strength and Weaknesses
One of the main advantages of the acute care inpatient hospital is its ability to serve a wide range of patients. An EBP initiative could benefit from the hospital’s variegated and representative sample of patients diagnosed with various conditions and have distinct requirements. According to Hagle et al. (2020), a varied target population is ideal for evaluating the effectiveness of an evidence-based intervention since it offers a thorough and representative sample. In order to offer patient care, healthcare professionals from many specialties collaborate in the hospital’s collaborative environment. This can help with the implementation and assessment of an EBP project. However, the limited amount of time available poses a significant obstacle. Acute care inpatient hospitals are dynamic and bustling environments, which can challenge finding opportunities to implement and assess an EBP project.
Long-term care facilities excel at patient population access. Long-term care facilities often cater to a specific population with chronic or persistent medical conditions, making them an ideal sample for an EBP project. Examining variables over time allows for a comprehensive understanding of the effects of the intervention. In addition, long-term care facilities offer extended patient care, allowing for comprehensive follow-up over a prolonged duration (Connor et al., 2023). An essential drawback of a long-term healthcare facility pertains to ethical considerations. When doing research, long-term care institutions may have solid ethical requirements and regulations to follow, which might impact the design and execution of an EBP study. For instance, specific individuals residing in long-term care facilities may experience mental health challenges, which can hinder their participation in the EBP project.
Finally, hospice care centers can significantly impact a large scale. Hospice care centers play a crucial role in serving a substantial portion of the population. The findings of an EBP project conducted at a hospice care center could profoundly affect patients’ treatment and outcomes (Connor et al., 2023). One advantage of a hospice care center as an evidence-based practice (EBP) project site is the high level of expertise among healthcare providers. Hospice care centers often employ skilled and knowledgeable staff with expertise in caring for this population. These professionals can offer valuable perspectives and insights for an evidence-based practice project. However, the stringent ethical guidelines for conducting research could hinder the EBP project.
Practice Problem
CAUTIs are the fourth most prevalent healthcare-associated infections in acute care hospitals in the US. A CAUTI is a type of urinary tract infection that can develop in patients who have or had a urinary catheter in place within 48 hours before the infection starts. One significant issue long-term healthcare facilities face is patient falls, as highlighted by Singh (2021, p. 58). Patients in long-term care facilities face the potential risk of falls, which can be attributed to various factors, including mobility limitations, disorientation, and the use of drugs that may induce dizziness or drowsiness. Patient falls are a significant issue with far-reaching consequences for the patient, the hospital, and the healthcare professional in attendance. Finally, pressure ulcers are a common issue encountered in hospice care centers. Patients who are unable to leave their beds or have limited mobility face the potential of developing pressure ulcers, a condition that can cause pain and prove challenging to treat (Otts et al., 2023).
Potential Focus
CAUTIs have been found to result in extended duration of hospitalization. Patients diagnosed with CAUTIs may necessitate further medical intervention and an extended hospital stay, resulting in increased expenses and potential inconveniences for the patient (Hughes et al., 2023). Infections can result in complications, including sepsis, a severe condition caused by an infection in the bloodstream. Patients diagnosed with CAUTIs face a heightened mortality risk, particularly if they have preexisting health issues (Parker et al., 2020). CAUTIs also present a potential risk to the hospital’s reputation.
However, falls have the potential to cause significant harm, including fractures, trauma to the head, and cuts. These injuries can have a particularly severe impact on older adults, who may have a more delicate physical condition and a slower healing process. Falls are also linked to higher care expenses, diminished quality of life, patient discontent, and a loss of autonomy. Pressure ulcers can potentially become infected, resulting in sepsis, a severe condition where the body’s immune system overreacts to an infection (Otts et al., 2023). The ulcers cause significant pain and discomfort, leading to discomfort for the patient. The healing process for pressure ulcers may be prolonged, leading to an extended hospitalization period and heightened susceptibility to additional complications. When the three practice issues are addressed together, patient care quality and, by extension, clinical results may be maximized.
Stakeholders
In order to implement evidence-based practices, it is necessary to obtain the approval of the relevant stakeholders. The main stakeholders in an acute care inpatient hospital are the clinical staff, patients, managers, administrators, board of executives, funding agencies, and external experts. Implementing the EBP project in a long-term care center involves various stakeholders. These include nurses, doctors, psychiatrists, management, administrators, patients, their families, and outside experts (Shadle et al., 2021). In a hospice care center, the stakeholders involved in EBP encompass a range of individuals, such as nurses, nursing managers, physicians, and patients and their families/caregivers. In order to ensure the success of an EBP project, it is crucial to involve every pertinent stakeholder in the approval process. This will help to secure the necessary support and resources for the project. This might include getting opinions and suggestions from every stakeholder group and getting the go-ahead from pertinent decision-making organizations like funding organizations or the board of directors.
