Theoretical and Scientific Foundations of Nursing

DISCUSSION RESPONSE

TRANSLATION OF EVIDENCE AND APPLICATION

Respond to two 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 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.

PEER #1

Mario Truman Sanchez

Main Post

Translating evidence into practice can be a daunting task, it continues to remain a slow process regardless of the increasing amount of healthcare research presented (Abu‐Odah et al., 2022). Within my organization some of the challenges of translating evidence into practice have come in the form of our organizational culture, lack of capabilities, and lack of time. Recently, there was an evidence-based practice change in the PICU to implement a new patient hand off process using a updated hand off report sheet, unfortunately the project did not succeed. The project fell short, when later reviewed it was determined that lack of interest and organizational culture were the main factors to the project demise.

Combatting lack of interest requires multidisciplinary plan that drives interest in the project, this can be done through improved research familiarization about the importance, indication, and dissemination of the project (Abu‐Odah et al., 2022). Organizational culture change requires a whole health approach from leadership, as the two themes are intertwined (Smith & Johnson, 2023). Considerable investment and time help transition culture within an organization, leaders must make a decision, provide resources and seek change (Smith & Johnson, 2023).

I view the DNP-prepared nurse as a model for change, we are in unique position to translate evidence for quality improvement into practice through our in-depth understanding of organizational systems, research and implementation strategies. DNP-prepared nurses are educated in complex adaptive systems, process models, implementation theories, and stakeholder engagement, thus making us leaders in quality improvement initiatives (Advancing Scholarship Through Translational Research: The Role of PhD and DNP Prepared Nurses | OJIN: The Online Journal of Issues in Nursing, n.d.).

Through the leading of healthcare initiative that improve patient outcomes DNP-prepared nurses can contribute to the growth of healthcare. For example, a DNP-prepared nurse can data analytics to determine if patient flow through the emergency department is adequately handling the influx of patients seen. If there is a need for improvement in regards to better patient outcomes, the DNP-prepared nurse can establish an EBP QI project to facilitate a change within their organization. In regards to social change the DNP-prepared nurse can join a professional organization, such as the American Nurses Association, these organizations provide nurses with a forum where healthcare issues are being discussed and proposed (Duquesne University School of Nursing Online, 2020). Utilizing this forum one could lobby for change for social determinants of health, for example many NICU parents suffer from food and housing insecurity. The DNP-prepared nurse can establish an initiative to conduct food insecurity screenings to identify hunger as a health need and report their findings to the Association.

References:

Abu‐Odah, H., Said, N. B., Nair, S. C., Allsop, M. J., Currow, D. C., Salah, M. S., Hamad, B. A., Elessi, K., Alkhatib, A., ElMokhallalati, Y., Bayuo, J., & AlKhaldi, M. (2022). Identifying barriers and facilitators of translating research evidence into clinical practice: A systematic review of reviews. Health & Social Care in the Community, 30(6). 
https://doi.org/10.1111/hsc.13898
Links to an external site.

Duquesne University School of Nursing Online. (2020, April 16). Doctor nurse practitioners influencing health care policy. Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/dnps-influencing-health-care-policy/#:~:text=Lobby%20for%20change%20in%20the,research%20and%20evidence%2Dbased%20practic

Smith, S., & Johnson, G. (2023). A systematic review of the barriers, enablers and strategies to embedding translational research within the public hospital system focusing on nursing and allied health professions. PloS one, 18(2), e0281819. 
https://doi.org/10.1371/journal.pone.0281819
Links to an external site.

Advancing Scholarship through Translational Research: The Role of PhD and DNP Prepared Nurses | OJIN: The Online Journal of Issues in Nursing. (n.d.). https://ojin.nursingworld.org/table-of-contents/volume-23-2018/number-2-may-2018/advancing-scholarship-through-translational-research/#:~:text=Many%20DNP%2Dprepared%20nurses%20oversee,innovations%20at%20the%20systems%20level.

