Discussion replies-theory course

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Respond to the four colleagues by suggesting other theories, strategies, ideas, and/or best practices for addressing the challenges and barriers they identify. Also agree or disagree with their view of the DNP’s professional role in creating a culture that enables translation of evidence and support your reasoning, including with other actions that promote a culture that embraces translation of evidence. Cite sources to support your posts and to recommend to colleagues. provide at least two references each

Amy: Making changes are never easy and especially in a healthcare setting where there are many people with many different views working. There is a typical standard way of doing things but everyone goes about them differently and getting use to a new way of doing things can be difficult. My current healthcare facility tends to have a hard time with change. I work at the VA and I feel that technology is behind here and the standard is not best most up to date practices. Executive leadership tend to go against any new ideas that are mentioned and it is very difficult to get them on board unless it feels like an idea that came from them. This is unfortunate and difficult, as nothing ever seems to change. The success of an organization is really dependent upon a good leadership team that works well with others and has a good foundation of up to date practices. In the past, there have been many ideas suggested and shot down right away. I feel that the best way to approach this situation and how I have been handling it is when I present something new or a new process/idea I submit the research and evidence with it, as well as outcomes. This tends to get a little more attention. Research shows that best practices are supported by high quality evidence and also improve health outcomes and quality of care, in turn making the organization stronger (Ham-Baloyi, et. al., 2020). This is enough of a reason that leaders need to consider how changes will help the organization. 

Although gathering the research is not the most difficult part, translating the evidence into practice is. When organizations fail to adopt new policies it is usually due to the culture (White, et, al., 2019). The culture of an organization can really hold the organization back from doing the right things, as well as the best things for the patient. The culture of my organization is really a hinderance and this is partly due to the attitude of executive leadership and their inability to be flexible with change. I view my role as a DNP prepared nurse as very important and I view myself as a change agent. DNP prepared nurses are trained to find research, understand it, and put it into practice. Therefore, I feel a due diligence to ensure I have the right information to present to others. The Mayo Clinic Nursing Research model is one that could be helpful to promote a change using evidence based practice. This model uses the sciences of caregiving, symptoms, and self management with technology, teamwork, data, and innovation to improve patients overall well being (Chesek, et. al. 2022).  Looking at the many different aspects seems like it would be more beneficial vs. just one category. I would use this model for a project to implement a change as I see the many levels to be beneficial. 

Hani: Quality improvement (QI) initiatives, particularly in healthcare settings, face various barriers. These hurdles range from resistance to change, lack of resources, and limited staff education and training to the need for more institutional commitment to evidence-based practice (EBP) (Djulbegovic et al., 2019). However, these challenges provide an opportunity for Doctor of Nursing Practice (DNP) professionals like myself to advocate for EBP and QI projects.

One challenging and damaging issue in critical care nursing practice involves Ventilator-Associated Pneumonia (VAP). VAP significantly impacts patient morbidity and mortality rates in ICUs (Shaka et al., 2022). However, various studies show a significant reduction in VAP rates with effective oral hygiene care (OHC) strategies, such as consistent application of antiseptics or novel interventions like the combined use of colostrum and sodium bicarbonate.

Translating these evidence-based practices into routine patient care faces several hurdles. The inconsistency seen across studies regarding the preferred antiseptic, frequency of application, and the effectiveness of alternative OHC strategies poses a challenge to protocol standardization. Additionally, resource allocation, staff education, and shifting pre-existing attitudes toward OHC practices in ICUs further complicate the translation of evidence into practice.

DNP-prepared nurses play an essential role in affecting change by leveraging their expertise in blending clinical, organizational, economic, and leadership skills (Boswell et al., 2021). As a future DNP nurse, my role involves implementing EBP, disseminating research findings, reviewing institutional policies, engaging stakeholders, and leading QI projects. The profession’s mission aligns with creating a healthcare culture that promotes the translation of evidence for quality improvement, thereby improving patient outcomes and advancing the nursing discipline.

To address VAP incidence in the target healthcare organization, I propose developing and implementing a QI project focusing on OHC protocol standardization. This project will involve identifying optimal OHC strategies based on current evidence and systematically teaching them in the ICU routine. Providing standardized training to multidisciplinary care staff will ensure consistency in OHC applications, strengthening the fight against VAP. Regular audits and research will measure the impact and facilitate appropriate revisions.