Similarities and Differences
Stakeholder approval is required at all three EBP QI project sites. Securing stakeholder approval is a crucial step in implementing an EBP project. This approval guarantees the project’s backing, enhances its feasibility, ensures that it is well-informed and successful through expert input, and optimizes the allocation and mobilization of resources (Keen et al., 2023). Implementing the EBP project in the acute care inpatient hospital should be approved by the clinical and system leaders, the nursing team lead, and the senior management team. The stakeholders possess a comprehensive grasp of the intervention’s impact on the healthcare system. In contrast, the sanction is granted by the chief physician in long-term care facilities, where a single physician is accountable for the holistic health of the residents. Ultimately, the EBP project receives approval from the nursing director of a hospice care center.
Proposed Health Care Setting and Practice Problem
The chosen location for the initiative is an acute care inpatient facility. Acute care is typically of a shorter duration, in contrast to chronic or long-term care. Acute care is often delivered in a hospital environment by a team of skilled physicians who can diagnose, treat, and care for various diseases, symptoms, and injuries. CAUTIs are the chosen practice issue of attention (Parker et al., 2020). As per the CDC, a significant proportion of hospitalized patients, ranging from 15% to 25%, undergo urinary catheterization during their admission, which exposes them to the potential risk of developing a Catheter-Associated Urinary Tract Infection (CAUTI) (Hughes et al., 2023). Every year, approximately 13,000 deaths are linked to CAUTIs. With a fatality rate of around 10%, they are also the primary source of subsequent bloodstream infections. This quality improvement project aimed to improve the understanding of hospital nurses regarding indwelling urinary catheter care. The goal was to reduce the incidence of cauti in hospitalized patients. This method has effectively enhanced the quality of care within acute care hospitals while being sustainable and cost-efficient.
NURS 8114 Module 3 Exploring EBP Quality Improvement Essay
NURS 8114 Module 3 Exploring EBP Quality Improvement Essay
For this Assignment you will explore key components of a quality improvement initiative, which will be the focus of the DNP Project required for your doctoral program. This Assignment is designed to help you begin investigating potential practice sites for your project, possible practice problems to address based on your interests and the needs of specific sites, and how to identify and approach stakeholders with whom to work and align in a health care setting.
Photo Credit: [Steve Hix/Fuse]/[None]/Getty Images
You will begin the Assignment this week and submit it by Day 7 of Week 6. The topic focus on the science of translation and Learning Resources in Weeks 5 and 6 will further support development of this Assignment.
Important Note: Your activities in this Module 3 Assignment are exploratory and hypothetical only. You should not begin any formal contact with regard to your DNP Project. Consult the DNP Project Process Guide in the Learning Resources for information, including on the project implementation schedule.
To prepare:
Review the readings and media in the Week 4 Learning Resources. Pay particular attention to how Quality Improvement (QI) is defined in the DNP Glossary and Chapter 8 of the White, Dudley-Brown, and Terhaar text.
Identify three potential sites within your community for a quality improvement project. These might be a health care organization in which you practice and two other locations. For example, you might practice in a large organization and consider a small clinic and a skilled care facility as other potential settings for your project.
Based on your practice experience, consider potential practice problems as the focus of an EBP Quality Improvement initiative. Investigate the three practice sites you have identified for specific needs, including by making informal contact with staff members you know. (Remember the importance of confidentiality in any such discussions.)
Note: You may continue to address the same practice issue that was the focus of your Discussions in Weeks 2 and 3. You may also draw on the Week 4 blog to consider a broad focus on EBP and then drill down on specific practice problems to address through application of EBP. The PET model described in the video, An Evidence-Based Practice Model, also provides examples for identifying practice issues to address.
Research the literature for scholarly articles to support developing a quality improvement project that applies evidence-based practice to address specific practice problems. Aim to identify at least three scholarly articles to support this Assignment.
Based on the practice problems you are identifying, investigate your potential practice sites for key stakeholders that would be involved in a quality improvement initiative. Using website and other information available to you for each site, explore for:
A department that leads quality improvement or, if one does not exist, who within the organization would approve a quality improvement initiative;
Stakeholder titles, from the highest level of required approval to health care associates who would implement QI changes in the practice of patient care.
From your research into potential sites and practice problems, choose one practice problem and one site as your focus.Based on your target practice problem and selected site, identify an implementation framework and consider the steps or process required for an EBP QI project that would follow this framework/model. Note: Week 5 Learning Resources and Discussion will provide strategic support.
Outline how you would present the elements of your proposed QI project to stakeholders to gain their approval. Reminder: Your purpose is to prepare for a future presentation to stakeholders. Do not contact stakeholders for this Assignment.
Use the College of Nursing PowerPoint Template, provided in the Learning Resources, for developing a presentation to stakeholders. The template offers options in a cover slide and format options for other slides, to enable you to customize your presentation. Also refer to the handout, Preparing for an EBP QI Presentation to Stakeholders at a Practice Site, in the Learning Resources for guidance.
The Assignment
Part 1: Key Project Elements
In a paper of 6–8 pages, plus cover page and references page, include the following:
Describe the three health care settings that you explored as proposed sites for an EBP QI project. For each health care setting, identify the following defining features: patient population, mission, public or private entity, single institution or member of a corporation, and others you identify as significant.
Compare the settings for strengths and weaknesses as sites for an EBP QI project. Be specific and provide examples.
Explain the practice problems that you explored based on your interests and identified needs of the health care settings you investigated.
