NUR 590  Stakeholder Barriers Experienced During Implementation Phase Of  EBP Project

NUR 590  Stakeholder Barriers Experienced During Implementation Phase Of  EBP Project
NUR 590  Stakeholder Barriers Experienced During Implementation Phase Of  EBP Project
 
Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. What strategies can you implement to gain stakeholder support for the project implementation. Provide a suggestion you would give to a colleague who is struggling with obtaining stakeholder support.
NUR 590  Stakeholder Barriers Experienced During Implementation Phase Of  EBP Project
Cohesive Collaboration is important to the survival of and success of an organization. Implementation plans can face numerous challenges as a result of lack of knowledge of the problems hurting an organization. This lack of knowledge is common in many organizations were leaders and management are disconnected from day to day operations that help to run the organization. When a person rises through the ranks of the organization into a leadership role they have knowledge of and experience that other managers lack if they hired from the outside. The person who rises through the ranks has more understanding of the how the organization works, the weakness that exist, the organizations strength and how the organization needs to function in order to survive. Where there is s disconnect between stakeholders in higher positions and those working the day to day operations, noting will get done.
Some of the things that one might experience during the implementation phase are resistance and timing. “Lack of time is often cited as a barrier to implementing EBP. In addition, uncertainty or lack of knowledge about the EBP process is also a barrier, which includes critiquing and appraising the literature related to the clinical problem being addressed” (Ginex, 2018). In busy hospitals lack of time to study and understand new changes and policies can be a barrier. On time of this, resistance to change can also be a barrier. In there is already a flow that nurses are accustomed to even if it is chaotic, having to change that flow requires learning something new or changing ones workflow habits and that can cause resistance to change.
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The one suggestion I would give to a fellow colleague would be for them to ask questions, slow down the pace in order for them to understand the new policy and give themselves time to become accustom to it and to always remember that it will take them time to learn something new before they can master it.
 
Reference:
 
Ginex, P. (2018). Overcome Barriers to Applying an Evidence-Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-chang
Stakeholders are the people involved in carrying out the process under review or individuals who become affected with the change in practice (“John Hopkins Nursing”, 2021). It is important to determine the potential stakeholder barriers that will be encountered in order to address them accordingly. The two stakeholder barriers that can be experienced are resistance to change and lack of authority. Physicians, who are one of the main stakeholders, are perceived to be the least supportive in EBP implementation (Jordan et al., 2021). Without their support, it can make the implementation process difficult. Resistance of practitioners to change from traditional practices to newer concepts introduced in EBP can be a barrier to the implementation process (Jordan et al., 2021). Moreover, some staff nurses feel that they lack authority to make changes in their unit or they do not have the “power” to implement the EBP project. One study suggested that majority of the nurses in a private ICU reported that they lacked the authority to change practice in order to facilitate the implementation of EBP (Jordan et al., 2021).
There are several strategies to gain stakeholder support. First, the support of physicians for the implementation of EBP should be encouraged (Jordan et al., 2021). It is important to keep an open communication between the researcher and physicians. Explaining the goals and benefits of the EBP project in improving patient care can help gain their support. Second, it is recommended to carefully identify individual barriers versus organizational barriers at an early stage (Jordan et al., 2021). Lastly, identifying your stakeholders as well as engaging them early in the EBP process is important because stakeholder buy-in is important for its successful implementation (“John Hopkins Nursing”, 2021). The goal is to gain their trust and confidence and gain as much support as possible for the successful project implementation.
 
References
 
Jordan, P., Bowers, C., Cur, M. & Morton, D. (2016). Barriers to implementing evidence-based practice in a
private intensive care unit in the eastern cape. SAJCC, 32(2). DOI:10.7196/SAJCC.2016.v32i2.253
 
“John Hopkins Nursing”. (2021). Upstate Medical University. https://guides.upstate.edu/c.php?g=1023176&p=7411256
Stakeholders are vital to the implementation process as support supplied can hinder the potential outcomes and results of the research or interventions. Two stakeholder barriers I believe I would encounter during the implementation process for my project would be staff engagement and organizational allowance for collaboration.
Staff engagement from a nursing perspective can be difficult as education about nutrition (specifically types of diets) may be unfamiliar and uncomfortable. Although nutrition within an acute setting from a nursing perspective can be seen from meals and nutrition deficits. Expecting nursing to utilize nutrition education within an acute setting may be inappropriate as the focus of patient care and safety would be the priority, engaging them on nutrition education would demand them to switch their focus and may decrease patient outcomes. Nurses may not be motivated to participate in interventions if it does not directly affect acute care outcomes within this setting. This is why education may be promoted as a nursing education intervention as a preparation for post-acute health and wellness and the intervention should be made to address nursing at a community health or public health perspective (Leung, Trevena, & Waters, 2016).
 
