NURS 8114 Blog Observation of Evidence-Based Practice
NURS 8114 Blog Observation of Evidence-Based Practice
NURS 8114 Blog Observation of Evidence-Based Practice
Interdisciplinary Collaboration in Healthcare
Interdisciplinary collaboration in clinical practice reduces fragmentation and improves the quality of patient care—this outcome prompted the Institute of Medicine to include interdisciplinary collaborative patient care as one of ten tenets for redesigning and promoting better health care (Bender et al., 2013). Hospital-acquired infections (HAI) are globally recognized as a persistent health problem primarily because patients acquire them during the treatment process, resulting in unwanted expenditure (Lewis et al., 2013). Therefore, the role of a multidisciplinary team is essential towards identifying underlying patient problems that may lead to contracted infection. The proposed interdisciplinary team will consist of the DNP, a clinical nurse specialist, infection preventionist, epidemiologist, dietician, physiotherapist, and clinical pharmacist.
The role of the DNP in addressing HAI incidences in the hospital setting is crucial towards enhancing patient care outcomes. The nurse is generally considered the first point of contact with the patient and their family members (Fattirolli et al., 2018). The specific task of the nurse, in this case, will be to identify and intercept underlying risk factors, intervene in co-occurring patient conditions, and facilitate adherence to therapy. According to a study by Snowdon et al. (2014), preoperative interventions for cardiovascular patients reduce the risk of postoperative complications such as respiratory infection or failure. The emergent role of the Clinical Nurse Specialist Perioperative Certification (CNS-CP) ensures proper care for the patient before, during, and after cardiovascular surgery.
One of the most critical healthcare specialists addressing patient infections is the infection preventionist (IP), whose role is to maintain working knowledge about the core function of rapid interventions and the knowledge they offer. The IP will also determine the best technology needed to meet the demands posed by the HAI prevention program. Additionally, the IP assumes the role of early detection of infections, close surveillance of bacteremia and multidrug-resistant organisms (MDROs) and monitoring changes in antibiograms for emergent bacterial resistance (Edmiston et al., 2018). In a case where the patient is an infant or newborn, the contributions of a podiatrist would be most constructive towards establishing a pattern for infection. Similarly, a geriatrist would provide valuable insights in the event of the patient being an older adult.
The IP also closely collaborates with the healthcare epidemiologist (HE) in conducting Antimicrobial Stewardship (AS), which refers to the optimal, informed, and judicious administration of antimicrobial drugs for patients across the entire healthcare continuum—that is, from acute to long-term patient care. Moody et al. (2012) noted that the expertise and knowledge availed by highly-skilled HEs and IPs in a hospital’s AS program accelerate patient progress towards preventing MDROs. With the emergence of MDRO being associated with increased risk of HAIs, the role of AS programs promotes the discovery of infection causes whereby both the IP and HE perform surveillance activities targeting syndromes of interest, propose interventions for evidence-based practice and provide translational insights concerning infection data to administrative personnel, healthcare workers, and nurses.
Among the functional interventions afforded through postoperative care to cardiovascular patients is the need for specialized nutrition. Waitzberg et al. (2006) reported that IMPACT specialized nutrition support resulted in significantly reduced infectious complications and hospital length of stay. The study also recommended supplementing a patient’s diet with IMPACT over a period of between 5 to 7 days prior to surgery. These results thus emphasize the role of a dietician in reducing HAI incidence and preventing reoccurrence among cardiovascular patients. The dietician designs and implements a patient care regimen informed by an assessment, dietary diagnosis, a clinically informed intervention, and a scheduled reassessment ((Fattirolli et al., 2018). Conducting preoperative and postoperative dietary assessments thus provides essential insights into the importance of dietician inputs.
Another postoperative intervention for cardiovascular patients relates to physiotherapy, which serves to provide optimum regain of functional capacity and patient autonomy within the expected time. An initial assessment conducted by the physiotherapist offers information about the functional requirements, dysfunctional features, and care needs of a patient. The final assessment then verifies the initial assessment results and offers insights into factors such as patient stability, autonomy level, and perceived fatigue. Depending on the reported levels of severity and patient immobility, a number of inferences can be made in this regard. Possible interventions to promote better patient outcomes include controlled breathing exercises, strengthening the upper and lower limb muscles, reeducating patient gait, active-assisted mobility, postural gymnastics, verification of patient ability to self-manage physical exercising in the home environment, incremental aerobic training, and trained independent walking (Fattirolli et al., 2018). Physiotherapy forms part of the recovery process, which allows for faster patient discharge.