Additionally, research advocacy is crucial, as it encourages constant scrutiny and evolution of EBP, enhancing generalizability and application across different settings (Harper & Maloney, 2019). As a DNP nurse, I can contribute to EBP by conducting studies exploring optimal OHC administration frequency, the potential correlation between VAP incidence rate and OHC practices, and investigating alternative strategies for VAP reduction.

Moreover, modeling the integration of EBP in daily practice is vital. Clinical rounding, presenting current research in departmental and unit-based meetings, involving staff in journal clubs and reviews, and creating safe spaces where queries, apprehensions, and suggestions can be freely discussed are just a few practical ways to achieve this. By consistently promoting and highlighting the benefits of EBP, staff can be encouraged to embrace these methods, which pave the way for enhanced quality healthcare and favorable patient results.

As a future DNP nurse, my role goes beyond addressing immediate patient needs. It extends to shaping a care culture rooted in EBP and leading initiatives driving quality improvement in healthcare (Harvey et al., 2019). Although challenges in translating and applying evidence are multi-faceted, the opportunities to improve patient care, nursing practices, and healthcare outcomes are immense. Every resistance encountered is an invitation to advocate for better practice, and every barrier propels nursing a step forward toward a safer, quality healthcare landscape.

Myriah: Translating and applying evidence for practice change in correctional health facilities is challenging due to the unique nature of the setting. One major challenge is the complex interplay of security concerns, limited resources, and diverse inmate needs, which presents significant hurdles (Freudenberg, 2018). Additionally, there might be resistance to change among staff, a need for more awareness or knowledge about evidence-based practices, and a historical reliance on traditional approaches to healthcare within the correctional system. Limited research tailored to correctional health facilities can also pose a challenge, making it difficult to find evidence directly applicable to this context.

One issue of concern is the high prevalence of mental health disorders among inmates and the subsequent lack of appropriate mental health interventions. Addressing the high prevalence of mental health disorders among inmates is a critical concern in these facilities (Steadman et al., 2009). Tailored evidence-based interventions are necessary, considering security protocols and inmate safety (Binswanger et al., 2016).

 

To address these challenges, specific approaches can be implemented:

Staff Training and Education: One practical approach is ongoing training for healthcare staff to enhance their understanding of evidence-based practices (Young et al., 2014). Well-trained staff can critically evaluate research and implement evidence-based interventions effectively.

Adaptation of Interventions: Adapting evidence-based interventions to meet specific needs is essential. Modifying existing mental health programs while retaining core therapeutic components can align interventions with security protocols (Sacks et al., 2018).

Promoting a Culture of Inquiry: Fostering a culture of inquiry within correctional health facilities encourages staff to question existing practices and seek evidence-based solutions (Salisbury-Afshar et al., 2017). Promoting research literacy, providing access to relevant literature, and supporting staff in small-scale research projects can achieve this goal.

Collaboration and Networking: Encouraging collaboration between correctional health facilities, academic institutions, and external healthcare agencies is paramount (Kouyoumdjian et al., 2017). Collaborations facilitate the sharing of best practices and provide access to experts who can guide evidence-based interventions.

 

As a Doctor of Nursing Practice (DNP), I am determined to shape and promote a healthcare culture centered around evidence-based practice, particularly within the unique and challenging context of correctional health facilities. The Institute of Medicine (IOM) recognized the significance of nurses, especially those with advanced degrees like DNPs, in transforming healthcare delivery. By integrating the latest research findings and evidence-based interventions into practice, I can influence policy changes at various levels of the correctional system. This influence might involve engaging with policymakers and advocating for evidence-based guidelines that prioritize the well-being of inmates. By bridging the gap between research and policy, I can contribute to the establishment of comprehensive healthcare protocols within correctional facilities, ensuring that evidence-based approaches are integrated into the core of the system.

Moreover, as a DNP, I am well-equipped to guide healthcare staff within correctional facilities in the practical application of evidence-based practices. With advanced clinical knowledge and expertise in research appraisal, I can serve as a mentor, providing education and training to nurses and other healthcare professionals. By translating complex research findings into practical, actionable insights, I empower the staff to deliver high-quality, evidence-based care to inmates. This guidance extends beyond theoretical knowledge, incorporating hands-on training, role modeling, and continuous support. By instilling confidence in the staff’s ability to implement evidence-based interventions, I contribute to a culture of excellence, fostering an environment where evidence-based practices become the norm rather than the exception, ultimately enhancing the quality of healthcare services provided to inmates within the correctional system (IOM, 2011).