Organizational tolerance of implementing research internally can be difficult as well because most organizations would not want to provide resources to interventions that would not benefit both the patient and organization. This would mean that there is less likeliness to provide resources within the organization and the researcher must acquire and obtain information and deploy internal interventions on their own accord. There is also the chance of declination of approval to implement interventions because the organization may not want to sacrifice work time of the education or nutrition staff on an intervention that may not have significant outcomes to care in the long term (Williams. Candon, Stewart, Byeon, Bewtra, Buttenheim, Zentgraf, Comeau, Shoyinka & Beidas, 2021).
 
A decent suggestion to a colleague who is struggling with stakeholders would be to understand and present what may become of the outcomes and provide enough evidence that says that supporting the intervention can be part of a greater investment to the care provided. This may help increase stakeholder’s confidence in supporting an intervention.
 
References:
Williams. N, Candon, M., Stewart, R., Byeon, V., Bewtra, M., Buttenheim, A., Zentgraf, K., Comeau, C., Shoyinka, S., & Beidas, R. (2021). Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment. BMC Psychiatry, 21(1), 1–12. https://doi-org.lopes.idm.oclc.org/10.1186/s12888-021-03072-x
 
Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189–196. https://doi-org.lopes.idm.oclc.org/10.1016/j.nedt.2016.01.026
When in a leadership role, leaders need to develop relationships with stakeholders. Engaging with stakeholders will build trust and develop learning systems for evidence-based projects. Stakeholders can also help define outcome metrics. Having buy-in from the beginning will aid in the planning of a more substantial project and execution approach. The two stakeholder barriers that one may experience during the implementation phase of the evidence paste project are resources and participation. Limited financial and personnel resources and competing goals might provide significant difficulties (Murphy et al., 2021). Financial assistance, space, and training were all limited, as was access to mental health treatment. Investing in and exploiting established local experience and capabilities can assist in resolving. The difficulty in obtaining active involvement from stakeholders and differing expectations about the nature of participation was recognized as obstacles, whereas possibilities for meaningful participation and empowerment were identified as drives (Ginex, 2019). Participants address the implications of working with and educating providers in the context of failing healthcare delivery systems, complicated socioeconomic settings, and management and organizational hurdles in the medical sector.
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
Murphy, J., Qureshi, O., Endale, T., Esponda, G. M., Pathare, S., Eaton, J., De Silva, M., & Ryan, G. (2021). Barriers and drivers to stakeholder engagement in global mental health projects. International Journal of Mental Health Systems, 15(1). https://doi.org/10.1186/s13033-021-00458-y
Two stakeholder barriers that I think I will encounter are staff engagement with the project and lack of staff time. For the staff engagement barrier, I would first need to start by making sure the staff understood the reason behind the project. I would need to create a vision and understanding of how the project can improve patient outcomes by using examples of real clinical scenarios (Melnyk & Fineout-Overholt, 2019).I would utilize the unit-based nursing council to help with the education of colleagues and identification of project champions (Melnyk & Fineout-Overholt, 2019). This is important because a top-down approach is not successful because it leads to a lack of ownership from front line staff (Mathieson et al., 2019). The project champions would also be utilized to conduct audits and provide feedback.
For the lack of time barrier, it is important to start with organizational support of the project (DeNisco, 2021). Being a Magnet organization and an HRO there is always support over EBP (Evidence Based Practice) projects and quality improvement projects. I would need to set aside uninterrupted time for the unit-based council/champions to learn about the project and educate colleagues. The education would be done during change of shift nursing huddles to save time verses doing it during the work shift. As a NM I may need to wait to implement the project when the unit is better staffed. I am actively hiring and training new nurses in the unit. Once the nurses are trained and on their own this will allow for sufficient staff to implement the project. The project involves patient and family engagement, and the RN (Registered Nurse) needs to be able to educate the importance of CAUTI (Catheter Associated Urinary Tract Infection) prevention. This is not something that should be rushed.
 
 
DeNisco, S.M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.
Matheson, 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 and Development, 20 doi:10.1017/S1463423618000488
Melnyk, B.M. & Fineout-Overholt, E. (2019). Evidence-Based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer, Inc
 
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