Critical to postoperative patient recovery is the type and dosage of pharmacological drugs recommended to patients at various levels of the healthcare continuum. In a study by Draxler et al. (2019), tranexamic acid (TXA) has antifibrinolytic properties, which prevent plasmin formation, thus reducing immunosuppressive outcomes. Administering TXA thus leads to a reduced frequency in the occurrence of postsurgical infections due to its supposed hemostatic properties. The role of a clinical pharmacist in establishing appropriate TXA doses, possible multi-dose options, and prescription periods. The clinical pharmacist engages in medical activities that facilitate optimized drug use and preventive interventions (Dunn et al., 2015). Through their training and experience, clinical pharmacists are capable of contributing critical pharmacy services that benefit both the interdisciplinary healthcare team and the patient.
This report was an investigation into the roles of various professionals within the interdisciplinary team towards identifying underlying causes for postsurgical cardiovascular patient infections. As the burden of intervention rests heavily on the DNP, the input of other professionals helps relieve this pressure and allows healthcare provision to be more patient-centered and informed. Integrating expertise from various professionals reduces fragmentation and allows patient care to be holistic and specialty-driven.
References
Bender, M., Connelly, C. D., & Brown, C. (2013). Interdisciplinary collaboration: The role of the clinical nurse leader. Journal of Nursing Management, 21(1), 165-174. https://doi.org/10.1111/j.1365-2834.2012.01385.x
Draxler, D. F., Yep, K., Hanafi, G., Winton, A., Daglas, M., Ho, H., Sashindranath, M., Wutzlhofer, L. M., Forbes, A., Goncalves, I., Tran, H. A., Wallace, S., Plebanski, M., Myles, P. S., & Medcalf, R. L. (2019). Tranexamic acid modulates the immune response and reduces postsurgical infection rates. Blood Advances, 3(10), 1598-1609. https://doi.org/10.1182/bloodadvances.2019000092
Dunn, S. P., Birtcher, K. K., Beavers, C. J., Baker, W. L., Brouse, S. D., Page, R. L., Bittner, V. & Walsh, M. N. (2015). The role of the clinical pharmacist in the care of patients with cardiovascular disease. Journal of the American College of Cardiology, 66(19), 2129-2139. https://www.jacc.org/doi/full/10.1016/j.jacc.2015.09.025
Edmiston, C. E., Garcia, R., Barnden, M., DeBaun, B., & Johnson, H. B. (2018). Rapid diagnostics for bloodstream infections: a primer for infection preventionists. American journal of infection control, 46(9), 1060-1068. https://doi.org/10.1016/j.ajic.2018.02.022
Fattirolli, F., Bettinardi, O., Angelino, E., da Vico, L., Ferrari, M., Pierobon, A., Temporelli, D., Agostini, S., Ambrosetti, M., Biffi, B., Borghi, S., Brazzo, S., Faggiano, P., Iannucci, M., Maffezzoni, B., Masini, M. L., Mazza, A., Pedretti, R., Sommaruga, M., Barro, S., Griffo, R., & Piepoli, M. (2018). What constitutes the ‘minimal care’ interventions of the nurse, physiotherapist, dietician and psychologist in cardiovascular rehabilitation and secondary prevention?: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology. European Journal of Preventive Cardiology, 25(17), 1799-1810. https://doi.org/10.1177/2047487318789497
Lewis, S. S., Moehring, R. W., Chen, L. F., Sexton, D. J., & Anderson, D. J. (2013). Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infection Control & Hospital Epidemiology, 34(11), 1229-1230. https://doi.org/10.1086/673443
Moody, J., Cosgrove, S. E., Olmsted, R., Septimus, E., Aureden, K., Oriola, S., … & Trivedi, K. K. (2012). Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists. Infection Control & Hospital Epidemiology, 33(4), 328-330. https://www.jstor.org/stable/10.1086/665037
Snowdon, D., Haines, T. P., & Skinner, E. H. (2014). Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. Journal of Physiotherapy, 60(2), 66-77. https://doi.org/10.1016/j.jphys.2014.04.002
Waitzberg, D. L., Saito, H., Plank, L. D., Jamieson, G. G., Jagannath, P., Hwang, T. L., Mijares,, J. M., & Bihari, D. (2006). Postsurgical infections are reduced with specialized nutrition support. World Journal of Surgery, 30(8), 1592-1604. https://doi.org/10.1007/s00268-005-0657-x
NURS 8114 Blog Observation of Evidence-Based Practice
As a DNP, you will have a significant voice in your health care setting to advocate for evidence-based nursing practice. Understanding how evidence can inform better nursing care and patient outcomes is fundamental to successful advocacy, as are examples of where, why, and how evidence-based practice is needed.
Photo Credit: steheap / Adobe Stock
For this activity, you will essentially observe for evidence to support evidence-based practice. You will write and post a blog in which you identify examples of evidence-based practice in your health care organization and/or examples of need for application of evidence-based practice. Although the blog functions like a Discussion Board, the aim is to be somewhat more informal in sharing your perspectives. Colleagues will respond to your blog, as you will respond to theirs.