PEER #2

Janie Marie Fleming (
She/Her)

Main Post 

Challenges and Barriers to Translating and Applying Evidence for Practice Change

In our target healthcare organization, implementing evidence-based practice changes can be a formidable task due to several challenges and barriers. Firstly, resistance to change among healthcare professionals remains a significant hurdle. Clinicians and staff may be reluctant to embrace new practices, particularly when they disrupt established routines and may require additional workload (Nakase, 2020). Additionally, resource constraints pose a challenge as investments in new technologies like remote monitoring can strain the organization’s budget, hindering their implementation. Data security and privacy concerns also loom large, with the need to safeguard sensitive patient information in compliance with regulatory requirements like HIPAA (El-Rashidy, 2021). Integrating these new practices into existing workflows can be a complex process, causing workflow disruption and necessitating time-consuming adaptations. Furthermore, navigating the complex landscape of regulatory and legal issues surrounding healthcare practices is another barrier that healthcare organizations face. Overcoming these challenges requires proactive leadership and an evidence-based approach to demonstrate the benefits of change and ensure the best possible care for patients while addressing staff concerns and ensuring compliance.

Issue of Concern and Approaches for Addressing These Challenges

The issue of concern is remote monitoring for patients with chronic medical conditions to prevent hospital re-admission. This approach aims to provide continuous care and early intervention for patients with chronic conditions in their homes, reducing the likelihood of hospital readmissions and improving overall health outcomes.

Patient remote monitoring involves the use of devices like wearable sensors, smartphones, and home monitoring equipment to collect vital signs, physical activity, and symptoms (Taylor, et al., 2021). This data is securely transmitted to healthcare providers for real-time monitoring, allowing for continuous observation and early detection of health changes. Automated systems generate alerts if data deviates from set parameters, enabling prompt interventions (Taylor, 2021). Patients actively participate by inputting self-reported data and receiving guidance from healthcare providers, fostering a more engaged and responsive healthcare approach.

Role as a DNP in Creating a Health Care Culture that Promotes Translation of Evidence for Quality Improvement

As a Doctor of Nursing Practice (DNP), I perceive my role as essential in fostering a healthcare culture that champions the translation of evidence for quality improvement. DNPs serve as catalysts for positive change in healthcare organizations by leveraging their unique blend of clinical expertise, research acumen, and leadership skills. By actively engaging in evidence-based practice and championing its adoption, I can influence colleagues and healthcare teams to embrace a culture that prioritizes data-driven decision-making and quality enhancement. DNPs are not only well-versed in appraising and applying research findings but also possess the capacity to lead quality improvement initiatives. By collaborating with interprofessional teams, advocating for evidence-based policies, and emphasizing patient-centered care, we can bridge the gap between research and practice, ultimately yielding better patient outcomes and a higher standard of care. In doing so, we contribute to a healthcare environment that continually evolves, adapts, and improves in response to the latest evidence and best practices, ensuring that patient well-being remains at the forefront of our healthcare mission.

Actions and Activities that Could be modeled and Lead

As a DNP, I play a crucial role in advancing quality improvement and driving social change in nursing. I lead by spearheading Evidence-Based Practice (EBP) Quality Improvement (QI) projects, assembling teams, conducting evidence-based interventions, and demonstrating the value of EBP. I also develop educational programs for healthcare staff, foster interprofessional collaboration, advocate for policy changes, emphasize patient-centered care, engage with the local community, publish research findings, and mentor emerging nursing leaders. Through these actions, I aim to create a healthcare culture that prioritizes EBP, resulting in improved patient outcomes, enhanced healthcare quality, and greater equity in the healthcare system, ultimately catalyzing positive changes in nursing and society.

References

El-Rashidy N, El-Sappagh S, Islam SMR, M. El-Bakry H, Abdelrazek S. Mobile Health in Remote Patient Monitoring for Chronic Diseases: Principles, Trends, and Challenges. Diagnostics. 2021; 11(4):607. https://doi.org/10.3390/diagnostics11040607

Nakase, H., Uchino, M., Shinzaki, S. 
et al. Evidence-based clinical practice guidelines for inflammatory bowel disease 2020. 
J Gastroenterol 56, 489–526 (2021). https://doi.org/10.1007/s00535-021-01784-1

Links to an external site.
Taylor ML, Thomas EE, Snoswell CL, et al.  Does remote patient monitoring reduce acute care use? A systematic review.  BMJ Open 2021;11:e040232. 
doi: 10.1136/bmjopen-2020-040232