 

The implementation of an Evidence-Based Practice Quality Improvement (EBP QI) project targeted at enhancing mental health interventions for reducing depression and anxiety symptoms among inmates holds immense promise within correctional health facilities. Research, such as the study conducted by Simpson et al. (2017), provides a foundation for evidence-based mental health interventions, and applying these findings in practice can significantly improve the overall well-being of inmates. By focusing on staff training and ensuring they are well-versed in the most current and effective mental health techniques, the project ensures a knowledgeable and skilled workforce capable of delivering high-quality care. Additionally, adapting cognitive-behavioral therapy techniques, as suggested by Steele et al. (2018), showcases a proactive approach toward tailoring evidence-based interventions to the unique context of correctional settings. This adaptation ensures that the interventions remain effective while considering the specific challenges posed by the incarcerated population, such as security protocols and limited resources.

Regular outcome monitoring, a crucial aspect of the project, allows for continuous assessment and adjustment of the interventions based on real-time data. By collecting and analyzing data on the outcomes of the mental health interventions, the project can demonstrate their positive impact on inmates’ mental health. This empirical evidence becomes a powerful tool for advocacy and policymaking within correctional facilities. Moreover, the success of this project, as highlighted by Butler et al. (2018), can serve as a model for future initiatives, encouraging the adoption of evidence-based practices in other aspects of healthcare delivery within the facility. Ultimately, the EBP QI project not only improves the mental health outcomes of inmates but also sets a precedent for evidence-based approaches, fostering a culture of continuous improvement and ensuring the provision of high-quality care in the challenging environment of correctional health facilities.

Winnie: The prevalence of catheter-associated urinary tract infections (CAUTIs) among nursing home patients is a matter of great concern, given the substantial risk they offer to the vulnerable elderly population. Various problems and barriers exist associated with implementing evidence-based therapies to reduce rates of Catheter-Associated Urinary Tract Infections (CAUTI).

Cultural Resistance: The resistance to change among healthcare personnel, particularly about modifying established practices, has been observed (Saint et al., 2016).

Limitations in Resources: The availability of limited financial and human resources can hinder the successful deployment of new equipment or protocols that are essential for the prevention of Catheter-Associated Urinary Tract Infections (CAUTIs) (Meddings et al., 2017).

Educational Deficiencies: There needs to be adequate provision of continuous education and training in contemporary catheter management procedures to lead to the utilization of outmoded techniques (Stone et al., 2017).

To address these challenges, specific strategies include:

Promoting Engagement and Education: Implementing periodic training sessions to emphasize the significance of evidence-based procedures in preventing Catheter-Associated Urinary Tract Infections (CAUTIs).

Resource Allocation: Promoting the allocation of essential resources to ensure the provision of suitable materials and personnel.

Policy Revision: Engaging in a collaborative process with organizational leadership to critically evaluate and enhance existing policies to align them with the most current and relevant evidence available.

Interdisciplinary Collaboration: Engaging professionals from several disciplines, such as doctors, nurses, and aides, to collaboratively develop a comprehensive approach toward preventing Catheter-Associated Urinary Tract Infections (CAUTI).

As a Doctor of Nursing Practice (DNP), my position is crucial in fostering a culture that facilitates the application of empirical knowledge into practical settings to enhance the overall quality of care. The reason for this is that Doctor of Nursing Practice (DNP) professionals possess the essential clinical knowledge and leadership abilities required to initiate transformative shifts within healthcare environments (Melnyk et al., 2014). The responsibilities assigned to me encompass the following:

· Catalyzing promotes implementing evidence-based practices by demonstrating leadership and setting a positive example.

· The application of data to illustrate the necessity for modification and to assess the results of implemented modifications.

· Spearheading evidence-based practice (EBP), initiatives focused on reducing Catheter-Associated Urinary Tract Infections (CAUTI) through quality improvement (QI) interventions.

· Engaging in the promotion of patient safety and the enhancement of care practices, both internally within the organization and outside into the broader healthcare discourse.

Through active participation in these endeavors, a Doctor of Nursing Practice (DNP) can cultivate an environment that promotes ongoing enhancement, guaranteeing that the provision of patient care consistently aligns with the most current and reliable evidence. This, in turn, culminates in improved health outcomes and catalyzes effecting societal transformations within the nursing profession.

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