To prepare:
Review the Learning Resources, particularly the chapter on evidence-based practice from McEwen and Wills, and readings in the White, Dudley-Brown, and Terhaar text.
With your understanding of evidence-based practice in mind, observe for examples of evidence-based practice (EBP) in the health care organization where you practice, and/or examples of nursing practice that are tradition bound and lack an evidence base.
Consider conditions that support EBP within health care organizations and recommendations for application of EBP.
With these thoughts in mind …
By Day 3 of Week 4
Post a blog on the topic of evidence-based practice in the health care organization where you practice. Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog:
Briefly describe one specific example of evidence-based practice that produced/is producing significant patient outcomes. Or, if you are lacking examples, describe a recent patient experience that might have been improved through application of evidence-based practice. Explain your reasoning. Note: To maintain confidentiality, do not refer to individuals by name or with identifying details.
Evaluate the overall application of evidence-based practice within your health care organization, including conditions that support it or roadblocks to overcome. Explain your reasoning, including how you have arrived at your conclusions.
Describe how you can advocate for application of evidence-based practice within your health care organization.
Read a selection of your colleagues’ blogs.
By Day 6 of Week 4
Respond to at least two of your colleagues on 2 different days. Compare their observations and evaluations of EBP in their health care organizations with your own and offer recommendations for advancing EBP or identify suggestions you will apply in your own practice setting.
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
Rew, L., Cauvin, S., Cengiz, A., Pretorius, K., & Johnson, K. (2020). Application of project management tools and techniques to support nursing intervention research. Nursing Outlook, 68(4), 396–405. https://doi.org/10.1016/j.outlook.2020.01.007
Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9(7), 1–15.
Walden University Academic Skills Center. (n.d.). How do I create a strong PowerPoint presentation? https://academicanswers.waldenu.edu/faq/72804
Walden University Academic Skills Center. (n.d.). MS PowerPoint resources: Getting started. https://academicanswers.waldenu.edu/faq/330533
Document: College of Nursing PowerPoint Template (PPT document)
Document: DNP Project Process Guide (Word document)
Document: Handout: Preparing for an EBP QI Presentation to Stakeholders at a Practice Site (Word document)
Required Media (click to expand/reduce)
Walden University. (2011). An evidence-based practice model [Video]. Author.
Translation text lead author Kathleen White discusses the PET model.
Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript
Walden University. (2021). DNP glossary [Interactive media]. Walden University Blackboard. https://class.waldenu.edu
Optional Resources (click to expand/reduce)
Walden University Writing Center. (n.d.). Webinars: Scholarly writing. https://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-9094031
Walden University Writing Center. (n.d.). Writing as a process. https://academicguides.waldenu.edu/writingcenter/doctoral/capstone/preproposal/writingasaprocess
NURS 8114 Blog Observation of Evidence-Based Practice
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Module 3: The Science of Translation
Just as translation is required to understand varying languages or customs or any number of differences that define the world, translation of evidence is a requirement in the world of quality improvement. With this module you will begin digging into your primary text, Translation of Evidence into Nursing and Healthcare. That title precisely conveys the intent of this module, and looking ahead, important aspects of your work as a DNP. Leading change for quality improvement necessitates understanding the science of translation and how to make leaps in practice, step by step.
In this 3-week module you will explore the foundations and beginning stages of initiating practice changes within a health care setting. Week 4 examines Evidence-Based Practice, Quality Improvement, and Implementation Science: Interrelationships. Weeks 5 and 6, Introduction to the Science of Translation, I and II, respectively, provide models and frameworks for implementing evidence-based quality improvement. Throughout the module, you will begin a “practice run” for a practice change as the focus of your signature DNP Project in this doctoral program. Imagine a translator who enables communication and connection and how you can do the same as an advocate of evidence-based practice quality improvement.
What’s Happening in This Module?
Preview your module activities and schedule.
What do I have to do? When do I have to do it?
Review your Learning Resources Days 1–7, Weeks 4, 5, and 6
Week 4 Blog: Observation of Evidence-Based Practice Post by Day 3 of Week 4, and respond to your colleagues by Day 6 of Week 4.
Module 3 Assignment: Exploring EBP Quality Improvement You are encouraged to begin your Assignment in Week 4; submit by Day 7 of Week 6.
Week 5 Discussion: Translation Models and Frameworks Post by Day 3 of Week 5, and respond to your colleagues by Day 6 of Week 5.
Go to the Week’s Content
What’s Coming Up in Module 3!
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In the next module, you will examine the interrelationships of evidence-based practice, quality improvement, and implementation science, all of which will play vital roles in planning and executing your DNP Project in your program of study. Get ready for an important module in this course with a dynamic module Assignment.