Explain why each problem is a potential focus for an EBP QI project. Be specific and provide examples.
For each health care setting, describe the stakeholders whose approval would be required to initiate an EBP QI project and implement the results.
Compare similarities and differences in stakeholder requirements across the settings.
Identify the one proposed health care setting/practice site and one proposed practice problem you have selected as the focus of a hypothetical presentation to stakeholders, and explain your choices.
Part 2: Implementation Science Presentation
Develop a PowerPoint presentation of 3–5 slides, plus cover and reference slides, to inform a set of potential stakeholders at the practice site you have identified for a proposed EBP QI project. Although you will not make your presentation, it should be authentic to the purpose and include the following:
Introduce the framework or model you have selected for the EBP QI project and your reasoning. (1–2 slides)
Present a draft of the proposed practice problem. Include notes for each slide describing points you would make to the assembled stakeholders to obtain their approval or buy-in for the EBP QI project. (2–3 slides)
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NURS 8114 Module 3 Exploring EBP Quality Improvement Essay
There is no submission this week.
Module 3 Assignment is due by Day 7 of Week 6.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
What’s Coming Up in Week 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week you will begin an introduction to translation science as a component of evidence-based practice and quality improvement projects. Remember to access the interactive DNP Glossary in the Learning Resources for needed clarity on this and other key terms as you move through the course.
Week 5: Module 3 Assignment Activities
Continue to develop the Module 3 Assignment, including investigating three health care settings within your community or region as potential sites for an EBP QI project. Keep in mind your work in this Assignment is hypothetical and intended to help prepare for, not execute, your DNP Project. Although you may make informal contacts at your focus sites, do not make any formal inquiries about a site hosting a possible project.
Plan your time accordingly in researching and preparing both Parts 1 and 2 of the Assignment. You are encouraged to complete the gathering of required information for the Part 1 written paper this week.
Next Week
To go to the next week:
Week 5
Week 4: Evidence-Based Practice, Quality Improvement, and Implementation Science: Interrelationships
From your experience as a registered nurse or APRN, how does change occur in a health care setting? How do outdated protocols get updated or the actual root cause of a persistent problem get uncovered and resolved?
You may have answers that speak to the commitment of health care organizations to continually improve. You may also have examples that demonstrate the inherent challenges in any change initiative. If only change were as clear and quick as striking a key. Rather, it requires a whole series of figurative keystrokes and, depending on the setting, may seem as though the whole world needs to be onboard.
This week you will explore a particular set of keys to quality improvement in health care. It involves reliance on science for evidence to inform nursing practice and implementation that makes sense to practitioners and patients. Your getting-started activities will include observing for and blogging about evidence-based practice, and looking for health care settings in your locale for investigating needs and acceptance of practice change.
Learning Objectives
Students will:
Evaluate application of evidence-based practice in health care organizations
Analyze approaches to advocacy of evidence-based practice in health care organizations
Compare health care settings for quality improvement projects
Justify practice problems for quality improvement
Analyze site and stakeholder requirements for quality improvement projects in nursing practice settings
Compare stakeholder requirements for quality improvement projects across nursing practice settings
Apply implementation science frameworks/models for evidence-based practice quality improvement projects
Learning Resources
Required Readings (click to expand/reduce)
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
Chapter 12, “Evidence-Based Practice and Nursing Theory” (pp. 253–272 [PDF]Theoretical Basis for Nursing, 5th Edition by McEwen, M.; Wills, E. Copyright 2019 by Wolters Kluwer. Reprinted by permission of Wolters Kluwer via the Copyright Clearance Center. Licensed in 2020.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.
Chapter 1, “Evidence-Based Practice” (pp. 3–25); for reading about the PET model, focus on pp.14–16
Chapter 2, “The Science of Translation and Major Frameworks” (pp. 27–58)
Chapter 8, “Methods for Translation” (pp. 185–187 Quality Improvement and RCPI)
Chapter 9, “Project Management for Translation” (pp. 199–228)
Dang, D., & Dearholt, S. L. (Eds.). (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.
Chapter 5, “Searching for Evidence” (pp. 79–96)
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. https://doi.org/10.1111/jnu.12510
Dunagan, P. B. (2017). The quality improvement attitude survey: Development and preliminary psychometric characteristics. Journal of Clinical Nursing, 26(23–24), 5113–5120. https://doi.org/10.1111/jocn.14054
Note: The survey findings can be used to explore relationships between nursing attitudes concerning QI and other organizational characteristics such as QI environment.
Hammersla, M., Belcher, A., Ruccio, L. R., Martin, J., & Bingham, D. (2021). Practice and quality improvement leaders survey of expectations of DNP graduates’ quality improvement expertise. Nurse Educator [Epub ahead of print]. https://doi.org/10.1097/NNE.0000000000001009
Jones-Schenk, J., & Bleich, M. R. (2019). Implementation science as a leadership and doctor of nursing practice competency. The Journal of Continuing Education in Nursing, 50(11), 491–492. https://doi.org/10.3928/00220124-20191015-03
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10:21. https://doi.org/10.1186/s13012-015-0209-1
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