Looking Ahead: Week 4 Blog
Week 4 contains the only blog in this course. A blog offers a more informal approach to engaging with your colleagues. Note you are still required to post your blog by Day 3 and respond to at least two colleagues by Day 6. Review the Week 4 Blog guidelines to prepare.
Week 4 Video: Evidence-Based Practice With Dr. Kathleen White
The Learning Resources in Week 4 feature a video interview with Dr. Kathleen White, lead author of your Translation course text. She provides an example of evidence-based practice and steps in implementing quality improvement, including building consensus among stakeholders for a practice change. Plan to view this video at least once as you begin the module.
Next Module
To go to the next module:
Module 3
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_8114_Week_4_Blog
Grid View
List View
Excellent Good Fair Poor
Main Posting:
Response to the Blog prompt is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
5 (8.33%) – 5 (8.33%)
Thoroughly responds to the Blog prompt(s).
Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and/or current practice experiences.
No less than 75% of post has exceptional depth and breadth.
4 (6.67%) – 4 (6.67%)
Responds to most of the Blog prompt(s).
Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and/or current practice experiences.
50% of the post has exceptional depth and breadth.
3 (5%) – 3 (5%)
Responds to some of the Blog prompt(s).
One to two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
0 (0%) – 2 (3.33%)
Does not respond to the Blog prompt(s).
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Main Posting:
Writing
5 (8.33%) – 5 (8.33%)
Written clearly and concisely.
Contains no grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
4 (6.67%) – 4 (6.67%)
Written concisely.
May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
3 (5%) – 3 (5%)
Written somewhat concisely.
May contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 2 (3.33%)
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Posting:
Timely and full participation
9 (15%) – 10 (16.67%)
Meets requirements for timely, full, and active participation.
Posts main Blog post by due date.
8 (13.33%) – 8 (13.33%)
Posts main Discussion by due date.
Meets requirements for full participation.
7 (11.67%) – 7 (11.67%)
Posts main Blog post by due date.
0 (0%) – 6 (10%)
Does not meet requirements for full participation.
Does not post main Blog post by due date.
First Response:
Post to colleague’s main post that is reflective.
9 (15%) – 9 (15%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
8 (13.33%) – 8 (13.33%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (11.67%) – 7 (11.67%)
Response is on topic and may have some depth.
0 (0%) – 6 (10%)
Response may not be on topic and lacks depth.
First Response:
Writing 6 (10%) – 6 (10%)
Communication is professional and respectful to colleagues.
Response fully answers faculty questions, if posed.
Provides clear, concise opinions and ideas.
Response is effectively written in standard, edited English.
5 (8.33%) – 5 (8.33%)
Communication is mostly professional and respectful to colleagues.
Response mostly answers faculty questions, if posed.
Provides opinions and ideas.
Response is written in standard, edited English.
4 (6.67%) – 4 (6.67%)
Response posed in the Blog may lack effective professional communication.
Response somewhat answers faculty questions, if posed.
0 (0%) – 3 (5%)
Responses posted in the Blog lack effective communication.
Response to faculty questions is missing
First Response:
Timely and full participation 5 (8.33%) – 5 (8.33%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (6.67%) – 4 (6.67%)
Meets requirements for full participation.
Posts by due date.
3 (5%) – 3 (5%)
Posts by due date.
0 (0%) – 2 (3.33%)
Does not meet requirements for full participation.
Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective. 9 (15%) – 9 (15%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
8 (13.33%) – 8 (13.33%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (11.67%) – 7 (11.67%)
Response is on topic and may have some depth.
0 (0%) – 6 (10%)
Response may not be on topic and lacks depth.
Second Response:
Writing 6 (10%) – 6 (10%)
Communication is professional and respectful to colleagues.
Response fully answers faculty questions, if posed.
Provides clear, concise opinions and ideas.
Response is effectively written in standard, edited English.
5 (8.33%) – 5 (8.33%)
Communication is mostly professional and respectful to colleagues.
Response mostly answers faculty questions, if posed.
Provides opinions and ideas.
Response is written in standard, edited English.
4 (6.67%) – 4 (6.67%)
Response posed in the Blog may lack effective professional communication.
Response somewhat answers faculty questions, if posed.
0 (0%) – 3 (5%)
Responses posted in the Blog lack effective communication.
Response to faculty questions is missing.
Second Response:
Timely and full participation 5 (8.33%) – 5 (8.33%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (6.67%) – 4 (6.67%)
Meets requirements for full participation.
Posts by due date.
3 (5%) – 3 (5%)
Posts by due date.
0 (0%) – 2 (3.33%)
Does not meet requirements for full participation.
Does not post by due date.
Total Points: 60
Name: NURS_8114_Week_4_Blog
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